WorldWideScience

Sample records for end-of-life irradiation performance

  1. Accuracy and Reliability in the Prediction of End-of-Life Performance of Solar Generators

    Science.gov (United States)

    Rapp, Etienne

    2008-09-01

    The end-of-life power analysis of solar arrays is calculated using a combination of arithmetic and root square sums of loss factors. These loss factors are sometimes linked to degradations, sometimes linked to uncertainties. The uncertainties of the degradations are taken into account considering contractual "worst cases". This paper will put the first stones for a move "metrological" evaluation of the probable performance associated with a standard uncertainty. The turn from silicon to triple junction solar cells induces some changes in the degradation parameters of solar arrays: * The triple junction cells are more sensitive to UV darkening than silicon ones. * The cell voltage is higher and the current is lower. Then the cell strings are shorter, and there are more strings in parallel. This induces some changes in the reliability analyses and risk management. * The failure modes and failure rates of these cells have to be compared and discussed. We try to define improved rules to design solar arrays for end of life performance, for a better knowledge of the margins and a better reliability.

  2. End-of-Life Indicators for NIMA's High-Performance Cesium Frequency Standards

    National Research Council Canada - National Science Library

    Brock, C; Tolman, B. W; Taylor, R. E

    2002-01-01

    .... The mean lifetime of the cesium-beam tube (CBT) is approximately 6 years; failure or end-of-life of the CBT is a significant cause in the reduction of data used to produce the NIMA GPS precise ephemeris...

  3. End of Life Issues

    Science.gov (United States)

    Planning for the end of life can be difficult. But by deciding what end-of-life care best suits your needs when you are healthy, you can ... right choices when the time comes. End-of-life planning usually includes making choices about the following: ...

  4. End of Life Care

    Science.gov (United States)

    ... Related Topics Choosing Wisely Join our e-newsletter! Aging & Health A to Z End of Life Care ... be used. Ice chips, popsicles, moist swabs, or artificial saliva can help prevent the mouth from becoming ...

  5. Improving Gas Furnace Performance: A Field and Laboratory Study at End of Life

    Energy Technology Data Exchange (ETDEWEB)

    Brand, L. [Gas Technology Inst., Des Plaines, IL (United States); Yee, S. [Gas Technology Inst., Des Plaines, IL (United States); Baker, J. [Gas Technology Inst., Des Plaines, IL (United States)

    2015-02-01

    In 2010, natural gas provided 54% of total residential space heating energy the U.S. on a source basis, or 3.5 Quadrillion Btu. Natural gas burned in furnaces accounted for 92% of that total, and boilers and other equipment made up the remainder. A better understanding of installed furnace performance is a key to energy savings for this significant energy usage. Natural gas furnace performance can be measured in many ways. The annual fuel utilization efficiency (AFUE) rating provides a fixed value under specified conditions, akin to the EPA miles per gallon rating for new vehicles. The AFUE rating is provided by the manufacturer to the consumer and is a way to choose between models tested on the same basis. This value is commonly used in energy modeling calculations. ASHRAE 103 is a consensus furnace testing standard developed by the engineering community. The procedure provided in the standard covers heat-up, cool down, condensate heat loss, and steady-state conditions and an imposed oversize factor. The procedure can be used to evaluate furnace performance with specified conditions or with some variation chosen by the tester. In this report the ASHRAE 103 test result will be referred to as Annualized Efficiency (AE) to avoid confusion, and any non-standard test conditions will be noted. Aside from these two laboratory tests, steady state or flue loss efficiency can be measured in the field under many conditions; typically as found or tuned to the manufacturers recommended settings. In this report, AE and steady-state efficiency will be used as measures of furnace performance.

  6. Improving Gas Furnace Performance: A Field and Laboratory Study at End of Life

    Energy Technology Data Exchange (ETDEWEB)

    Brand, L. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States); Yee, S. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States); Baker, J. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States)

    2015-02-01

    In 2010, natural gas provided 54% of total residential space heating energy the U.S. on a source basis, or 3.5 Quadrillion Btu. Natural gas burned in furnaces accounted for 92% of that total, and boilers and other equipment made up the remainder. A better understanding of installed furnace performance is a key to energy savings for this significant energy usage. In this project, the U.S. Department of Energy Building America team Partnership for Advanced Residential Retrofit examined the impact that common installation practices and age-induced equipment degradation may have on the installed performance of natural gas furnaces over the life of the product, as measured by steady-state efficiency and annual efficiency. The team identified 12 furnaces of various ages and efficiencies that were operating in residential homes in the Des Moines, Iowa, metropolitan area and worked with a local heating, ventilation, and air conditioning contractor to retrieve furnaces and test them at the Gas Technology Institute laboratory for steady-state efficiency and annual efficiency. Prior to removal, system airflow, static pressure, equipment temperature rise, and flue loss measurements were recorded for each furnace as installed in the house.

  7. Benchmark Analyses on the Control Rod Withdrawal Tests Performed During the PHÉNIX End-of-Life Experiments. Report of a Coordinated Research Project 2008–2011

    International Nuclear Information System (INIS)

    2014-06-01

    The IAEA supports Member State activities in advanced fast reactor technology development by providing a major fulcrum for information exchange and collaborative research programmes. The IAEA’s activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. In the broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at improving Member States’ capabilities in fast reactor design and analysis. An important opportunity to conduct collaborative research activities was provided by the experimental campaign run by the French Alternative Energies and Atomic Energy Commission (CEA, Commissariat à l’énergie atomique et aux énergies alternatives) at the PHÉNIX, a prototype sodium cooled fast reactor. Before the definitive shutdown in 2009, end-of-life tests were conducted to gather additional experience on the operation of sodium cooled reactors. Thanks to the CEA opening the experiments to international cooperation, the IAEA decided in 2007 to launch the CRP entitled Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHÉNIX End-of-Life Experiments. The CRP, together with institutes from seven States, contributed to improving capabilities in sodium cooled fast reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this publication is to document the results and main achievements of the benchmark analyses on the control rod withdrawal test performed within the framework of the PHÉNIX end-of-life experimental campaign

  8. Benchmark Analyses on the Natural Circulation Test Performed During the PHENIX End-of-Life Experiments. Final Report of a Co-ordinated Research Project 2008-2011

    International Nuclear Information System (INIS)

    2013-07-01

    The International Atomic Energy Agency (IAEA) supports Member State activities in the area of advanced fast reactor technology development by providing a forum for information exchange and collaborative research programmes. The Agency's activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. Among its broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at the improvement of Member State capabilities in the area of fast reactor design and analysis. An important opportunity to undertake collaborative research was provided by the experimental campaign of the French Alternative Energies and Atomic Energy Commission (CEA) in the prototype sodium fast reactor PHENIX before it was shut down in 2009. The overall purpose of the end of life tests was to gather additional experience on the operation of sodium cooled reactors. As the CEA opened the experiments to international cooperation, in 2007 the IAEA launched a CRP on ''Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHENIX End-of-Life Experiments''. The CRP, with the participation of institutes from eight countries, contributed to improving capabilities in sodium cooled reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this report is to document the results and main achievements of the benchmark analyses on the natural circulation test performed in the framework of the PHENIX end of life experimental campaign

  9. Benchmark Analyses on the Control Rod Withdrawal Tests Performed During the PHÉNIX End-of-Life Experiments. Report of a Coordinated Research Project 2008–2011

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-06-15

    The IAEA supports Member State activities in advanced fast reactor technology development by providing a major fulcrum for information exchange and collaborative research programmes. The IAEA’s activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. In the broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at improving Member States’ capabilities in fast reactor design and analysis. An important opportunity to conduct collaborative research activities was provided by the experimental campaign run by the French Alternative Energies and Atomic Energy Commission (CEA, Commissariat à l’énergie atomique et aux énergies alternatives) at the PHÉNIX, a prototype sodium cooled fast reactor. Before the definitive shutdown in 2009, end-of-life tests were conducted to gather additional experience on the operation of sodium cooled reactors. Thanks to the CEA opening the experiments to international cooperation, the IAEA decided in 2007 to launch the CRP entitled Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHÉNIX End-of-Life Experiments. The CRP, together with institutes from seven States, contributed to improving capabilities in sodium cooled fast reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this publication is to document the results and main achievements of the benchmark analyses on the control rod withdrawal test performed within the framework of the PHÉNIX end-of-life experimental campaign.

  10. End of Life: Suicide Grief

    Science.gov (United States)

    Healthy Lifestyle End of life A loved one's suicide can be emotionally devastating. Use healthy coping strategies — ... Clinic Staff When a loved one dies by suicide, overwhelming emotions can leave you reeling. Your grief ...

  11. End of Life: An Overview

    Science.gov (United States)

    Toner, Mary Ann; Shadden, Barbara B.

    2012-01-01

    Speech-language pathologists (SLPs) provide services to patients confronting the end of life (EOL) in a variety of settings. Instead of targeting improvement of health or sustaining life, EOL services focus primarily on quality of life. Although SLPs may not consider themselves core members of the health care team providing EOL services, the…

  12. Issues surrounding end-of-life decision-making

    Directory of Open Access Journals (Sweden)

    Tejwani V

    2013-08-01

    Full Text Available Vickram Tejwani,1,* YiFan Wu,1,* Sabrina Serrano,2 Luis Segura,2 Michael Bannon,3 Qi Qian1 1Department of Medicine, Division of Nephrology and Hypertension, 2Mayo Graduate School, 3Department of Trauma, Critical Care, and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA *These authors contributed equally to this work Abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes. Keywords: end-of-life care, advance directive, surrogate, futility dispute, conflict resolution

  13. Challenges in end-of-life communication.

    Science.gov (United States)

    Galushko, Maren; Romotzky, Vanessa; Voltz, Raymond

    2012-09-01

    The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication. Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits. Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.

  14. Pharmacotherapy at the end-of-life.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2011-07-01

    Older people reaching end-of-life status are particularly at risk from inter-related adverse effects of pharmacotherapy, including polypharmacy, inappropriate medications and adverse drug events. These adverse effects of pharmacotherapy may be highly detrimental, as well as highly expensive. End-of-life pharmacotherapy is sometimes perceived to be complex and challenging, probably unnecessarily. This relates in part to the poorly developed evidence base and lack of high-quality research in this area. In this article, we deal with some of the key issues relating to pharmacotherapy in end-of-life patients, namely (i) the guiding principles of drug selection, (ii) the main drugs and drug classes that are best avoided, (iii) the benefits of \\'oligopharmacy\\' (i.e. deliberate avoidance of polypharmacy) in end-of-life patients.

  15. End-of-life decisions: Christian perspectives.

    Science.gov (United States)

    Stempsey, William E

    1997-12-01

    While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.

  16. [End-of-life care and end-of-life medical decisions: the ITAELD study].

    Science.gov (United States)

    Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

    2011-01-01

    To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

  17. DESIGN CONSIDERATIONS UPON PRODUCT END-OF-LIFE OPTIONS

    Directory of Open Access Journals (Sweden)

    BARSAN Lucian

    2016-11-01

    Full Text Available The paper presents some considerations about the necessity of evaluating the environmental impact of a product during its entire life. The present situation (economic, social and ecologic imposes solutions to reduce this impact as a result of an analysis performed during all stages of the life cycle. This paper focuses on design solutions with consequences in the last stage, the end-of-life. Reusing products, with, or without remanufacturing and recycling the materials from products that cannot be reused represent some options analysed in this paper. The end-of-life options should be known even from the beginning of the design process and should be included as design objectives or, at least as constrictions. Considering them as human needs would naturally include them in the requirements list.

  18. Pricing end-of-life components

    Science.gov (United States)

    Vadde, Srikanth; Kamarthi, Sagar V.; Gupta, Surendra M.

    2005-11-01

    The main objective of a product recovery facility (PRF) is to disassemble end-of-life (EOL) products and sell the reclaimed components for reuse and recovered materials in second-hand markets. Variability in the inflow of EOL products and fluctuation in demand for reusable components contribute to the volatility in inventory levels. To stay profitable the PRFs ought to manage their inventory by regulating the price appropriately to minimize holding costs. This work presents two deterministic pricing models for a PRF bounded by environmental regulations. In the first model, the demand is price dependent and in the second, the demand is both price and time dependent. The models are valid for single component with no inventory replenishment sale during the selling horizon . Numerical examples are presented to illustrate the models.

  19. Networking to improve end of life care

    Science.gov (United States)

    2009-01-01

    Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a ‘network’ as a formal entity and the more informal process of ‘networking’. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and ‘distributed leadership’ facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS. PMID:25949588

  20. Environmental assessment of end-of-life textiles in Denmark

    DEFF Research Database (Denmark)

    Koligkioni, Athina; Parajuly, Keshav; Sørensen, Birgitte Lilholt

    2018-01-01

    The European Union is on its way to a circular economy through eco-design, waste prevention, reuse and recycling of products and materials. This study analyzes the environmental effects of end-of-life textile management in Denmark. First, a Mass Flow Analysis was performed for textile flows from...... sales to consumers to end processes, which revealed that absolute consumption has grown significantly over the last years. Data on generation and management of used textiles indicated that around 40% are discarded with residual waste, another 40% are captured by collection for reuse channels, and around...

  1. Recent Analyses of Phenix End of Life Tests and Perspectives

    International Nuclear Information System (INIS)

    Fontaine, B.; Martin, L.; Prulhière, G.; Eschbach, R.; Portier, J.-L.; Masoni, P.; Tauveron, N.; Bavière, R.; Verwaerde, D.; Hamy, J.-M.

    2013-01-01

    Conclusion: • End of Life tests performed at PHENIX in 2009 gathered a lot of information concerning thermalhydraulics, core physics and fuel behavior in SFR cores. • The analysis of these tests is still undergoing for some of them, involving international collaborations. • To better understand the measurements, complex models are developed thanks to recent computer science progress: • thermalhydraulics: coupling CFD and system codes neutronics: - perturbation theory applied to Bateman equations - model of distorted core; • mechanics: fluid-structure interaction. The test results allow to validate these developments, which could be applied in the future for new SFR design

  2. Institutional disposition and management of end-of-life electronics.

    Science.gov (United States)

    Babbitt, Callie W; Williams, Eric; Kahhat, Ramzy

    2011-06-15

    Institutions both public and private face a challenge to develop policies to manage purchase, use, and disposal of electronics. Environmental considerations play an increasing role in addition to traditional factors of cost, performance and security. Characterizing current disposition practices for end-of-life electronics is a key step in developing policies that prevent negative environmental and health impacts while maximizing potential for positive social and economic benefits though reuse. To provide a baseline, we develop the first characterization of quantity, value, disposition, and flows of end-of-life electronics at a major U.S. educational institution. Results of the empirical study indicate that most end-of-first-life electronics were resold through public auction to individuals and small companies who refurbish working equipment for resale or sell unusable products for reclamation of scrap metal. Desktop and laptop computers sold for refurbishing and resale averaged U.S. $20-100 per unit, with computers sold directly to individuals for reuse reaching $250-350 per unit. This detailed assessment was coupled with a benchmarking survey of end-of-life electronics management practices at other U.S. universities. Survey results indicate that while auctions are still commonplace, an increasing number of institutions are responding to environmental concerns by creating partnerships with local recycling and resale entities and mandating domestic recycling. We use the analyses of current disposition practices as input to discuss institutional strategies for managing electronics. One key issue is the tension between benefits of used equipment sales, in terms of income for the institution and increased reuse for society, and the environmental risks because of unknown downstream practices.

  3. Questioning care at the end of life.

    Science.gov (United States)

    Ruopp, Patricia; Good, Mary-Jo Delvecchio; Lakoma, Matthew; Gadmer, Nina M; Arnold, Robert M; Block, Susan D

    2005-06-01

    The goal of the larger study was to explore physicians' emotional responses to the death of their patients; this study analyzed a subset of physician transcripts to elucidate the construct of questioning care, which emerged from the larger study. To analyzes how physicians question care-expressing concern, unease, or uncertainty about treatment decisions and practices, errors, or adverse events-as they attend dying patients. Retrospective interview study of physicians caring for randomly selected deaths on the medical service of a major academic teaching hospital, using qualitative and quantitative measures. SETTING, SUBJECTS: 188 attendings, residents, and interns on the internal medical services of two academic medical centers were part of the larger study. A subsample of 75 physician narratives was selected for qualitative data analysis for this study. Qualitative measures included open-ended questions eliciting physicians' stories of the most recent and a most emotionally powerful patient death they have experienced. Grounded theory was used to analyze physician narratives. Quantitative instruments measured physician attitudes toward end-of-life care and responses to the most recent and most emotional patient death. Physicians question care more frequently in most emotional deaths (42%) than in most recent deaths (34%). Physicians question communication with patients and families and within medical teams, medical judgment and technique, standards of practice, and high-risk treatments, often assigning responsibility for medical management they perceive as inappropriate, futile, overly aggressive, or mistakes in judgment and technique. Responsibility ranges from the distal (the culture of medicine) to the proximal (personal). Frustration, guilt, and anger are more frequently expressed in these narratives when care is questioned. A typology of questioning care emerged from these physicians' narratives that parallels and reflects recent and classic research on

  4. End-of-life care: Indian perspective

    Science.gov (United States)

    Sharma, Himanshu; Jagdish, Vankar; Anusha, Prabhakaran; Bharti, Sharma

    2013-01-01

    According to Hinduism, the main religion of India, the end-of-life (EOL) deals with good and bad death. The WHO definition of palliative care stresses on improving not only the quality of life of patients facing incurable diseases but also their families by providing relief from the pain and suffering that includes the psychosocial and spiritual needs as well. The Indian Society of Palliative Care has been doing a commendable work and appreciable efforts are being done by the Kerala model of delivering the EOL care. The spiritual, ethical issues and ethical challenges raised when the patients are in terminal phase are also reviewed keeping in mind the socio-cultural norms. The Indian Penal Code (IPC) has lacunae, which hamper the physicians from taking proper decision in the EOL care. Some of the sections like IPC 309 are defunct and need to be changed. The Indian Society for Critical Care Medicine has developed a position statement on the patient management of the terminally ill patient in the Intensive Care Unit (ICU) which states that the society should move from the paternalistic model to the share based decision model of the West when deciding the fate of such patients. The literature review on the Indian research on palliative care shows very little emphatic results and the medical under graduates show illiteracy. To strengthen it Medical Council of India has included the palliative care in its curriculum by starting a PG course. Literature review revealed that more research from Indian perspective should be done in this area. This article studies the core issues of developing palliative care in Indian setting keeping in mind the ethical, spiritual and legal issues. PMID:23858271

  5. [Vulnerations of Human Dignity At The End of Life].

    Science.gov (United States)

    Germán Zurriaráin, Roberto

    2017-01-01

    Death is constitutive of human nature and therefore it must happen naturally. But there are mainly two ways that falsify it: euthanasia and therapeutic obstinacy. Two wrong choices that do not accept the human reality of death (the first, anticipates death and the second, delays it). From the philosophical and ethical point of view, both options are rejected, because they are against human dignity at the end of life. Aside from these, this article also rejects the different names which are given to refer to euthanasia, that also go against human nature at the end of life. On the other hand, do not confuse euthanasia with sedation. Both have a common goal to prevent the patient from feeling pain and suffering. To achieve this goal, both options administer ″drugs″ to the patient. But in the administration of drugs in euthanasia involves ending patient's life. The administration of drugs in sedation aims for the patient's death to occur naturally. Finally, we briefly discuss the basic care necessary in these situations. The absence of basic care cannot become a covert euthanasia. The patient must die from his/her illness, never from a lack of care. All human actions (euthanasia, sedation, therapeutic obstinacy and basic care) should be an expression and manifestation of what human dignity demands. Such dignity is expressed in the actions performed by human beings.

  6. End-of-Life Nursing Care and Education: End-of-Life Nursing Education: Past and Present.

    Science.gov (United States)

    DʼAntonio, Jocelyn

    The dying experience is forever carried in the life story of those for whom the nurse cares. A goal of end-of-life nursing education is to produce nurses who are comfortable with death and dying and who have had the opportunity to reflect on their thoughts and feelings about end-of-life care. This article reviews the history, development, and teaching methods of end-of-life care, offering recommendations for future education.

  7. [End of life and vulnerability, a public health issue].

    Science.gov (United States)

    Boucomont, Aude

    2016-02-01

    End of life and precarity, two words which were linked by the French national observatory for end of life care in its work carried out in 2014. The study provided an overview of current support practices in different areas, highlighting certain lessons to be learned and making recommendations to the different partners involved. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

  9. End-of-life resource recovery from emerging electronic products

    DEFF Research Database (Denmark)

    Parajuly, Keshav; Habib, Komal; Cimpan, Ciprian

    2016-01-01

    Integrating product design with appropriate end-of-life (EoL) processing is widely recognized to have huge potentials in improving resource recovery from electronic products. In this study, we investigate both the product characteristics and EoL processing of robotic vacuum cleaner (RVC), as a case...... of emerging electronic product, in order to understand the recovery fate of different materials and its linkage to product design. Ten different brands of RVC were dismantled and their material composition and design profiles were studied. Another 125 RVCs (349 kg) were used for an experimental trial...... at a conventional ‘shred-and-separate’ type preprocessing plant in Denmark. A detailed material flow analysis was performed throughout the recycling chain. The results show a mismatch between product design and EoL processing, and the lack of practical implementation of ‘Design for EoL’ thinking. In the best...

  10. Use of opioids and sedatives at End-of-Life

    Directory of Open Access Journals (Sweden)

    Shin Wei Sim

    2014-01-01

    Full Text Available Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore′s government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients′ under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.

  11. Eliciting regret improves decision making at the end of life.

    Science.gov (United States)

    Djulbegovic, Benjamin; Tsalatsanis, Athanasios; Mhaskar, Rahul; Hozo, Iztok; Miladinovic, Branko; Tuch, Howard

    2016-11-01

    Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease. The patients were at the point in care where they had to decide between continuing potentially 'curative/life-prolonging' treatment (Rx) versus hospice care. Preferences were elicited using a Dual Visual Analog Scale regarding the level of regret of omission versus commission (RgO/RgC) towards hospice care and Rx. Each patient's RgO/RgC was contrasted against the predictive probability of death to suggest a management plan, which was then compared with the patient's actual choice. The probability of death was estimated using validated Palliative Performance Scale predictive model. Eighty-five percent (151/178) of patients agreed with the model's recommendations (p < 0.000001). Model predicted the actual choices for 72% (128/178) of patients (p < 0.00001). Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model have close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected their choice. Using regret to elicit choices in the end-of-life setting is both descriptively and prescriptively valid. People with terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. End of life care - the importance of culture and ethnicity.

    Science.gov (United States)

    Clark, Katherine; Phillips, Jane

    2010-04-01

    Australia is a culturally and ethnically diverse country. Within such diversity there will be differing beliefs systems about death and dying. This may be a challenging prospect for health professionals. This article discusses how cultural diversity may impact care and provides some strategies for the general practitioner when considering the provision of end of life care. This article does not attempt to provide GPs with a prescriptive approach to multicultural care, as this would run the risk of stereotyping individuals. Rather, it discusses the barriers to end of life care among different cultural and ethnic groups, and suggests ways in which to improve understanding of different cultural needs in end of life care.

  13. End-of-Life Conversation Game Increases Confidence for Having End-of-Life Conversations for Chaplains-in-Training.

    Science.gov (United States)

    Van Scoy, Lauren Jodi; Watson-Martin, Elizabeth; Bohr, Tiffany A; Levi, Benjamin H; Green, Michael J

    2018-04-01

    Discussing end-of-life issues with patients is an essential role for chaplains. Few tools are available to help chaplains-in-training develop end-of-life communication skills. This study aimed to determine whether playing an end-of-life conversation game increases the confidence for chaplain-in-trainings to discuss end-of-life issues with patients. We used a convergent mixed methods design. Chaplains-in-training played the end-of-life conversation game twice over 2 weeks. For each game, pre- and postgame questionnaires measured confidence discussing end-of-life issues with patients and emotional affect. Between games, chaplains-in-training discussed end-of-life issues with an inpatient. One week after game 2, chaplains-in-training were individually interviewed. Quantitative data were analyzed using descriptive statistics and Wilcoxon rank-sum t tests. Content analysis identified interview themes. Quantitative and qualitative data sets were then integrated using a joint display. Twenty-three chaplains-in-training (52% female; 87% Caucasian; 70% were in year 1 of training) completed the study. Confidence scores (scale: 15-75; 75 = very confident) increased significantly after each game, increasing by 10.0 points from pregame 1 to postgame 2 ( P game, and shyness subscale scores decreased significantly after each game. Content analysis found that chaplains-in-training found the game to be a positive, useful experience and reported that playing twice was beneficial (not redundant). Mixed methods analysis suggest that an end-of-life conversation game is a useful tool that can increase chaplain-in-trainings' confidence for initiating end-of-life discussions with patients. A larger sample size is needed to confirm these findings.

  14. Culturally Diverse Communities and End-of-Life Care

    Science.gov (United States)

    ... Azen, S.P. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274, 820-5 . Phipps, E., True, G., & ... briefly about end-of-life options and neglect culture or values (Tulsky, Fischer, Rose, & Arnold, 1998). Speaking ...

  15. Wind Turbine Blades: An End of Life Perspective

    DEFF Research Database (Denmark)

    Beauson, Justine; Brøndsted, Povl

    2016-01-01

    In 2016, the first offshore windfarm constructed in the world—located in Denmark, near Ravnsborg—is turning 25 years old, and will soon be decommissioned. After decommissioning, most of the material of the turbine can be recycled; only the composite materials found in the blades represent...... a challenge. This part looks at end of life solutions for this material. Wind turbine blade structure and material are described. The ends of life solutions existing and under development are detailed....

  16. Uncharted terrain: preference construction at the end of life.

    Science.gov (United States)

    White, Mary T

    2014-01-01

    Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

  17. Three factors critical for end-of-life care.

    Science.gov (United States)

    Franey, S G

    1996-01-01

    Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.

  18. Palliative sedation in end-of-life care.

    Science.gov (United States)

    Maltoni, Marco; Scarpi, Emanuela; Nanni, Oriana

    2013-07-01

    The aim of this review was to present and comment on recent data published on palliative sedation in palliative and end-of-life care. Palliative sedation is a medical procedure used to deal with the refractory symptoms occurring in the advanced stages of cancer. It has clinical, nursing, relational and ethical implications, making it a highly sensitive issue. Over the last 12 months, a number of authors have published interesting new findings on different areas of palliative sedation, that is prevalence, indications, monitoring, duration and choice of drugs. In particular, a clear definition of palliative sedation and of its more pronounced form, deep continuous sedation (DCS), has emerged. It has been confirmed that, when performed in the correct way and with the right aims, palliative sedation does not have a detrimental impact on survival. Recent findings confirm that palliative sedation is an integral part of a medical palliative care approach and is needed in certain clinical situations. It is a legitimate clinical practice from any ethical point of view. While oncologists should have a basic knowledge of the procedure, its in depth study is a core competency for palliative care physicians.

  19. Network modeling for reverse flows of end-of-life vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Ene, Seval; Öztürk, Nursel

    2015-04-15

    Highlights: • We developed a network model for reverse flows of end-of-life vehicles. • The model considers all recovery operations for end-of-life vehicles. • A scenario-based model is used for uncertainty to improve real case applications. • The model is adequate to real case applications for end-of-life vehicles recovery. • Considerable insights are gained from the model by sensitivity analyses. - Abstract: Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles’ recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment.

  20. Network modeling for reverse flows of end-of-life vehicles

    International Nuclear Information System (INIS)

    Ene, Seval; Öztürk, Nursel

    2015-01-01

    Highlights: • We developed a network model for reverse flows of end-of-life vehicles. • The model considers all recovery operations for end-of-life vehicles. • A scenario-based model is used for uncertainty to improve real case applications. • The model is adequate to real case applications for end-of-life vehicles recovery. • Considerable insights are gained from the model by sensitivity analyses. - Abstract: Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles’ recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment

  1. Symptomatic Control in End-of-Life Patients

    Directory of Open Access Journals (Sweden)

    Mariana Alves

    2017-01-01

    Full Text Available End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

  2. End-of-life decision making in the ICU.

    Science.gov (United States)

    Siegel, Mark D

    2009-03-01

    A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

  3. ORIGINAL ARTICLES Medical futility and end-of-life care

    African Journals Online (AJOL)

    2008-04-01

    Apr 1, 2008 ... It is based on the probability of a treatment not having the desired effect ... as empathetic participants in end-of-life decision-making is underscored. .... growing awareness of the limits of medical science's propensity to cure ...

  4. End-of-Life Preferences: A Theory-Driven Inventory

    Science.gov (United States)

    Bonin-Scaon, Sylvie; Munoz Sastre, Maria Teresa; Chasseigne, Gerard; Sorum, Paul C.; Mullet, Etienne

    2009-01-01

    The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons…

  5. Improving end-of-life care: Recommendations from the IOM.

    Science.gov (United States)

    Dobbins, Elizabeth H

    2016-09-22

    A 2014 consensus report by the Institute of Medicine offers recommendations for healthcare providers to decrease unwanted care and improve the quality of life at the end of life. This article discusses the recommendations of interest to advanced practice registered nurses.

  6. Labelling of end-of-life decisions by physicians

    NARCIS (Netherlands)

    Deyaert, J.; Chambaere, K.; Cohen, J.; Roelands, M.; Deliens, L.

    2014-01-01

    Objectives: Potentially life-shortening medical end-oflife practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the

  7. 47 CFR 25.283 - End-of-life disposal.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false End-of-life disposal. 25.283 Section 25.283 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS... satellite orbit under this part shall be relocated, at the end of its useful life, barring catastrophic...

  8. END-OF-LIFE DECISIONS IN DUTCH NEONATOLOGY

    NARCIS (Netherlands)

    Moratti, Sofia

    2010-01-01

    This contribution describes the regulation of end-of-life decisions in neonatology in the Netherlands. An account is given of the process of formulating rules, which includes a report by the Dutch Association for Paediatrics, two Court rulings, a report by a Consultation Group appointed by the

  9. End-of-life practices: The opinions of undergraduate medical ...

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... illness, injury or other physical or mental condition that, in medical judgment, will .... was all the registered first- to fifth-year medical students at the School ..... patient should have sole responsibility in end-of-life decisions. The.

  10. Continuous subcutaneous infusion of opiates at end-of-life.

    Science.gov (United States)

    Anderson, Stacey L; Shreve, Scott T

    2004-06-01

    To review pertinent controlled trials using the continuous subcutaneous infusion of opioids (CSIO) at end-of-life and offer insight to pharmacists and clinicians into the appropriate use of this route of administration. A MEDLINE search for information regarding the subcutaneous administration of opioids in terminally ill patients (1975-December 2002) was conducted using the key words subcutaneous, narcotics, morphine, hydromorphone, fentanyl, pain, hospices, and palliative care. Additional references were located through review of bibliographies of the articles cited. Case reports and postsurgical studies were excluded. Searches were limited to English-language studies using humans. Experimental and observational studies were evaluated, using prospective trials as the evidence base for conclusions and including pertinent retrospective trials as they relate to the subcutaneous infusion of opioids at end-of-life. CSIO is effective and safe for use in terminal illness. Appropriate situations for consideration of CSIO are when difficulties arise in using the oral route, standard oral opiate therapy has failed adequate trials, the patient has limited intravenous access, adequate supervision of the CSIO is present, and CSIO will not unduly limit the functional activity of the patient. CSIO has a proven role in the management of pain at end-of-life. CSIO should not be considered the first route for administration of opiates, but does offer distinct advantages in the appropriate setting. CSIO continues to be a choice for end-of-life patients and is gradually becoming a standard practice in palliative medicine.

  11. End-of-life-vignettes. A Chaplain's story.

    Science.gov (United States)

    Bodemann, Christina

    2014-03-01

    Julia, a 31-year-old woman, is brain dead after having suffered a cardiac arrest. This article describes a hospital chaplain's journey with her family through the tragedy of letting her die. It addresses the power of pastoral presence and prayer in a situation of loss and grief and the importance of storytelling for everyone involved in Julia's end-of-life care.

  12. Enabling occupation at the end of life: A literature review.

    Science.gov (United States)

    Mills, Katherine; Payne, Angela

    2015-12-01

    Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams. Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments. Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy. A "good death" involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning

  13. End-of-life care in pediatric neuro-oncology.

    Science.gov (United States)

    Vallero, Stefano Gabriele; Lijoi, Stefano; Bertin, Daniele; Pittana, Laura Stefania; Bellini, Simona; Rossi, Francesca; Peretta, Paola; Basso, Maria Eleonora; Fagioli, Franca

    2014-11-01

    The management of children with cancer during the end-of-life (EOL) period is often difficult and requires skilled medical professionals. Patients with tumors of the central nervous system (CNS) with relapse or disease progression might have additional needs because of the presence of unique issues, such as neurological impairment and altered consciousness. Very few reports specifically concerning the EOL period in pediatric neuro-oncology are available. Among all patients followed at our center during the EOL, we retrospectively analyzed data from 39 children and adolescents with brain tumors, in order to point out on their peculiar needs. Patients were followed-up for a median time of 20.1 months. Eighty-two percent were receiving only palliative therapy before death. Almost half the patients (44%) died at home, while 56% died in a hospital. Palliative sedation with midazolam was performed in 58% of cases; morphine was administered in 51.6% of cases. No patient had uncontrolled pain. The EOL in children with advanced CNS cancer is a period of active medical care. Patients may develop complex neurological symptoms and often require long hospitalization. We organized a network-based collaboration among the reference pediatric oncology center, other pediatric hospitals and domiciliary care personnel, with the aim to ameliorate the quality of care during the EOL period. In our cohort, palliative sedation was widely used while no patients died with uncontrolled pain. A precise process of data collection and a better sharing of knowledge are necessary in order to improve the management of such patients. © 2014 Wiley Periodicals, Inc.

  14. Pleurodesis for effusions in pediatric oncology patients at end of life

    Energy Technology Data Exchange (ETDEWEB)

    Hoffer, Fredric A. [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Children' s Hospital and Regional Medical Center, Department of Radiology, R-5438, Seattle, WA (United States); Hancock, Michael L.; Rai, Shesh N. [St. Jude Children' s Research Hospital, Department of Biostatistics, Memphis, TN (United States); Hinds, Pamela S. [St. Jude Children' s Research Hospital, Division of Nursing Research, Memphis, TN (United States); Oigbokie, Nikita [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Rao, Bhaskar [St. Jude Children' s Research Hospital, Department of Surgery, Memphis, TN (United States)

    2007-03-15

    Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

  15. The new challenges of end-of-life tyres management systems: A Spanish case study

    International Nuclear Information System (INIS)

    Uruburu, Ángel; Ponce-Cueto, Eva; Cobo-Benita, José Ramón; Ordieres-Meré, Joaquín

    2013-01-01

    Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key products throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years

  16. Pleurodesis for effusions in pediatric oncology patients at end of life

    International Nuclear Information System (INIS)

    Hoffer, Fredric A.; Hancock, Michael L.; Rai, Shesh N.; Hinds, Pamela S.; Oigbokie, Nikita; Rao, Bhaskar

    2007-01-01

    Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

  17. The new challenges of end-of-life tyres management systems: A Spanish case study

    Energy Technology Data Exchange (ETDEWEB)

    Uruburu, Ángel, E-mail: angel.uruburu@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Ponce-Cueto, Eva, E-mail: eva.ponce@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Center for Transportation and Logistics, Massachusetts Institute of Technology, Cambridge, MA (United States); Cobo-Benita, José Ramón, E-mail: joseramon.cobo@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Ordieres-Meré, Joaquín, E-mail: j.ordieres@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain)

    2013-03-15

    Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key products throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years.

  18. Pain relief at the end of life: nurses' experiences regarding end-of-life pain relief in patients with dementia.

    Science.gov (United States)

    Brorson, Hanna; Plymoth, Henrietta; Örmon, Karin; Bolmsjö, Ingrid

    2014-03-01

    Patients with dementia receive suboptimal palliative care, and this patient group is at risk to have pain at the end of life. Because communicative impairments are common in this patient group, nurses play an important caregiver role in identifying, assessing, and relieving patients' pain. This study aimed to describe nurses' experiences regarding end-of-life pain relief in patients with dementia. This descriptive exploratory qualitative study was based on seven semistructured interviews. Burnard's content analysis inspired the data analysis. Two main categories were identified: (1) nurses' experience of difficulties concerning pain relief and (2) nurses' experience of resources concerning pain relief. Nurses experienced difficulties, such as feeling of powerlessness because of difficulties in obtaining adequate prescriptions for analgesics, ethical dilemmas, feeling of inadequacy because analgesia did not have the desired effect, and a feeling of not being able to connect with the patient. Factors, including knowledge about the patient, professional experience, utilization of pain assessment tools, interpersonal relationships, and interprofessional cooperation, served as resources and enabled end-of-life pain relief. The results of this study highlight the complexity of pain relief in patients with dementia at the end of life from a nursing perspective. The inability of patients with dementia to verbally communicate their pain makes them a vulnerable patient group, dependent on their caregivers. Knowing the life story of the patient, professional experience, teamwork based on good communication, and use of a pain assessment tool were reported by the nurses to improve pain relief at the end of life for patients with dementia. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  19. Perspectives on spirituality at the end of life: a meta-summary.

    Science.gov (United States)

    Williams, Anna-Leila

    2006-12-01

    A meta-summary of the qualitative literature on spiritual perspectives of adults who are at the end of life was undertaken to summarily analyze the research to date and identify areas for future research on the relationship of spirituality with physical, functional, and psychosocial outcomes in the health care setting. Included were all English language reports from 1966 to the present catalogued in PubMed, Medline, PsycInfo, and CINAHL, identifiable as qualitative investigations of the spiritual perspectives of adults at the end of life. The final sample includes 11 articles, collectively representing data from 217 adults. The preponderance of participants had a diagnosis of cancer; those with HIV/AIDS, cardiovascular disease, and ALS were also represented. Approximately half the studies were conducted in the United States; others were performed in Australia, Finland, Scotland, and Taiwan. Following a process of theme extraction and abstraction, thematic patterns emerged and effect sizes were calculated. A spectrum of spirituality at the end of life encompassing spiritual despair (alienation, loss of self, dissonance), spiritual work (forgiveness, self-exploration, search for balance), and spiritual well-being (connection, self-actualization, consonance) emerged. The findings from this meta-summary confirm the fundamental importance of spirituality at the end of life and highlight the shifts in spiritual health that are possible when a terminally ill person is able to do the necessary spiritual work. Existing end-of-life frameworks neglect spiritual work and consequently may be deficient in guiding research. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among the dying.

  20. Doctors' learning experiences in end-of-life care

    DEFF Research Database (Denmark)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti

    2017-01-01

    death could even be welcomed. Through challenging dialogues dealing with family members’ hope and trust, they learnt how to adjust words and decisions according to family and patient’s life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position......Background: Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life...... care. The aim of this study was to explore newly qualified doctors’ learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. Methods: House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped...

  1. REUSE OF AUTOMOTIVE COMPONENTS FROM DISMANTLED END OF LIFE VEHICLES

    Directory of Open Access Journals (Sweden)

    Piotr NOWAKOWSKI

    2013-12-01

    Full Text Available The problem of recycling end of life automotive vehicles is serious worldwide. It is one of the most important streams of waste in developed countries. It has big importance as recycling potential of raw materials content in automotive vehicles is valuable. Different parts and assemblies after dismantling can also be reused in vehicles where replacement of specific component is necessary. Reuse of the components should be taken into consideration in selecting the vehicles dismantling strategy. It also complies with European Union policy concerning end of life vehicles (ELV. In the paper it is presented systematic approach to dismantling strategies including disassembly oriented on further reuse of components. It is focused on decision making and possible benefits calculation from economic and environmental point of view.

  2. Palliative and end-of-life care in South Dakota.

    Science.gov (United States)

    Minton, Mary E; Kerkvliet, Jennifer L; Mitchell, Amanda; Fahrenwald, Nancy L

    2014-05-01

    Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

  3. [Precarity, vulnerability, anticipating end-of-life care at home].

    Science.gov (United States)

    Bonneval, Camille

    2016-02-01

    Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Use of Simulation in End-of-Life Care Education.

    Science.gov (United States)

    Grabow, Debra

    Death and dying encompasses the period when individuals present with a limited prognosis and are near death or have recently died. Using simulation to educate nurses on end-of-life (EOL) care helps focus more on the needs of the learner rather than the patient, and allows the learner to process feelings in preparation for a real experience. Incorporating simulation with a spiritual perspective is essential and needed in EOL nursing care.

  5. Team Leadership and Cancer End-of-Life Decision Making.

    Science.gov (United States)

    Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

    2016-11-01

    End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

  6. A relational ethical approach to end-of-life delirium.

    Science.gov (United States)

    Wright, David Kenneth; Brajtman, Susan; Macdonald, Mary Ellen

    2014-08-01

    Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Spiritual distress of military veterans at the end of life.

    Science.gov (United States)

    Chang, Bei-Hung; Stein, Nathan R; Skarf, Lara M

    2015-06-01

    Although combat experiences can have a profound impact on individuals' spirituality, there is a dearth of research in this area. Our recent study indicates that one unique spiritual need of veterans who are at the end of life is to resolve distress caused by combat-related events that conflict with their personal beliefs. This study sought to gain an understanding of chaplains' perspectives on this type of spiritual need, as well as the spiritual care that chaplains provide to help veterans ease this distress. We individually interviewed five chaplains who have provided spiritual care to veterans at the end of life in a Veterans Administration hospital. The interviews were recorded, transcribed, and analyzed based on "grounded theory." Chaplains reported that they frequently encounter veterans at the end of life who are still suffering from thoughts or images of events that occurred during their military career. Although some veterans are hesitant to discuss their experiences, chaplains reported that they have had some success with helping the veterans to open up. Additionally, chaplains reported using both religious (e.g., confessing sins) and nonreligious approaches (e.g., recording military experience) to help veterans to heal. Our pilot study provides some insight into the spiritual distress that many military veterans may be experiencing, as well as methods that a chaplain can employ to help these veterans. Further studies are needed to confirm our findings and to examine the value of integrating the chaplain service into mental health care for veterans.

  8. The significance of end-of-life dreams and visions.

    Science.gov (United States)

    Grant, Pei; Wright, Scott; Depner, Rachel; Luczkiewicz, Debra

    End-of-life dreams and visions (ELDVs) have been well documented through history and across cultures. They appear to affect both dying people and their families deeply, and may be a source of profound meaning and comfort. The aims of the study were to; document hospice patients' ELDV experiences over time using a daily survey, examine the content and subjective significance of ELDVs, and relate the prevalence, content and significance of end-of-life experiences over time until death. Patients (n = 66) in a hospice inpatient unit, between January 2011 and July 2012, were interviewed daily. The interview contained closed questions about the content, frequency and level of comfort or distress of dreams and visions. Most participants reported at least one dream or vision and almost half of the dreams and visions occurred during sleep. Nearly all patients reported that their experience felt real. The most common content featured deceased friends and relatives, followed by living friends and relatives. As participants approached death, comforting dreams and visions of the deceased became more prevalent. End-of-life dreams and visions are commonly experienced during dying. These dreams and visions may be a profound source of potential meaning and comfort to the dying.

  9. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study.

    Science.gov (United States)

    Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng

    2018-01-01

    To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

  10. A Multinational perspective to managing end-of-life electronics

    Energy Technology Data Exchange (ETDEWEB)

    Herold, M.

    2007-07-01

    This thesis focuses on how multinational electronics manufacturers manage used products in the EU, USA, Japan and China. Managing used or end-of-life products has interesting environmental and commercial implications. Recovering end-of-life products can reduce the environmental effects of disposal, raw material extraction, transport, and production. Whereas the commercial effects include image benefits and savings on raw material costs. Manufacturer involvement in end-of-life management is especially topical in the electronics industry, which is the focus of this thesis. Electronics products, such as TVs and computers, have been targeted with extended producer responsibility (EPR) legislation in different countries across the world. EPR is an environmental policy approach that forces manufacturers to take physical and/or financial responsibility for end-of-life products. The main objective of this dissertation was to increase understanding of how multinational manufacturers manage end-of-life products in the EU, in the USA, and in China and Japan, and the regional and company-specific factors explain their levels of involvement. This study consisted of an inductive 16-case multiple case study. The products and companies included in the study were as follows: Refrigerators (Bosch und Siemens Hausgeraete, Electrolux, Whirlpool); TVs (Samsung, Philips, Hitachi); PCs (Hewlett Packard, NEC, Fujitsu Limited and Fujitsu-Siemens Computers and an anonymous company, Alpha Computers); Mobile phones (Nokia, Motorola, Samsung); Telecommunication network equipment (Nokia, Motorola, Huawei). A manufacturer's level of involvement in end-of-life management can be characterized in terms of the level of organizational capabilities. These capabilities range from none to running a treatment facility and recovering value from own branded products. Levels in between can be characterized by outsourcing end-of-life management to industry-wide schemes, managing contracts for treating

  11. GPs and end of life decisions : views and experiences

    OpenAIRE

    Abela, Jurgen

    2015-01-01

    The views and experiences of GPs with respect to end of life (EoL) care are seldom addressed. The aim of this article is to better understand this aspect of care. A cross-sectional survey of all doctors in the country was designed and set up. The overall response was 396 (39.7%), 160 of which were GPs. 28.7% of GPs received no formal training in palliative medicine. 89.8% of respondents declared that their religion was important in EoL care. 45.3% agreed with the right of a patient to decide ...

  12. Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care.

    Science.gov (United States)

    Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

    2014-01-01

    Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

  13. End-of-life issues as perceived by Lebanese judges.

    Science.gov (United States)

    Adib, Salim M; Kawas, Sami H; Hajjar, Theresa A

    2003-05-01

    to assess the attitudes of judges in Beirut, Lebanon, regarding end-of-life issues such as assisted suicide and withholding or withdrawing life-sustaining treatment. 85% of all currently acting and in-training judges and public prosecutors in Beirut (N=135) were surveyed using a mailed questionnaire that assessed attitudes toward intervention in five hypothetical cases. The associations of attitudes, on a scale from least to most 'sympathetic' toward assisting those who desire to end their lives, were measured by a variety of personal, social and professional variables. younger individuals, and those who have not yet been formally appointed as judges, were significantly more sympathetic to withdrawal or withholding of life-sustaining devices when patients or their proxies requested it, and more in support of assisted suicide. Gender, religious denomination, religious practice, and personal experience with prolonged illness leading to death among close friends or family, were generally not significant predictors of respondents' attitudes. Years of experience as a judge correlated strongly with age and may have contributed to its predictive effect. a relatively more sympathetic attitude among younger judges, many of them women, and among trainees, may reflect a historical evolution in younger age-groups in Lebanon today. A survey of opinions in the public may help reach a more conclusive understanding in this regard. In any case, judges in Lebanon will remain important partners in the debate, as they will continue to be the final interpreters of the letter of the law in end-of-life issues.

  14. End-of-Life Decisions and Advanced Old Age

    Directory of Open Access Journals (Sweden)

    Stoyles

    2014-07-01

    Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

  15. [End of life decisions, the Dutch form through Spanish eyes].

    Science.gov (United States)

    Belloc Rocasalbas, M; Girbes, A R J

    2011-03-01

    Abroad, but also in The Netherlands, there are many misunderstandings concerning end of life decisions and euthanasia. In general, euthanasia does not play any role in the intensive care units, simply because it does not fulfill the conditions to carry it out. However, there is still confusion, merely due to the assumption that the Dutch situation is different because of their legislation on euthanasia. The use of the unclear terminology such as "passive euthanasia", "voluntary euthanasia" or "involuntary euthanasia" contributes to the confusion of lay people and physicians, and should therefore be avoided. End of life decisions in intensive care patients are in fact a structural part of work of intensivists. Collecting all necessary information including the wishes and will of the patient, medical expertise and acknowledging limitations of medical treatment will help to determine futility of treatment goals. Once it is determined that surviving the intensive care unit with a quality of life acceptable for the patient is beyond reach, the goal of treatment should be improved and the dying process optimized. Stopping a treatment modality at the request of a will-competent patient or because of futility is not euthanasia. Copyright © 2010 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  16. Balancing dual roles in end-of-life research.

    Science.gov (United States)

    Martin, Wanda; Grey, Meredith; Webber, Terry; Robinson, Linnea; Hartt, Nancy; Cairns, Moira; Stajduhar, Kelli

    2007-01-01

    Ethical and practical issues are sure to arise from the majority of research studies done with palliative populations. Whether it is feeling opportunistic, being emotionally available, or struggling with witnessing a gap in service and needs of the participants receiving care, nurses involved in research find a way to balance both roles to meet the needs of the participants as well as the study (McIlfatrick, Sullivan, & McKenna, 2006). This paper highlights some of the practical and ethical issues that arise when frontline nurses also take on the role of research assistant for studies with palliative populations. Specifically, the authors highlight their personal experiences based on their research assistant work on a study examining family caregiver coping in end-of-life cancer care. The authors discuss the "balancing act" of taking on these dual roles and offer recommendations on how to be with and approach people when doing research at the end of life using a framework based on Swanson's Theory of Caring (1991).

  17. End-of-life palliative chemotherapy: Where do we stand?

    International Nuclear Information System (INIS)

    Mohammed, A.A.; Al-Zahrani, A.S.; Ghanem, H.M.; El Saify, A.M.; EL-Khatib, H.M.; Mohammed, A.A.; Farooq, M.U.

    2015-01-01

    Background: This study evaluates the use of palliative chemotherapy (PCT) and possible associated factors at the end of life. Method: The study includes all advanced non hematological cancer patients who died in the King Abdullah Medical City during the period from January 2011 to April 2014. Demographic and disease features were registered. Results: 420 patients were included in the study, median age 62 years (range 17-108); 52% female and 48% male. 87.4% of patients were Saudis and 12.6% non Saudis. 124 (29.5%) patients received PCT at the last month before death (LM-PCT): 21.8%, 22.6% and 55.6% within one, two and four weeks of death, respectively. Place of death (critical care vs. regular ward) and mode of admission (ER vs. OPD vs. Transferred) had a strong association with LM-PCT (p< 0.0001, / = 0.35) and (p< 0.0001, V = 0.43), respectively. There was a gradual increase in the number of patients receiving LM-PCT from January 2011 to April 2014; 15.3%, 28.2%, 37.1% and 19.4%, respectively. Conclusion: In our center; at the end of life, there is a gradual increase in the number of patients receiving chemotherapy which significantly increased cancer patients’ odds without clear predictive factors associated with its use, which calls into question the benefits of PCT in terminally ill cancer patients.

  18. Labelling of end-of-life decisions by physicians.

    Science.gov (United States)

    Deyaert, Jef; Chambaere, Kenneth; Cohen, Joachim; Roelands, Marc; Deliens, Luc

    2014-07-01

    Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an explicit patient request and the self-estimated degree of life shortening)they label as euthanasia or sedation. We conducted a large stratified random sample of death certificates from 2007 (N=6927).The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response rate was 58.4%. In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absentin 79.7%. Our results suggest that, unlike euthanasia,the concept of palliative or terminal sedation covers abroad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians.

  19. Preferences for autonomy in end-of-life decision making in modern Korean society.

    Science.gov (United States)

    Kim, Su Hyun

    2015-03-01

    The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

  20. Network modeling for reverse flows of end-of-life vehicles.

    Science.gov (United States)

    Ene, Seval; Öztürk, Nursel

    2015-04-01

    Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles' recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. [End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life].

    Science.gov (United States)

    Cyrol, Katharina; Fröhlich, Martin R; Piatti, Francesca; Imhof, Lorenz

    2018-06-01

    Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

  2. Spirituality in cancer care at the end of life.

    Science.gov (United States)

    Ferrell, Betty; Otis-Green, Shirley; Economou, Denice

    2013-01-01

    There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress.

  3. Examining End-of-Life Case Management: Systematic Review

    Directory of Open Access Journals (Sweden)

    Roger E. Thomas

    2014-01-01

    Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

  4. International Space Station End-of-Life Probabilistic Risk Assessment

    Science.gov (United States)

    Duncan, Gary W.

    2014-01-01

    The International Space Station (ISS) end-of-life (EOL) cycle is currently scheduled for 2020, although there are ongoing efforts to extend ISS life cycle through 2028. The EOL for the ISS will require deorbiting the ISS. This will be the largest manmade object ever to be de-orbited therefore safely deorbiting the station will be a very complex problem. This process is being planned by NASA and its international partners. Numerous factors will need to be considered to accomplish this such as target corridors, orbits, altitude, drag, maneuvering capabilities etc. The ISS EOL Probabilistic Risk Assessment (PRA) will play a part in this process by estimating the reliability of the hardware supplying the maneuvering capabilities. The PRA will model the probability of failure of the systems supplying and controlling the thrust needed to aid in the de-orbit maneuvering.

  5. Satellite end of life constraints: Technical and organisational solutions

    Science.gov (United States)

    Cabrières, Bernard; Alby, Fernand; Cazaux, Christian

    2012-04-01

    Since 1974 with the radiocommunication satellite Symphony1, CNES launched and operated 11 GEO and 20 LEO satellites. During those 36 years, both flight segment and ground segment dramatically evolved and operational organisations and techniques equally improved. At the present time, CNES operates 1 GEO satellite and 17 LEO satellites with not much more people and costs than in 1986 when its first Satellite Operation Direction in Toulouse was only in charge of Telecom1A, Telecom1B and Spot1. This fantastic technical evolution combined with the huge increase of services to citizens and governments given by Space systems was unfortunately also associated with an enormous growth of space pollution by debris of all sizes. From the beginning, CNES was a major actor of the international effort to promote regulations in order to try to reduce or at least control this problematic situation. Internally, CNES, not only set up an operational on-call service to deal with collision risks, but decided to do its best to apply the new guidelines to the end of life of satellites under its responsibility even for those developed and launched a very long time ago. For instance, that was the case in 2009 for the reorbitation of the GEO satellite Telecom 2C (launched in 1995) and for the deorbitation of the LEO satellite Spot2 (launched in 1990). In addition, CNES prepares procedures to be able to be as exemplary as possible for its other spacecrafts whose end of life approaches. The constraints and challenges to face in order to cope with these new requirements are multiple: choice of final orbit, realistic calculation of re-entry duration, estimation of residual propellant, electric passivation, management of explosion risks… All these studies and operational experience gained will be helpful for the new role of CNES, which recently became in charge of controlling space operators in the frame of the new French space law on space operations.

  6. Occupational Variation in End-of-Life Care Intensity.

    Science.gov (United States)

    Hyder, Joseph A; Haring, R Sterling; Sturgeon, Daniel; Gazarian, Priscilla K; Jiang, Wei; Cooper, Zara; Lipsitz, Stuart R; Prigerson, Holly G; Weissman, Joel S

    2018-03-01

    End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care. We investigated occupation as a source of variation in EOL care intensity. Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death. Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P EOL care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance. Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.

  7. ["Dignity" at the end of life: ethical and deontologic reflections].

    Science.gov (United States)

    Mazzon, Davide

    2015-12-01

    Bioethical reflection is often raised to qualify medical treatment in relation to the concept of "dignity" of the human being. In philosophy, the concept of human dignity is used to refer to the intrinsic value of every human being but it has been framed in many different ways depending on the theoretical matrix we refer to. According to Christian principles, the dignity of human beings resides on their being created in the image and likeness of God: hence, the holiness of life for the believer and the condemnation of all means of action intended to anticipate death from suicide to euthanasia. On the contrary, according to the liberal tradition, human dignity is especially expressed in the autonomy of every human being. The Italian and the German Constitutions recall the value of human dignity. In the article 32 of the Italian Constitution, the concept of dignity is taken into account when stating the autonomy of the individual decision-making about health treatment. This is confirmed by the Code of Medical Ethics (2014): the right to self-determination and the right of patients to decide for themselves in accordance with their own life plans, are at the core of the concept of "human dignity". For this reason, doctors should support and encourage the full right of every patient to be considered as an autonomous person until the end of life, affirming his dignity. The acronym ABCD (airway, breathing, circulation, drugs) synthetises the essentials of intensive care procedures in life-threatening events. The same acronym should guide our behavior in promoting dignity in clinical settings. Attitude: moving away from our certainties, to better understand the real nature of the sick person we are approaching. Behavior: always be inspired by kindness and respect. Compassion, that is, deep awareness of the suffering, coupled with the desire to bring relief. Dialogue, being open to know the human being "behind" disease. This approach, developed by Chochinov and called

  8. Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories.

    Science.gov (United States)

    Wagner, Jenny; Ram, Nilam; Smith, Jacqui; Gerstorf, Denis

    2016-09-01

    Empirical evidence over the past 20 years has documented that key aspects of personality traits change during adulthood. However, it is essentially an open question whether and how traits change at the very end of life and what role health, cognitive performance, perceived control, and social factors play in those changes. To examine these questions, we applied growth models to 13-year longitudinal data obtained from now-deceased participants in the Berlin Aging Study (N = 463; age at baseline M = 85.9 years, SD = 8.4; 51% men). Results revealed that neuroticism, on average, increases (about 0.3 SD in the last 10 years) and that this increase becomes even steeper at the end of life. In contrast, extraversion and openness decline rather steadily at the end of life (about -0.5 SD in the last 10 years). Additionally, poor health manifested as a risk factor for declines in extraversion and openness late in life but not neuroticism. Similar to earlier phases of life, better cognitive performance related to more openness. More loneliness was associated with higher neuroticism, whereas more social activity was associated with higher levels of extraversion and openness. Intriguing additional insights indicated that more personal control was associated with higher levels of extraversion and openness, whereas the feeling that one's life is controlled by others was associated with higher neuroticism but also with higher openness closer to death. We discuss potential pathways by which health, cognitive performance, control, and social inclusion resources and risk factors affect personality development late in life. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  9. Worldwide end-of-life practice for patients in ICUs.

    Science.gov (United States)

    Wong, Wai-Tat; Phua, Jason; Joynt, Gavin M

    2018-04-01

    Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

  10. [Conscience clause in end-of-life care.

    Science.gov (United States)

    De Panfilis, Ludovica; Cattaneo, Daniela; Cola, Luisanna; Gasparini, Maddalena; Porteri, Corinna; Tarquini, Daniela; Tiezzi, Alessandro; Veronese, Simone; Zullo, Silvia; Pucci, Eugenio

    2017-05-01

    The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento". In particular, the conscience clause has been discussed in the light of advance care planning (ACP), which represents the instrument to guarantee the shared planning of care and the shared-decision making. In this context, recourse to the clause of conscience brings out critical ethical and deontological issues that the article discusses, using the position paper SIAARTI and the text of law currently being debated, both built on the assumptions of a shared care relationship, where patient has a key-role in medical decisions.

  11. Attitude Towards End of Life Communication of Austrian Medical Students.

    Science.gov (United States)

    Rumpold, Tamara; Lütgendorf-Caucig, Carola; Löffler-Stastka, Henriette; Roider-Schur, Sophie; Pötter, Richard; Kirchheiner, Kathrin

    2018-04-23

    Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.

  12. Hospital end-of-life care in haematological malignancies.

    Science.gov (United States)

    Beaussant, Yvan; Daguindau, Etienne; Chauchet, Adrien; Rochigneux, Philippe; Tournigand, Christophe; Aubry, Régis; Morin, Lucas

    2018-02-06

    To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies. Nationwide register-based study, including all hospitalised adults ≥20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation. Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin's lymphoma (Pcare units. A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. End-of-life decision making is more than rational.

    Science.gov (United States)

    Eliott, Jaklin A; Olver, Ian N

    2005-01-01

    Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a 'modernist' repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a 'romanticist' repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply 'Sanity' and 'Stability' tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.

  14. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

    Science.gov (United States)

    2014-01-01

    Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

  15. Mental competence and surrogate decision-making towards the end of life.

    Science.gov (United States)

    Strätling, M; Scharf, V E; Schmucker, P

    2004-01-01

    German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction

  16. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  17. Doctors' learning experiences in end-of-life care - a focus group study from nursing homes.

    Science.gov (United States)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

    2017-01-31

    Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

  18. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective.

    Science.gov (United States)

    Phua, Jason; Kee, Adrian Chin-Leong; Tan, Adeline; Mukhopadhyay, Amartya; See, Kay Choong; Aung, Ngu Wah; Seah, Angeline S T; Lim, Tow Keang

    2011-12-01

    Despite international differences in cultural perspectives on end-of-life issues, little is known of the care for the dying in the general wards of acute hospitals in Asia. We performed a retrospective medical chart review of all 683 adult patients who died without intensive care unit (ICU) admission in our Singaporean hospital in 2007. We first evaluated the prevalence of do-not-resuscitate (DNR) orders and orders for or against life-sustaining therapies; second, if such orders were discussed with the patients and/or family members; and third, the actual treatments provided before death. There were DNR orders for 66.2% of patients and neither commitment for DNR nor cardiopulmonary resuscitation (CPR) for 28.1%. Orders to limit life-sustaining therapies, including ICU admission, intubation, and vasopressors/inotropes were infrequent. Only 6.2% of the alert and conversant patients with DNR orders were involved in discussions on these orders. In contrast, such discussions with their family members occurred 82.9% of the time. Interventions in the last 24 hours of life included CPR (9.4%), intubation (6.4%), vasopressors/inotropes (14.8%), tube feeding (24.7%), and antibiotics (44.9%). Analgesia was provided in 29.1% of patients. There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.

  19. Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values

    Directory of Open Access Journals (Sweden)

    Jonathan D. Santoro

    2018-04-01

    Full Text Available Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

  20. Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values.

    Science.gov (United States)

    Santoro, Jonathan D; Bennett, Mariko

    2018-04-26

    Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

  1. Multi-dimensional approach of MARS-LMR for the analysis of Phenix End-of-Life natural circulation test

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim

    2012-01-01

    Phenix is one of the important prototype sodium-cooled fast reactors (SFR) in nuclear reactor development history. It had been operated successfully for 35 years by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) achieving its original objectives of demonstrating a fast breeder reactor technology and of playing the role of irradiation facility for innovative fuels and materials. After its final shutdown in 2009, CEA launched the Phenix End-of-life (EOL) test program. It provided a unique opportunity to generate reliable test data which is inevitable in the validation and verification of a SFR system analysis code. KAERI joined this international collaboration program of IAEA CRP and has performed the pretest analysis and post-test analysis utilizing the one-dimensional modeling of the MARS-LMR code, which had been developed by KAERI for the transient analysis of SFR systems. Through the previous studies, it has been identified that there are some limitations in the modeling of complicated thermal-hydraulic behaviors in the large pool volumes with the one-dimensional modeling. Recently, KAERI performed the analysis of Phenix EOL natural circulation test with multi-dimensional pool modeling, which is detailed below

  2. Multi-dimensional approach of MARS-LMR for the analysis of Phenix End-of-Life natural circulation test

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2012-05-15

    Phenix is one of the important prototype sodium-cooled fast reactors (SFR) in nuclear reactor development history. It had been operated successfully for 35 years by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) achieving its original objectives of demonstrating a fast breeder reactor technology and of playing the role of irradiation facility for innovative fuels and materials. After its final shutdown in 2009, CEA launched the Phenix End-of-life (EOL) test program. It provided a unique opportunity to generate reliable test data which is inevitable in the validation and verification of a SFR system analysis code. KAERI joined this international collaboration program of IAEA CRP and has performed the pretest analysis and post-test analysis utilizing the one-dimensional modeling of the MARS-LMR code, which had been developed by KAERI for the transient analysis of SFR systems. Through the previous studies, it has been identified that there are some limitations in the modeling of complicated thermal-hydraulic behaviors in the large pool volumes with the one-dimensional modeling. Recently, KAERI performed the analysis of Phenix EOL natural circulation test with multi-dimensional pool modeling, which is detailed below

  3. Emotional Numbness Modifies the Effect of End-of-Life Discussions on End-of-Life Care

    Science.gov (United States)

    Maciejewski, Paul K.; Prigerson, Holly G.

    2012-01-01

    Context Overall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion. Objectives We hypothesized that emotional numbness would modify the influence of EOL discussions on the receipt of less aggressive EOL care. Methods Data were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of advanced cancer patients followed through their death. Patients’ reports of EOL discussions with their physician and emotional numbness were assessed a median of 4.6 months before death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the Intensive Care Unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression. Results The likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio=9.02, 95% confidence interval 1.37, 59.6, P=0.022) for every unit increase in a patient’s emotional numbness score. Conclusion Emotional numbness diminishes a patient’s capacity to benefit from EOL discussions. EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided. PMID:22926093

  4. Consequences count: against absolutism at the end of life.

    Science.gov (United States)

    Snelling, Paul C

    2004-05-01

    There has been a considerable amount of debate in the nursing literature about euthanasia, and especially the distinctions between acts and omissions, and killing and letting die. These distinctions are required by opponents of euthanasia to justify allowing some cases of passive euthanasia while forbidding all cases of active euthanasia. This paper adds to the debate by arguing that the position that absolutely forbids euthanasia is theoretically inconsistent. The paper first considers the place of moral theory in analysing moral problems, within the framework of the principles of biomedical ethics. It is argued that despite a moral pluralism that operates in many areas, the legal status of euthanasia is based upon an absolute deontological position against deliberate killing, which cannot be overridden by appeals to favourable consequences. In order that certain forms of passive euthanasia can be allowed, this position allows distinctions within three pairs of concepts--acts and omissions, killing and letting die, and ordinary and extraordinary means. A further method of justifying certain actions near the end of life is the doctrine of double effect. These paired concepts and the doctrine of double effect are analysed with special reference to their consequences. The application of the doctrine of double effect and the three distinctions relies on consideration of their consequences, allowing in practice what in theory is denied. This is important because it weakens the absolute case against euthanasia, which disallows any direct consequentialist appeal. If consequences count in the application of the doctrine and the distinctions, then they should also count directly prior to their application. This strengthens the argument for active euthanasia in certain cases.

  5. Fatigue in children with cancer at the end of life.

    Science.gov (United States)

    Ullrich, Christina K; Dussel, Veronica; Hilden, Joanne M; Sheaffer, Jan W; Moore, Caron L; Berde, Charles B; Wolfe, Joanne

    2010-10-01

    Fatigue is a prevalent source of suffering in children with advanced cancer; yet, little is known about it. This study aimed to describe fatigue experienced by children with advanced cancer and to identify the factors associated with suffering from fatigue and its treatment. A retrospective cross-sectional study of 141 parents of children who died of cancer (response rate: 64%) was conducted in two tertiary-level U.S. pediatric hospitals. By parent report, 96% of children experienced fatigue in the last month of life. Nearly 50% experienced significant suffering from fatigue; this was associated with suffering from pain, dyspnea, anorexia, nausea/vomiting, diarrhea, anxiety, sadness, or fear (Pfear (OR=5.13, 95% CI=2.03-12.96, P ≤ 0.001) remained independently associated with fatigue. Children suffering from fatigue had primary oncologists with fewer years' experience than children who did not suffer from fatigue (mean=7.7 years, standard deviation [SD]=4.9 vs. mean of 9.9 years, SD=6.0, P=0.02). Among children with fatigue, 17 of 129 (13%) received fatigue-directed treatment, which was successful in 3 of 12 (25%). Children experiencing side effects from dyspnea or pain treatment were more likely to be treated for fatigue (relative risk=1.25, 95% CI=1.06-1.47, P=0.009). Fatigue is a common source of suffering in children with cancer at the end of life. Palliation of this symptom is rarely successful. Increased attention to factors associated with fatigue and effective interventions to ameliorate fatigue are needed. Copyright © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  6. Homeless Individuals Approaching the End of Life: Symptoms and Attitudes.

    Science.gov (United States)

    Tobey, Matthew; Manasson, Julia; Decarlo, Kristen; Ciraldo-Maryniuk, Katrina; Gaeta, Jessie M; Wilson, Erica

    2017-04-01

    Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Ethical decision-making near the end of life.

    Science.gov (United States)

    Finucane, T E; Harper, M

    1996-05-01

    For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.

  8. Engaging homeless persons in end of life preparations.

    Science.gov (United States)

    Song, John; Wall, Melanie M; Ratner, Edward R; Bartels, Dianne M; Ulvestad, Nancy; Gelberg, Lillian

    2008-12-01

    There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population. To determine whether homeless persons will complete an advance directive (AD). Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG). Fifty-nine homeless persons recruited from a drop-in center. Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors. The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05). This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.

  9. End-of-life flows of multiple cycle consumer products

    International Nuclear Information System (INIS)

    Tsiliyannis, C.A.

    2011-01-01

    Explicit expressions for the end-of-life flows (EOL) of single and multiple cycle products (MCPs) are presented, including deterministic and stochastic EOL exit. The expressions are given in terms of the physical parameters (maximum lifetime, T, annual cycling frequency, f, number of cycles, N, and early discard or usage loss). EOL flows are also obtained for hi-tech products, which are rapidly renewed and thus may not attain steady state (e.g. electronic products, passenger cars). A ten-step recursive procedure for obtaining the dynamic EOL flow evolution is proposed. Applications of the EOL expressions and the ten-step procedure are given for electric household appliances, industrial machinery, tyres, vehicles and buildings, both for deterministic and stochastic EOL exit, (normal, Weibull and uniform exit distributions). The effect of the physical parameters and the stochastic characteristics on the EOL flow is investigated in the examples: it is shown that the EOL flow profile is determined primarily by the early discard dynamics; it also depends strongly on longevity and cycling frequency: higher lifetime or early discard/loss imply lower dynamic and steady state EOL flows. The stochastic exit shapes the overall EOL dynamic profile: Under symmetric EOL exit distribution, as the variance of the distribution increases (uniform to normal to deterministic) the initial EOL flow rise becomes steeper but the steady state or maximum EOL flow level is lower. The steepest EOL flow profile, featuring the highest steady state or maximum level, as well, corresponds to skew, earlier shifted EOL exit (e.g. Weibull). Since the EOL flow of returned products consists the sink of the reuse/remanufacturing cycle (sink to recycle) the results may be used in closed loop product lifecycle management operations for scheduling and sizing reverse manufacturing and for planning recycle logistics. Decoupling and quantification of both the full age EOL and of the early discard flows is

  10. A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-11-01

    The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them. © 2012 by the Society for Academic Emergency Medicine.

  11. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

    Directory of Open Access Journals (Sweden)

    Bossuyt Nathalie

    2009-03-01

    Full Text Available Abstract Background This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002. Methods We performed a mortality follow-back study in 2005–2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs. Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60% and southern French-speaking communities (40% controlling for population differences. Results We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8. Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7. Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant. Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9; while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9. Conclusion Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.

  12. [The pediatric patient at the end-of-life. A challenge for its identification and treatment. A survey in pediatricians and medical residents].

    Science.gov (United States)

    Rendón-Macías, Mario Enrique; Olvera-González, Héctor; Villasís-Keever, Miguel Angel

    2011-01-01

    Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults' criteria. In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life. Tertiary referral pediatric hospital. Staff pediatricians (SP) and medical residents (MR). A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). PARTICIPANTS identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants' characteristics were related to the identification of an end-of-life condition. Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants' characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios. Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.

  13. Investigation of control rod worth and nuclear end of life of BWR control rods

    International Nuclear Information System (INIS)

    Magnusson, Per

    2008-01-01

    This work has investigated the Control Rod Worth (CRW) and Nuclear End of Life (NEOL) values for BWR control rods. A study of how different parameters affect NEOL was performed with the transport code PHOENIX4. It was found that NEOL, expressed in terms of 10 B depletion, can be generalized beyond the conditions for which the rod is depleted, such as different power densities and void fractions, the corresponding variation in the NEOL will be about 0.2-0.4% 10 B. It was also found that NEOL results for different fuel types and different fuel enrichments have a variation of about 2-3% in 10 B depletion. A comparative study on NHOL and CRW was made between PHOENIX4 and the stochastic Monte Carlo code MCNP. It was found that there is a significant difference, both due to differences in the codes and to limitations in the geometrical modeling in PHOENIX4. Since MCNP is considered more physically correct, a methodology was developed to calculate the nuclear end of life of BWR control rods with MCNP. The advantages of the methodology are that it does not require other codes to perform the depletion of the absorber material, it can describe control rods of any design and it can deplete the control rod absorber material without burning the fuel. The disadvantage of the method is that is it time-consuming

  14. Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

    DEFF Research Database (Denmark)

    Cohen, J; van Delden, J; Mortier, F

    2008-01-01

    AIM: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. METHODS: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland......) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. DISCUSSION: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients...... large life-stance groups in each country. RESULTS: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten...

  15. End-of-Life Care Interventions: An Economic Analysis.

    Science.gov (United States)

    Pham, B; Krahn, M

    2014-01-01

    The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76-108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191-$385 million in health care costs. Results for the other interventions were uncertain. The cost-effectiveness analysis was

  16. Sustainable design for automotive products: dismantling and recycling of end-of-life vehicles.

    Science.gov (United States)

    Tian, Jin; Chen, Ming

    2014-02-01

    The growth in automotive production has increased the number of end-of-life vehicles (ELVs) annually. The traditional approach ELV processing involves dismantling, shredding, and landfill disposal. The "3R" (i.e., reduce, reuse, and recycle) principle has been increasingly employed in processing ELVs, particularly ELV parts, to promote sustainable development. The first step in processing ELVs is dismantling. However, certain parts of the vehicle are difficult to disassemble and use in practice. The extended producer responsibility policy requires carmakers to contribute in the processing of scrap cars either for their own developmental needs or for social responsibility. The design for dismantling approach can be an effective solution to the existing difficulties in dismantling ELVs. This approach can also provide guidelines in the design of automotive products. This paper illustrates the difficulty of handling polymers in dashboards. The physical properties of polymers prevent easy separation and recycling by using mechanical methods. Thus, dealers have to rely on chemical methods such as pyrolysis. Therefore, car designers should use a single material to benefit dealers. The use of materials for effective end-of-life processing without sacrificing the original performance requirements of the vehicle should be explored. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Gender Differences in Caregiving at End of Life: Implications for Hospice Teams.

    Science.gov (United States)

    Washington, Karla T; Pike, Kenneth C; Demiris, George; Parker Oliver, Debra; Albright, David L; Lewis, Alexandria M

    2015-12-01

    Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist. The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender. We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using χ(2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA). As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances. Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.

  18. A management system for end-of-life tyres: a Portuguese case study.

    Science.gov (United States)

    Ferrão, Paulo; Ribeiro, Paulo; Silva, Paulo

    2008-01-01

    The European Union introduced several policy instruments based in the extended producer responsibility (EPR) in order to improve the environmental performance of products and services through their life cycles. In this context, the Portuguese government decided to apply the EPR concept to tyres, and producers were obliged to constitute an end-of-life management system to promote the collection, recycling and reuse of end-of-life (EOL) tyres. This required producers, distributors, recyclers and retreaders to be identified and characterized, and local processing infrastructures to be analyzed. The information was used to design an economically optimised EOL tyre management system while promoting the activity of all EOL operators in order for the imposed collecting and recovery targets to be fulfilled. This paper discusses the interaction between the different governmental, private and academic institutions for the creation of the integrated management system for EOL tyres, the approach taken, the technical, political and legal aspects underneath them, as well as the environmental consequences induced by the creation of the management system. The results obtained during the first years of operation are reported and show an increase in the collection and recycling of EOL tyres and the consolidation of the collection and processing infrastructures.

  19. Assessment of end-of-life design in solid-state lighting

    Science.gov (United States)

    Dzombak, Rachel; Padon, Jack; Salsbury, Josh; Dillon, Heather

    2017-08-01

    Consumers in the US market and across the globe are beginning to widely adopt light emitting diode (LED) lighting products while the technology continues to undergo significant changes. While LED products are evolving to consume less energy, they are also more complex than traditional lighting products with a higher number of parts and a larger number of electronic components. Enthusiasm around the efficiency and long expected life span of LED lighting products is valid, but research to optimize product characteristics and design is needed. This study seeks to address that gap by characterizing LED lighting products' suitability for end of life (EOL) recycling and disposal. The authors disassembled and assessed 17 different lighting products to understand how designs differ between brands and manufacture year. Products were evaluated based on six parameters to quantify the design. The analysis indicates that while the efficiency of LED products has improved dramatically in the recent past, product designers and manufacturers could incorporate design strategies to improve environmental performance of lighting products at end-of-life.

  20. End-of-life care and mental illness: a model for community psychiatry and beyond.

    Science.gov (United States)

    Candilis, Philip J; Foti, Mary Ellen G; Holzer, Jacob C

    2004-02-01

    End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment.

  1. A Study on the Dimension Analysis of the End-of-Life Grid

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jaejun; Lee, Joungyeul; Kim, Hyeongkoo; Kim, Yonghwan [KEPCO Nuclear Fuel, Daejeon (Korea, Republic of)

    2014-05-15

    In this research, statistical analyses are performed for the components of cell dimension using the end-of-life (EOL) grids. The analyzed grids are the mid grids and the materials of the grids are the zirconium (Zr) based alloys. The analyses of grid dimensions are performed using the statistical method. The new factors are proposed and evaluated from hot cell data and nominal design values. It is worthy to note that the correlation between the relaxation factor and the cell size has the statistical significance and the cell relaxation and the cell pitch are analogized from the cell size. It is necessary in future that the analyses are performed between the grid width and these factors to obtain the effects for the grid width growth.

  2. 'End of life could be on any ward really': A qualitative study of hospital volunteers' end-of-life care training needs and learning preferences.

    Science.gov (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Robinson, Vicky; Khan, Shaheen A; George, Rob; Burman, Rachel; Selman, Lucy Ellen

    2017-10-01

    Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. Qualitative focus groups. Volunteers from a large teaching hospital were purposively sampled. Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.

  3. End of life could be on any ward really’: A qualitative study of hospital volunteers’ end-of-life care training needs and learning preferences

    Science.gov (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Robinson, Vicky; Khan, Shaheen A; George, Rob; Burman, Rachel; Selman, Lucy Ellen

    2017-01-01

    Background: Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. Aims: To explore hospital volunteers’ end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. Design: Qualitative focus groups. Setting/participants: Volunteers from a large teaching hospital were purposively sampled. Results: Five focus groups were conducted with 25 hospital volunteers (aged 19–80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to ‘refresh’ training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. Conclusion: Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals. PMID:28056642

  4. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives

    NARCIS (Netherlands)

    Wagemans, A.M.; Schrojenstein Lantman-de Valk, H.M. van; Proot, I.M.; Metsemakers, J.; Tuffrey-Wijne, I.; Curfs, L.M.G.

    2013-01-01

    Background: Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. Aim: To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. Design: A qualitative study

  5. Interviews on end-of-life care with older people: reflections on six european studies

    NARCIS (Netherlands)

    Pleschberger, S.; Seymour, J.E.; Payne, S.; Deschepper, R.; Onwuteaka-Philipsen, B.D.; Rurup, M.L.

    2011-01-01

    Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European

  6. Selection bias in family reports on end of life with dementia in nursing homes

    NARCIS (Netherlands)

    van der Steen, J.T.; Deliens, L.; Ribbe, M.W.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. Objectives: To assess possible selection bias in retrospective study of dementia at the end of life using family reports.

  7. End-of-Life Care Education for Psychiatric Residents: Attitudes, Preparedness, and Conceptualizations of Dignity

    Science.gov (United States)

    Tait, Glendon R.; Hodges, Brian D.

    2009-01-01

    Objective: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. Methods: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey…

  8. Good end-of-life care according to patients and their GPs

    NARCIS (Netherlands)

    Borgsteede, Sander D.; Graafland-Riedstra, Corrie; Deliens, Luc; Francke, Anneke L.; van Eijk, Jacques ThM; Willems, Dick L.

    2006-01-01

    BACKGROUND: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. AIM: To explore the aspects valued by both patients and GPs in

  9. The broad spectrum of unbearable suffering in end of life cancer studied in dutch primary care

    NARCIS (Netherlands)

    Ruijs, C.D.M.; Kerkhof, A.J.F.M.; van der Wal, G.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Unbearable suffering most frequently is reported in end-of-life cancer patients in primary care. However, research seldom addresses unbearable suffering. The aim of this study was to comprehensively investigate the various aspects of unbearable suffering in end-of-life cancer patients

  10. Do Older Korean Immigrants Engage in End-of-Life Communication?

    Science.gov (United States)

    Ko, Eunjeong; Roh, Soonhee; Higgins, Doreen

    2013-01-01

    End-of-life communication is an important process as it allows individuals' treatment preferences to be known, yet not every culture is receptive to such discussions. Planning for end-of-life care is not readily supported in Asian culture, and little is known about individuals' communication with family and health care professionals among older…

  11. End-of-life decisions: an important theme in the care for people with intellectual disabilities.

    NARCIS (Netherlands)

    Wagemans, A.; Schrojenstein Lantman, H.M.J. van; Tuffrey-Wijne, I.; Widdershoven, G.; Curfs, L.M.G.

    2010-01-01

    BACKGROUND: While end-of-life decisions in the general population have received attention in several countries, not much is known about this in people with intellectual disabilities (IDs). Therefore, the prevalence and nature of end-of-life decisions were investigated in a Dutch centre providing

  12. Looking at the end-of-life directive and challenges in recycling

    DEFF Research Database (Denmark)

    Smink, Carla

    2004-01-01

    The article deals with end-of-life vechile regulations. Focus is on the European end-of-life vechile directive (2000/53/EC) and how Denmark and the Netherlands have dealt with the regulations in the past 30 years....

  13. Nurse involvement in end-of-life decision making: the ETHICUS Study

    DEFF Research Database (Denmark)

    Benbenishty, Julie; Ganz, Freda DeKeyser; Lippert, Anne

    2006-01-01

    The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.......The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making....

  14. Good end-of-life care according to patients and their GPs.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Graafland-Riedstra, C.; Deliens, L.; Francke, A.L.; Eijk, J.T.M. van; Willems, D.L.

    2006-01-01

    Background: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. Aim: To explore the aspects valued by both patients and GPs in

  15. Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    Science.gov (United States)

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated…

  16. Affective science and avoidant end-of-life communication: Can the science of emotion help physicians talk with their patients about the end of life?

    Science.gov (United States)

    Soodalter, Jesse A; Siegle, Greg J; Klein-Fedyshin, Michele; Arnold, Robert; Schenker, Yael

    2018-05-01

    Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure. We propose that cognitive, behavioral, and neuroscience evidence from affective science may offer helpful insights into this problem. Data from other populations show that strong emotion impairs cognitive performance and multiple demands can overload cognitive resources. We discuss several affective processes that may apply to physicians attempting EOL discussions. We then discuss selected interventions that have been shown to modify some of these processes and associated behavioral outcomes. Evidence for change in behavioral outcomes of interest includes performance and mood enhancement in healthy populations. We suggest that such mechanistically-targeted interventions may be hypothesized to help decrease physician avoidance of EOL discussion. Physicians may be motivated to adopt such interventions in order to enhance normal emotional functioning to meet supra-normal occupational demand. We propose this as a promising area of future study. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Pain and symptom management in palliative care and at end of life.

    Science.gov (United States)

    Wilkie, Diana J; Ezenwa, Miriam O

    2012-01-01

    The purpose of this review is to provide a literature update of the research published since 2004 on pain and symptom management in palliative care and at end of life. Findings suggest that pain and symptoms are inadequately assessed and managed, even at the end of life. Although not pervasive, there is evidence of racial/ethnic disparities in symptom management in palliative care and at end of life. There is a need for a broader conceptualization and measurement of pain and symptom management as multidimensional experiences. There is insufficient evidence about mechanisms underlying pain at end of life. Although there are advances in the knowledge of pain as a multidimensional experience and the many symptoms that occur sometimes with pain, gaps remain. One approach to addressing the gaps will involve assessment and management of pain and symptoms as multidimensional experiences in people receiving palliative care and at end of life. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Involving healthcare professionals and family carers in setting research priorities for end-of-life care.

    Science.gov (United States)

    Diffin, Janet; Spence, Michael; Spencer, Rebecca; Mellor, Peter; Grande, Gunn

    2017-02-02

    It is important to ensure regional variances are considered when setting future end-of-life research priorities, given the differing demographics and service provision. This project sought to identify end-of-life research priorities within Greater Manchester (United Kingdom). Following an initial scoping exercise, six topics within the 10 national priorities outlined by The Palliative and end-of-life care Priority Setting Partnership were selected for exploration. A workshop involving 32 healthcare professionals and a consultation process with 26 family carers was conducted. Healthcare professionals and carers selected and discussed the topics important to them. The topics selected most frequently by both healthcare professionals and carers were 'Access to 24 hour care', 'Planning end-of-life care in advance' and 'Staff and carer education'. Healthcare professionals also developed research questions for their topics of choice which were refined to incorporate carers' views. These questions are an important starting point for future end-of-life research within Greater Manchester.

  19. Effects of a Simulation Exercise on Nursing Students' End-of-Life Care Attitudes.

    Science.gov (United States)

    Dame, Linda; Hoebeke, Roberta

    2016-12-01

    Students consider end-of-life care content in their nursing curricula to be inadequate and deficient in promoting the development of the necessary attitudes to care for dying patients. Research identifies simulation as an effective teaching strategy to examine nursing students' attitudes toward end-of-life care. An end-of-life care simulation was developed, implemented, and evaluated. Attitudes toward caring for dying patients were measured pre- and postsimulation on a convenience sample of 57 sophomore nursing students using the Frommelt Attitudes Toward Care of the Dying Scale-Form B. Repeated measures of ANOVA on outcome variables evaluated student attitudes toward end-of-life care. Participation in an end-of-life care simulation resulted in more positive student attitudes toward caring for dying patients (p life care in nursing curricula and improve student attitudes toward caring for dying patients. [J Nurs Educ. 2016;55(12):701-705.]. Copyright 2016, SLACK Incorporated.

  20. Analysis of Phenix end-of-life natural convection test with the MARS-LMR code

    International Nuclear Information System (INIS)

    Jeong, H. Y.; Ha, K. S.; Lee, K. L.; Chang, W. P.; Kim, Y. I.

    2012-01-01

    The end-of-life test of Phenix reactor performed by the CEA provided an opportunity to have reliable and valuable test data for the validation and verification of a SFR system analysis code. KAERI joined this international program for the analysis of Phenix end-of-life natural circulation test coordinated by the IAEA from 2008. The main objectives of this study were to evaluate the capability of existing SFR system analysis code MARS-LMR and to identify any limitation of the code. The analysis was performed in three stages: pre-test analysis, blind posttest analysis, and final post-test analysis. In the pre-test analysis, the design conditions provided by the CEA were used to obtain a prediction of the test. The blind post-test analysis was based on the test conditions measured during the tests but the test results were not provided from the CEA. The final post-test analysis was performed to predict the test results as accurate as possible by improving the previous modeling of the test. Based on the pre-test analysis and blind test analysis, the modeling for heat structures in the hot pool and cold pool, steel structures in the core, heat loss from roof and vessel, and the flow path at core outlet were reinforced in the final analysis. The results of the final post-test analysis could be characterized into three different phases. In the early phase, the MARS-LMR simulated the heat-up process correctly due to the enhanced heat structure modeling. In the mid phase before the opening of SG casing, the code reproduced the decrease of core outlet temperature successfully. Finally, in the later phase the increase of heat removal by the opening of the SG opening was well predicted with the MARS-LMR code. (authors)

  1. The development and prospects of the end-of-life vehicle recycling system in Taiwan.

    Science.gov (United States)

    Chen, Kuan-chung; Huang, Shih-han; Lian, I-wei

    2010-01-01

    Automobiles usually contain toxic substances, such as lubricants, acid solutions and coolants. Therefore, inappropriate handling of end-of-life vehicles (ELVs) will result in environmental pollution. ELV parts, which include metallic and non-metallic substances, are increasingly gaining recycling value due to the recent global shortage of raw materials. Hence, the establishment of a proper recycling system for ELVs will not only reduce the impact on the environment during the recycling process, but it will also facilitate the effective reuse of recycled resources. Prior to 1994, the recycling of ELVs in Taiwan was performed by related operators in the industry. Since the publishing of the "End-of-life vehicle recycling guidelines" under the authority of the Waste Disposal Act by the Environmental Protection Administration (EPA) in 1994, the recycling of ELVs in Taiwan has gradually become systematic. Subsequently, the Recycling Fund Management Board (RFMB) of the EPA was established in 1998 to collect a Collection-Disposal-Treatment Fee (recycling fee) from responsible enterprises for recycling and related tasks. Since then, the recycling channels, processing equipment, and techniques for ELVs in Taiwan have gradually become established. This paper reviews the establishment of the ELV recycling system, analyzes the current system and its performance, and provides some recommendations for future development. The reduction of auto shredder residue (ASR) is a key factor in maximizing the resource recovery rate and recycling efficiency. The RFMB needs to provide strong economic incentives to further increase the recycling rate and to encourage the automobile industry to design and market greener cars. 2010 Elsevier Ltd. All rights reserved.

  2. Recycling end-of-life vehicles of the future. Final CRADA report.

    Energy Technology Data Exchange (ETDEWEB)

    Jody, B. J.; Pomykala, J. A.; Spangenberger, J. S.; Daniels, E.; Energy Systems

    2010-01-14

    Argonne National Laboratory (the Contractor) entered into a Cooperative Research and Development Agreement (CRADA) with the following Participants: Vehicle Recycling Partnership, LLC (VRP, which consists of General Motors [GM], Ford, and Chrysler), and the American Chemistry Council - Plastics Division (ACC-PD). The purpose of this CRADA is to provide for the effective recycling of automotive materials. The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use of advanced lightweighting materials or systems in future vehicles. The issues, technical requirements, and cost and institutional considerations in achieving that goal are complex and will require a concerted, focused, and systematic analysis, together with a technology development program. The scope and tasks of this program are derived from 'A Roadmap for Recycling End-of-Life Vehicles of the Future,' prepared in May 2001 for the DOE Office of Energy, Efficiency, and Renewable Energy (EERE)-Vehicle Technologies Program. The objective of this research program is to enable the maximum recycling of automotive materials and obsolete vehicles through the development and commercialization of technologies for the separation and recovery of materials from end-of-life vehicles (ELVs). The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use

  3. Pharmacy Students' Attitudes Toward Death and End-of-life Care

    Science.gov (United States)

    Broeseker, Amy E.

    2010-01-01

    Objectives To assess pharmacy students' attitudes toward death and end-of-life care. Methods Third-year pharmacy students enrolled in the Ethics in Christianity and Health Care course were administered a survey instrument prior to introduction of the topic of end-of-life care. Students' attitudes toward different professions' roles in end-of-life care and their comfort in discussing end-of-life issues were assessed. The survey instrument was readministered to the same students at the end of their fourth year. Results On most survey items, female students responded more favorably toward death and end-of-life care than male students. One exception was the perceived emotional ability to be in the room of a dying patient or loved one. Post-experiential survey responses were generally more favorable toward death and end-of-life care than were pre-discussion responses. Conclusions In general, when surveyed concerning death and end-of-life care, female students responded more favorably than male students, and responses at the end of the fourth year were more favorable than at the beginning of the course. PMID:21045946

  4. Trends and determinants of end-of-life practices in ALS in the Netherlands.

    Science.gov (United States)

    Maessen, M; Veldink, Jan H; Onwuteaka-Philipsen, B D; de Vries, J M; Wokke, J H J; van der Wal, G; van den Berg, L H

    2009-09-22

    In the Netherlands, the proportion of patients with amyotrophic lateral sclerosis (ALS) who choose the option of euthanasia or physician-assisted suicide (PAS) is relatively high (20%). The objective of this study was to determine which factors influence end-of-life practices in ALS and whether rates are changing over time. In a cohort survey, 204 physicians and 198 informal caregivers (response rates 75% and 80%) of patients with ALS who died between 2000 and 2005 filled out questionnaires of the end-of-life circumstances of the patient. Results were compared with those of a similar study performed during the period 1994-1998. In 2000-2005, 16.8% of the patients decided on euthanasia or PAS compared to 20.2% in 1994-1998. Thirty-one (14.8%) patients died during continuous deep sedation (CDS) in 2000-2005. Euthanasia or PAS, but not CDS, were significantly associated with religion not being important to the patient, being more educated, and dying at home. Euthanasia or PAS were not associated with quality of care items or symptoms of depression. Loss of function was similar in both groups. Informal caregivers of patients who died after euthanasia or PAS more frequently reported fear of choking (p = 0.003), no chance of improvement (p = 0.001), loss of dignity (p = 0.02), being dependent on others (p = 0.002), and fatigue (p = 0.018) as reasons for shortening life. Hopelessness was associated with euthanasia or PAS, as with CDS. The frequency of euthanasia or physician-assisted suicide (PAS) in amyotrophic lateral sclerosis (ALS) appeared stable over time and 1 in 7 patients died during CDS. CDS is relatively common in ALS, but appears to have other determinants than euthanasia or PAS. Subjective factors may be important in explaining euthanasia or PAS in ALS.

  5. Life cycle assessment of the end-of-life phase of a residential building.

    Science.gov (United States)

    Vitale, Pierluca; Arena, Noemi; Di Gregorio, Fabrizio; Arena, Umberto

    2017-02-01

    The study investigates the potential environmental impacts related to the end-of-life phase of a residential building, identified in a multifamily dwelling of three levels, constructed in the South of Italy by utilizing conventional materials and up-to-date procedures. An attributional life cycle assessment has been utilised to quantify the contributions of each stage of the end-of-life phase, with a particular attention to the management of the demolition waste. The investigation takes into account the selective demolition, preliminary sorting and collection of main components of the building, together with the processes of sorting, recycling and/or disposal of main fractions of the demolition waste. It quantifies the connections between these on-site and off-site processes as well as the main streams of materials sent to recycling, energy recovery, and final disposal. A sensitivity analysis has been eventually carried out by comparing the overall environmental performances of some alternative scenarios, characterised by different criteria for the demolition of the reference building, management of demolition waste and assessment of avoided burdens of the main recycled materials. The results quantify the advantage of an appropriate technique of selective demolition, which could increase the quality and quantity of residues sent to the treatment of resource recovery and safe disposal. They also highlight the contributions to the positive or negative environmental impact of each stage of the investigated waste management system. The recycling of reinforcing steel appears to play a paramount role, accounting for 65% of the total avoided impacts related to respiratory inorganics, 89% of those for global warming and 73% of those for mineral extraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The temporary structures for Expo Milan 2015: environmental assessment and solutions for the end of life management

    Directory of Open Access Journals (Sweden)

    Monica Lavagna

    2014-05-01

    Full Text Available Politecnico di Milano University worked for the Italian Ministry of Environment, land and sea on the sustainability assessment of Expo Milan 2015 self-built temporary pavilions. The work has been focused on the improvement of the buildings environmental performances. Given the buildings short durability in place (Expo lasts for 6 months, the strategies for their end of life are of great importance for the carbon footprint reduction. Starting from the specific work on Expo Milan 2015, the Politecnico di Milano working group proceeded with the methodology research about this issue, applicable also to future events. This paper presents the different relevant aspects of mega events temporary buildings end of life management; dealing with methodological, technical and managerial aspects.

  7. Resource recovery from end-of-life tyres in Greece: a field survey, state-of-art and trends.

    Science.gov (United States)

    Karagiannidis, A; Kasampalis, T

    2010-06-01

    Lack of consistent and available information for the entire tyre industry has often hindered adequate understanding of current and future issues that need to be addressed for improving the sustainable end-of-life tyre management. The aim of this paper is to review related best available technologies and techniques for Greece, ranging from simple mechanical processing, up to complex multistep, mechanochemical and/or thermal treatment. End-of-life tyre management guidelines in the form of a manual for supporting future entrepreneurs in this field are also discussed. Extensive data mining, classification and inventorying was performed, both in the field via questionnaires and in the literature, for the purpose of accurately determining Hellenic conditions, in order to pinpoint encountered problems, propose interventions and determine new entrepreneurship opportunities.

  8. End of life care preferences among people of advanced age: LiLACS NZ.

    Science.gov (United States)

    Gott, Merryn; Frey, Rosemary; Wiles, Janine; Rolleston, Anna; Teh, Ruth; Moeke-Maxwell, Tess; Kerse, Ngaire

    2017-12-19

    Understanding end of life preferences amongst the oldest old is crucial to informing appropriate palliative and end of life care internationally. However, little has been reported in the academic literature about the end of life preferences of people in advanced age, particularly the preferences of indigenous older people, including New Zealand Māori. Data on end of life preferences were gathered from 147 Māori (aged >80 years) and 291 non- Māori aged (>85 years), during three waves of Te Puawaitangi O Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age (LiLACs NZ). An interviewer-led questionnaire using standardised tools and including Māori specific subsections was used. The top priority for both Māori and non-Māori participants at end of life was 'not being a burden to my family'. Interestingly, a home death was not a high priority for either group. End of life preferences differed by gender, however these differences were culturally contingent. More female Māori participants wanted spiritual practices at end of life than male Māori participants. More male non-Māori participants wanted to be resuscitated than female non- Māori participants. That a home death was not in the top three end of life priorities for our participants is not consistent with palliative care policy in most developed countries where place of death, and particularly home death, is a central concern. Conversely our participants' top concern - namely not being a burden - has received little research or policy attention. Our results also indicate a need to pay attention to diversity in end of life preferences amongst people of advanced age, as well as the socio-cultural context within which preferences are formulated.

  9. Embracing a broad spirituality in end of life discussions and advance care planning.

    Science.gov (United States)

    Churchill, Larry R

    2015-04-01

    Advance care planning for end of life typically focuses on the mechanics of completing living wills and durable power of attorney documents. Even when spiritual aspects of end of life care are discussed, the dominant assumptions are those of traditional religious systems. A broad view of spirituality is needed, one that may involve traditional religious beliefs but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honor an essential aspect of end of life discussions and promote greater discernment of the deep meaning in advance care documents.

  10. American Society for Pain Management Nursing position statement: pain management at the end of life.

    Science.gov (United States)

    Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

    2013-09-01

    Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  11. Performance assessment of the (Th,U)O2 HTI-Biso coated particle under PNP/HHT irradiation conditions

    International Nuclear Information System (INIS)

    Kania, M.J.; Nickel, H.

    1980-11-01

    The HTI Biso Particle, Variant-I: consisting of a dense 400 μm-diameter (Th,U)O 2 -kernel with a Biso coating using a methane derived pyrocarbon layer (HTI), is a candidate fuel for the advanced PNP/HHT High Temperature Reactor systems. This report presents the results of a comprehensive performance assessment of Variant-I represented by six relevant particle batches irradiated in 12 accelerated irradiation experiments. Fuel performance was judged based upon PNP/HHT qualification requirements with regard to in-reactor operating conditions and end-of-life (EOL) coated particle failure fraction. Fuel operating conditions in each irradiation experiment were obtained from two sources: 1) a thorough review of all available irradiation data on each experiment; and 2) a two-dimensional (R,theta) thermal modeling computer code, R2KTMP, was developed to calculate fuel operating temperature distributions within spherical elements. End-of-life particle failure fractions were determined from: gaseous fission product release, based on in-reactor R/B measurements and postirradiation annealing and room temperature investigations; solid fission product release, from single particle 137 Cs release into fuel element matrix and hot-gaseous chlorine leaching; and visual and ceramographic examinations. Failure fractions determined by solid fission product release yielded values 2-35 times higher than those determined by gaseous fission product release. (orig.) [de

  12. Evaluation of different end-of-life management alternatives for used natural cork stoppers through life cycle assessment.

    Science.gov (United States)

    Demertzi, Martha; Dias, Ana Cláudia; Matos, Arlindo; Arroja, Luís Manuel

    2015-12-01

    An important aspect of sustainable development is the implementation of effective and sustainable waste management strategies. The present study focuses on a Life Cycle Assessment (LCA) approach to different waste management strategies for natural cork stoppers, namely incineration at a municipal solid waste incinerator, landfilling in a sanitary landfill, and recycling. In the literature, there are no LCA studies analyzing in detail the end-of-life stage of natural cork stoppers as well as other cork products. In addition, cork is usually treated as wood at the end-of-life stage. Thus, the outcome of this study can provide an important insight into this matter. The results showed that different management alternatives, namely incineration and recycling, could be chosen depending on the impact category considered. The former alternative presented the best environmental results in the impact categories of climate change, ozone depletion and acidification, while the latter for photochemical ozone formation and mineral and fossil resource depletion. The landfilling alternative did not present the best environmental performance in any of the impact categories. However, when the biogenic carbon dioxide emission was assessed for the climate change category, the landfilling alternative was found to be the most effective since most of the biogenic carbon would be permanently stored in the cork products and not emitted into the atmosphere. A sensitivity analysis was performed and the results showed that there are various parameters that can significantly influence the results (e.g., carbon content in cork and decay rate of cork in the landfill). Thus, LCA studies should include a detailed description concerning their assumptions when the end-of-life stage is included in the boundaries since they can influence the results, and furthermore, to facilitate the comparison of different end-of-life scenarios. The present study and the obtained results could be useful for the

  13. Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.

    Science.gov (United States)

    Parikh, Priti P; Brown, Ronald; White, Mary; Markert, Ronald J; Eustace, Rosemary; Tchorz, Kathryn

    2015-06-15

    Assessment of interpersonal and psychosocial competencies during end-of-life care training is essential. This study reports the relationship between simulation-based end-of-life care Objective Structured Clinical Examination ratings and communication skills, trust, and self-assessed empathy along with the perceptions of students regarding their training experiences. Medical students underwent simulation-based end-of-life care OSCE training that involved standardized patients who evaluated students' communication skills and physician trust with the Kalamazoo Essential Elements Communication Checklist and the Wake Forest Physician Trust Scale. Students also completed the Jefferson Scale of Physician Empathy. Pearson correlation was used to examine the relationship between OSCE performance grades and communication, trust, and empathy scores. Student comments were analyzed using the constant comparative method of analysis to identify dominant themes. The 389 students (mean age 26.6 ± 2.8 y; 54.5% female) had OSCE grades that were positively correlated with physician trust scores (r = 0.325, P training to be a valuable learning experience and appreciated its placement early in clinical training. We found that simulation-based OSCE training in palliative and end-of-life care can be effectively conducted during a surgery clerkship. Moreover, the standardized patient encounters combined with the formal assessment of communication skills, physician trust, and empathy provide feedback to students at an early phase of their professional life. The positive and appreciative comments of students regarding the opportunity to practice difficult patient conversations suggest that attention to these professional characteristics and skills is a valued element of clinical training and conceivably a step toward better patient outcomes and satisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life

    Science.gov (United States)

    Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life It is very common for doctors to provide ... or recovering from surgery. This is called “artificial nutrition and hydration” and like all medical treatments, it ...

  15. End-of-life training for paid carers working with people with learning disabilities.

    Science.gov (United States)

    Codling, Mary; Knowles, Jane; Vevers, Ann

    2014-04-01

    People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted.

  16. Communication Matters: Exploring the Intersection of Family and Practitioner End of Life Communication

    Directory of Open Access Journals (Sweden)

    Leah M. Omilion-Hodges

    2017-03-01

    Full Text Available After establishing a baseline understanding of some of the factors that influence and shape family end of life communication, empirical research centered on the communication tendencies of nationally-recognized palliative care clinicians is presented. Because death is no longer confined to the bedroom and individuals are increasingly turning to hospitals and health care institutes to assist with end of life, the role of palliative care practitioners is vital. To that end, common communication-rooted issues that may transpire among various medical personnel are explored. Focus on a shared underlying tension—care vs. cure—links the findings between family and palliative care clinician communication regarding end of life. Practical communication solutions and suggestions are offered to facilitate productive and mindful end of life communication between and among family members and health care practitioners.

  17. Graduate Students' Reflections on Elder and End-of-Life Care for Prisoners.

    Science.gov (United States)

    Baumann, Steven L; Todaro-Franceschi, Vidette

    2017-07-01

    The focus of this report was graduate nursing students' reflections on elder and end-of-life care for prisoners. The personal reflections of 21 graduate nursing students who attended a presentation by Susan J. Loeb on October 26, 2016 were included in this report. The title of the presentation was "Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community." The student essays were synthesized to construct a summary essay, from which four themes were identified: aging in prison, dying in prison, ethical and professional issues in the elder and end-of-life care of prisoners, and ethical and professional issues in research involving elderly and end-of-life care of prisoners. These findings were interpreted from a global perspective in light of two different nursing perspectives: the humanbecoming tradition and the science of unitary human beings.

  18. How Can an Emergency Department Assist Patients and Caregivers at the End of Life?

    Science.gov (United States)

    ... And Caregivers At The End Of Life? How Can An Emergency Department Assist Patients And Caregivers At ... your family. Five ways that the Emergency Department can help 1. Assist in the recognition and understanding ...

  19. Hospital executive leadership: a critical component for improving care at the end of life.

    Science.gov (United States)

    Cooney, James P; Landers, Glenn M; Williams, Julianna M

    2002-01-01

    End-of-life care and its planning by individuals, in concert with their families and professional healthcare givers, pose important social, legal, and ethical issues. The authors evaluate the results of a multi-year (1997-2001) collaborative effort among representatives of Georgia healthcare providers, healthcare payers, and the general public that was designed to (a) improve end-of-life care through a community-focused field effort to increase public awareness, execution, and institutional management of advance directives and (b) impact institutional and state government systems and policies around end-of-life care. The authors conclude that a proactive presence of senior management is integral in implementing systematic change in hospital-based end-of-life care and offer practical recommendations to hospital leaders to affect real change in their institutions.

  20. Irradiation performance of metallic fuels

    International Nuclear Information System (INIS)

    Pahl, R.G.; Lahm, C.E.; Porter, D.L.; Batte, G.L.; Hofman, G.L.

    1989-01-01

    Argonne National Laboratory has been working for the past five years to develop and demonstrate the Integral Fast Reactor (IFR) concept. The concept involves a closed system for fast-reactor power generation and on-site fuel reprocessing, both designed specifically around the use of metallic fuel. The Experimental Breeder Reactor-II (EBR-II) has used metallic fuel for all of its 25-year life. In 1985, tests were begun to examine the irradiation performance of advanced-design metallic fuel systems based on U-Zr or U-Pu-Zr fuels. These tests have demonstrated the viable performance of these fuel systems to high burnup. The initial testing program will be described in this paper. 2 figs

  1. Training Providers and Patients to Talk about End-of-Life Care

    Science.gov (United States)

    Failing to discuss the transition from active cancer treatment to end-of-life care can leave doctors unsure of what a patient truly wants. Failing to receive end-of-life care in line with their values and wishes can cause patients and their families great distress. Researchers have developed innovative, evidence-based programs to help doctors and patients improve their communication skills and grow comfortable with these discussions.

  2. Oncologists' strategies and barriers to effective communication about the end of life.

    Science.gov (United States)

    Granek, Leeat; Krzyzanowska, Monika K; Tozer, Richard; Mazzotta, Paolo

    2013-07-01

    Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues.

  3. [Organising and supporting the end of life when faced with a refusal of care].

    Science.gov (United States)

    Rautureau, Pascal

    2018-04-01

    Often ethically complex, end-of-life situations can mean nursing teams are confronted with a refusal of care. Through a representative clinical situation, a nurse describes the support provided by a multidisciplinary team, in the home, to comply with the wishes of a person at the end of life, support the family, anticipate possible difficulties and organise adapted care which respects all those concerned. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  4. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  5. Diabetes and end of life: ethical and methodological issues in gathering evidence to guide care.

    Science.gov (United States)

    Dunning, Trisha; Duggan, Nicole; Savage, Sally; Martin, Peter

    2013-03-01

    Providing palliative care for people with diabetes at the end of life is part of the chronic disease care trajectory, but end of life care is complex and the presence of diabetes further complicates management. The aim of the paper is to discuss the ethical and methodological issues encountered when undertaking research to develop guidelines for managing diabetes at the end of life and the strategies used to address the issues. The issues emerged as we developed guidelines for managing diabetes at the end of life, which included conducting individual interviews with 14 people with diabetes requiring palliative care and 10 family members. A reflexive researcher journal was maintained throughout the guideline development process. The interview transcripts and researcher's journal were analysed to determine key methodological, ethical and researcher-related issues. Key themes were vulnerability of the sampling population, methodological issues included recruiting participants and ensuring rigor, ethical issues concerned benefit and risk, justice, autonomy, privacy, professional boundaries and informed consent. Researcher-related issues were identified such as managing participant distress and their own emotional distress. People were willing to discuss end of life diabetes management preferences. Undertaking research with people at the end of life is complex because of their vulnerability and the ethical issues involved. However, the ethical principles of autonomy and justice apply and people should be given the relevant information and opportunity to decide whether to participate or not. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  6. Leaching of metals from end-of-life solar cells.

    Science.gov (United States)

    Chakankar, Mital; Su, Chun Hui; Hocheng, Hong

    2018-04-10

    The issue of recycling waste solar cells is critical with regard to the expanded use of these cells, which increases waste production. Technology establishment for this recycling process is essential with respect to the valuable and hazardous metals present therein. In the present study, the leaching potentials of Acidithiobacillus thiooxidans, Acidithiobacillus ferrooxidans, Penicillium chrysogenum, and Penicillium simplicissimum were assessed for the recovery of metals from spent solar cells, with a focus on retrieval of the valuable metal Te. Batch experiments were performed to explore and compare the metal removal efficiencies of the aforementioned microorganisms using spent media. P. chrysogenum spent medium was found to be most effective, recovering 100% of B, Mg, Si, V, Ni, Zn, and Sr along with 93% of Te at 30 °C, 150 rpm and 1% (w/v) pulp density. Further optimization of the process parameters increased the leaching efficiency, and 100% of Te was recovered at the optimum conditions of 20 °C, 200 rpm shaking speed and 1% (w/v) pulp density. In addition, the recovery of aluminum increased from 31 to 89% upon process optimization. Thus, the process has considerable potential for metal recovery and is environmentally beneficial.

  7. End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making.

    Science.gov (United States)

    Schüklenk, Udo; van Delden, Johannes J M; Downie, Jocelyn; McLean, Sheila A M; Upshur, Ross; Weinstock, Daniel

    2011-11-01

    This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. © 2011 Blackwell Publishing Ltd.

  8. 76 FR 35221 - Proposed Collection; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-06-16

    ... Request; NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire... Collection: Title: NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source... Collection: The NINR End-of-Life Science Palliative Care (EOL PC) Needs Assessment: Funding Source...

  9. 76 FR 59145 - Submission for OMB Review; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-09-23

    ...; Comment Request; NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of... End-of-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of Authors). Type of Information Collection Request: NEW. Need and Use of Information Collection: The NINR End-of-Life Science...

  10. End of life care and decision making: Opinions and experiences of the general public, bereaved relatives, and professionals

    NARCIS (Netherlands)

    N.J.H. Raijmakers (Natasja)

    2013-01-01

    textabstractEnd-of-life care aims to improve quality of life of patients and their relatives facing problems associated with life-threatening illness in the last days of life. End-of-life decision-making is an important aspect of end-of-life care that can have a significant impact on the process of

  11. Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

    Science.gov (United States)

    Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

    2017-07-01

    Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

  12. [End-of-life in specialized medical pediatrics department: A French national survey].

    Science.gov (United States)

    Ravanello, Alice; Desguerre, Isabelle; Frache, Sandra; Hubert, Philippe; Orbach, Daniel; Aubry, Régis

    2017-03-01

    In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015. Among 94 specialized medical pediatrics departments in France, 53 participated in our survey (response rate=56%). At the time of the survey, 13% of inpatients were facing the end-of-life. Regarding training, 13% of departments did not have personnel trained in palliative care and 21% did not set up any professional support. However, when taking care of a child's end of life in 2014, 77% of these departments solicited a regional resource team of pediatric palliative care. This survey helps describe 225 end-of-life paths of children decease of a terminal illness in the specialized pediatrics departments. Seventy-two percent suffered from refractory symptoms before their death, 64% were concerned by a terminal sedation and 75% by a limitation of life-sustaining treatment decision. End-of-life care is a reality for specialized pediatrics departments. The frequency of major and refractory symptoms often requires the completion of sedation. The resources of service are acceptable but some deficiencies have been noted especially concerning training and support for caregivers, adaptation of premises or family support. Copyright © 2017. Published by Elsevier SAS.

  13. Current debates on end-of-life sedation: an international expert elicitation study.

    Science.gov (United States)

    Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

    2014-08-01

    End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

  14. How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway.

    Science.gov (United States)

    Romøren, Maria; Pedersen, Reidar; Førde, Reidun

    2016-01-14

    Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors' descriptions of how they include the patient and next of kin in end-of-life decisions. We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient's best interest. Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient's values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.

  15. Eco-Efficiency Assessment of Bioplastics Production Systems and End-of-Life Options

    Directory of Open Access Journals (Sweden)

    Kunnika Changwichan

    2018-03-01

    Full Text Available Bioplastics demand has been increased globally due to concerns regarding environmentally friendly consumption and production. Polylactic acid (PLA, polyhydroxyalkanoates (PHAs, and polybutylene succinate (PBS are promising bioplastics with bio-based feedstocks and property of biodegradability. They are produced by bacterial fermentation of sugars from carbohydrate sources. With flexibility in their properties, PLA, PHAs, and PBS can potentially substitute conventional plastics such as polypropylene (PP, polyethylene terephthalate (PET, and polystyrene (PS. This study aims at evaluating the environmental and economic sustainability of bioplastics production together with end-of-life (EOL options. The combination of environmental and economic indicators, eco-efficiency (E/E, was selected to investigate the performance of PLA, PHAs, and PBS from sugarcane and cassava in comparison with PP. The environmental impacts were determined using life cycle assessment. The product cost was used to represent the economic value. The E/E results showed that the environmental and economic sustainability could be enhanced with 100% mechanical recycling of all kinds of studied plastics. It is also important to highlight that mechanical recycling showed a better performance in terms of E/E than composting of bioplastics.

  16. End of life discussion in an academic family health team in Kingston, Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Reta French

    2013-01-01

    Full Text Available Background: End-of-life (EOL discussions remain difficult in non-terminal patients as death is often perceived as a taboo and uncertainty. However, the call for proper EOL discussions has recently received public attention and media coverage. Evidence also reveals that non-terminal patients are more satisfied with health-care encounters when EOL has been discussed. Objectives and Methods: The objective of this study was to explore the prevalence of EOL discussions in non-terminal adult patients, the perceived barriers to such discussions and suggested methods for improvement. A study mixed-methods study was performed by a group of PGY1 family medicine residents in an academic health team in Kingston, Ontario. Results: EOL discussion was performed in a very small proportion of non-terminal patient encounters. Compared with attending physicians, residents were less likely to discuss EOL issues and reported more perceived barriers. Conclusion: Our findings reflect the need for an early and open approach in conducting EOL discussion for non-terminal healthy patients.

  17. Impact of End-of-Life manoeuvres on the collision risk in protected regions

    Science.gov (United States)

    Frey, Stefan; Lemmens, Stijn; Bastida Virgili, Benjamin; Flohrer, Tim; Gass, Volker

    2017-09-01

    The Inter-Agency Space Debris Coordination Committee (IADC) Space Debris Mitigation Guidelines, issued in 2002 and revised in 2007, address the post mission disposal of objects in orbit. After their mission, objects crossing the Low Earth Orbit (LEO) should have a remaining lifetime in orbit not exceeding 25 years. Objects near the Geostationary Orbit (GEO) region should be placed in an orbit that remains outside of the GEO protected region. In this paper, the impact of satellites and rocket bodies performing End-of-Life (EOL) orbital manoeuvres on the collision risk in the LEO and GEO protected regions is investigated. The cases of full or partial compliance with the IADC post mission disposal guideline are studied. ESA's Meteoroid and Space Debris Terrestrial Environment Reference (MASTER) model is used to compare the space debris flux rate of the object during the remaining lifetime estimated for the pre-EOL-manoeuvre and for the post-EOL-manoeuvre orbit. The study shows that, on average, the probability of collision can be significantly decreased by performing an EOL-manoeuver.

  18. Sustainable Logistics of End-of-life Vehicles – Trends in Europe

    Directory of Open Access Journals (Sweden)

    Agata Mesjasz-Lech

    2017-06-01

    Full Text Available Purpose of the article: In the article we have focused on the trends determining the development of reverse logistics of end-of-life vehicles in selected European countries. The analysis concentrates on quantity of end-of-life vehicles which are especially interesting for reverse logistics because of their fitness for recovery or reuse. End-of-life products contain fully valuable elements which, according to the idea of sustainable use of resources, should be recovered. Accordingly, reverse logistics aims at protecting natural resources and the environment through reintroduction of processed waste materials into the economic cycle as valuable products and materials. Methodology/methods: The aim of the article was achieved on the basis of a critical analysis of subject literature and the analysis of statistical data. In the article the method of descriptive and mathematical statistics and dynamic analysis were used. The 2006–2014 years were analyzed. The data come from the data base of the Eurostat, the statistical office of the European Union. The following variables were taken into account: the amount of end-of-life vehicles (in tonnes and in number of cars, reuse level (in tonnes, recovery level (in tonnes, and recycling level (in tonnes. The analysis was based on a t-Student test for two average values of dependent samples, sign test and the Wilcoxon signed rank test. In order to see if the reverse logistics actions implemented in European countries were effective, the analysis compares the average values of individual variables from the year 2014 and 2006. Measurements were done for the same countries on the same element of population. The chain indexes and the average change tempo for specified variables were calculated. The similarity of the formation of specified variables in each year was compared on the basis of the index of similarity structures. Scientific aim: The scientific aim of the article is to identify the basic trends

  19. Physician Communication in Pediatric End-of-Life Care: A Simulation Study.

    Science.gov (United States)

    Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L

    2016-12-01

    The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

  20. Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life.

    Science.gov (United States)

    Glick, Debra M; Cook, Joan M; Moye, Jennifer; Kaiser, Anica Pless

    2018-01-01

    Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature 1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.

  1. The Evolution of End-of-Life Care: Ethical Implications for Case Management.

    Science.gov (United States)

    Fink-Samnick, Ellen

    2016-01-01

    This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

  2. Considerations of physicians about the depth of palliative sedation at the end of life

    Science.gov (United States)

    Swart, Siebe J.; van der Heide, Agnes; van Zuylen, Lia; Perez, Roberto S.G.M.; Zuurmond, Wouter W.A.; van der Maas, Paul J.; van Delden, Johannes J.M.; Rietjens, Judith A.C.

    2012-01-01

    Background: Although guidelines advise titration of palliative sedation at the end of life, in practice the depth of sedation can range from mild to deep. We investigated physicians’ considerations about the depth of continuous sedation. Methods: We performed a qualitative study in which 54 physicians underwent semistructured interviewing about the last patient for whom they had been responsible for providing continuous palliative sedation. We also asked about their practices and general attitudes toward sedation. Results: We found two approaches toward the depth of continuous sedation: starting with mild sedation and only increasing the depth if necessary, and deep sedation right from the start. Physicians described similar determinants for both approaches, including titration of sedatives to the relief of refractory symptoms, patient preferences, wishes of relatives, expert advice and esthetic consequences of the sedation. However, physicians who preferred starting with mild sedation emphasized being guided by the patient’s condition and response, and physicians who preferred starting with deep sedation emphasized ensuring that relief of suffering would be maintained. Physicians who preferred each approach also expressed different perspectives about whether patient communication was important and whether waking up after sedation is started was problematic. Interpretation: Physicians who choose either mild or deep sedation appear to be guided by the same objective of delivering sedation in proportion to the relief of refractory symptoms, as well as other needs of patients and their families. This suggests that proportionality should be seen as a multidimensional notion that can result in different approaches toward the depth of sedation. PMID:22331961

  3. Needs of people with severe dementia at the end-of-life: a systematic review.

    Science.gov (United States)

    Perrar, Klaus Maria; Schmidt, Holger; Eisenmann, Yvonne; Cremer, Bernadette; Voltz, Raymond

    2015-01-01

    Epidemiological data shows an increasing number of people affected by dementia. It is mentioned that people with severe dementia have special care needs which are intensified at the end-of-life. This paper offers a systematic analysis of the current status of research on the needs of people with severe dementia in the last phase of their lives. A systematic review of the MEDLINE, CINAHL, Cochrane Library, PsycINFO, and AMED databases performed up to April 2014 was further expanded by contacting experts, conducting internet searches, and screening relevant reference lists. Studies were screened according to defined criteria and appraised for methodological quality. Findings were then synthesized using a narrative thematic approach to identify and categorize relevant needs into thematic categories and subcategories. A total of ten studies published from 1993-2013 were identified, encompassing qualitative (n = 7), quantitative (n = 2), and a mixed-methods study (n = 1). Data synthesis yielded seven themes, with physical, social, and psychological needs the categories most frequently mentioned. Other categories were spiritual, supportive, and environmental needs and needs related to individuality. Needs were often named, but what they entailed operationally was not highlighted in detail. This systematic review shows the paucity of empirical findings on the needs of people with severe dementia. The structured presentation of thematic categories points to a clearer delineation of these needs. Thus, this overview emphasizes the topics for future research and can likewise serve as an orientation for care provision.

  4. Life cycle assessment of EPS and CPB inserts: design considerations and end of life scenarios.

    Science.gov (United States)

    Tan, Reginald B H; Khoo, Hsien H

    2005-02-01

    Expanded polystyrene (EPS) and corrugated paperboard (CPB) are used in many industrial applications, such as containers, shock absorbers or simply as inserts. Both materials pose two different types of environmental problems. The first is the pollution and resource consumption that occur during the production of these materials; the second is the growing landfills that arise out of the excessive disposal of these packaging materials. Life cycle assessment or LCA will be introduced in this paper as a useful tool to compare the environmental performance of both EPS and CPB throughout their life cycle stages. This paper is divided into two main parts. The first part investigates the environmental impacts of the production of EPS and CPB from 'cradle-to-gate', comparing two inserts--both the original and proposed new designs. In the second part, LCA is applied to investigate various end-of-life cases for the same materials. The study will evaluate the environmental impacts of the present waste management practices in Singapore. Several 'what-if' cases are also discussed, including various percentages of landfilling and incineration. The SimaPro LCA Version 5.0 software's Eco-indicator 99 method is used to investigate the following five environmental impact categories: climate change, acidification/eutrophication, ecotoxicity, fossil fuels and respiratory inorganics.

  5. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  6. TU-D-201-00: Use of End-Of-Life Brachytherapy Devices

    International Nuclear Information System (INIS)

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue

  7. TU-D-201-03: Proposed Solutions to End-Of-Life Issue

    International Nuclear Information System (INIS)

    Ouhib, Z.

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue

  8. Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives.

    Science.gov (United States)

    Koh, Su-Jin; Kim, Shinmi; Kim, JinShil; Keam, Bhumsuk; Heo, Dae Seog; Lee, Kyung Hee; Kim, Bong-Seog; Kim, Jee Hyun; Chang, Hye Jung; Baek, Sun Kyung

    2018-04-01

    The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of "terminal state," and mostrespondents tried to disclose the patient's condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

  9. The effect of rapid response teams on end-of-life care: A retrospective chart review

    Science.gov (United States)

    Tam, Benjamin; Salib, Mary; Fox-Robichaud, Alison

    2014-01-01

    BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care. OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes. METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital-wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long-Term Care Critical Care Information Systemic database, and were interrogated by two reviewers. RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; PEOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (PEOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions. PMID:25299222

  10. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

    Science.gov (United States)

    Van Scoy, Lauren J; Green, Michael J; Reading, Jean M; Scott, Allison M; Chuang, Cynthia H; Levi, Benjamin H

    2017-09-01

    Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones. Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention. This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

  11. Condition Assessment and End-of-Life Prediction System for Electric Machines and Their Loads

    Science.gov (United States)

    Parlos, Alexander G.; Toliyat, Hamid A.

    2005-01-01

    An end-of-life prediction system developed for electric machines and their loads could be used in integrated vehicle health monitoring at NASA and in other government agencies. This system will provide on-line, real-time condition assessment and end-of-life prediction of electric machines (e.g., motors, generators) and/or their loads of mechanically coupled machinery (e.g., pumps, fans, compressors, turbines, conveyor belts, magnetic levitation trains, and others). In long-duration space flight, the ability to predict the lifetime of machinery could spell the difference between mission success or failure. Therefore, the system described here may be of inestimable value to the U.S. space program. The system will provide continuous monitoring for on-line condition assessment and end-of-life prediction as opposed to the current off-line diagnoses.

  12. Community gardens as sites of solace and end-of-life support: a literature review.

    Science.gov (United States)

    Marsh, Pauline; Spinaze, Anna

    2016-05-01

    In a pilot project, members of a community garden explored how they might provide better end-of-life support for their regional community. As part of the project, a literature review was undertaken to investigate the nexus between community gardens and end-of-life experiences (including grief and bereavement) in academic research. This article documents the findings of that review. The authors discovered there is little academic material that focuses specifically on community gardens and end-of-life experiences, but nonetheless the two subjects were seen to intersect. The authors found three points of commonality: both share a need and capacity for a) social/informal support, b) therapeutic space, and c) opportunities for solace.

  13. Spirituality in end-of-life care: attending the person on their journey.

    LENUS (Irish Health Repository)

    Hayden, Deborah

    2011-11-01

    Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-of-life care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses\\' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.

  14. End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

    Science.gov (United States)

    Kassim, Puteri Nemie Jahn; Alias, Fadhlina

    2015-06-01

    End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

  15. Reflections on Hope and Its Implications for End-of-Life Care.

    Science.gov (United States)

    Mattes, Malcolm D; Sloane, Michelle A

    2015-05-01

    Physicians caring for individuals with life-altering, incurable illnesses often have a desire to convey a sense of hope while also helping their patients prepare for the end of life to minimize unnecessary suffering and grief. Unfortunately, in the United States, most people receive more-aggressive treatments toward the end of life than studies would suggest that they desire. This reflects the challenging task of balancing optimism and realism, and how providing a false sense of hope for a cure for too long a time while avoiding advance care planning may contribute significantly to the problem. This article explores the interplay of hope and advance care planning, and suggests a need for excellent individualized communication in the setting of advanced cancer to improve end-of-life care. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  16. End-of-life care beliefs among Hindu physicians in the United States.

    Science.gov (United States)

    Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan

    2015-02-01

    Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.

  17. End-of-life expectations and experiences among nursing home patients and their relatives

    DEFF Research Database (Denmark)

    Fosse, Anette; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-01-01

    . CONCLUSION: Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief. PRACTICE IMPLICATIONS: High-quality end-of-life care in nursing homes relies on organization, funding......OBJECTIVE: Synthesize research about patients' and relatives' expectations and experiences on how doctors can improve end-of-life care in nursing homes. METHODS: We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane...... decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients' ability to consent, and patients' preferences were not always recognized...

  18. Economic impact analysis of an end-of-life programme for nursing home residents.

    Science.gov (United States)

    Teo, W-S Kelvin; Raj, Anusha Govinda; Tan, Woan Shin; Ng, Charis Wei Ling; Heng, Bee Hoon; Leong, Ian Yi-Onn

    2014-05-01

    Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs. Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life. The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3). This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.

  19. A practice model for rural district nursing success in end-of-life advocacy care.

    Science.gov (United States)

    Reed, Frances M; Fitzgerald, Les; Bish, Melanie R

    2017-08-24

    The development of a practice model for rural district nursing successful end-of-life advocacy care. Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study. A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model. The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model. Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care. A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific

  20. How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians.

    Science.gov (United States)

    Leong, Madeline; Olnick, Sage; Akmal, Tahara; Copenhaver, Amanda; Razzak, Rab

    2016-12-01

    According to the Joint Commission, cultural competency is a core skill required for end-of-life care. Religious and cultural beliefs predominantly influence patients' lives, especially during the dying process. Therefore, palliative care clinicians should have at least a basic understanding of major world religions. Islam is a major world religion with 1.7 billion followers. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. To improve knowledge of clinically relevant Islamic teachings regarding end-of-life care. After consultation with a Muslim chaplain, we identified key topics and created a 10-question pretest. The pretest was administered, followed by a one-hour educational intervention with a Muslim chaplain. Next, a post-test (identical to the pretest) was administered. Eleven palliative care clinicians participated in this study. The average score on the pretest was 6.0 ± 1.2 (mean + SD) (maximum 10). After the educational intervention, the average score improved to 9.6 ± 0.7 (95% CI 2.7-4.4; P Islam influences patients' end-of-life decisions. In this pilot study, a one-hour educational intervention improved knowledge of Islamic teachings regarding end-of-life care. We present a framework for this intervention, which can be easily replicated. We also provide key teaching points on Islam and end-of-life care. Additional research is necessary to determine the clinical effects of this intervention over time and in practice. In the future, we plan to expand the educational material to include other world religions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  1. Haemodialysis patients and end-of-life decisions: a theory of personal preservation.

    Science.gov (United States)

    Calvin, Amy Olivier

    2004-06-01

    Lack of knowledge about the end-of-life treatment preferences of patients undergoing haemodialysis is problematic in the acute care setting as, often, patients are unable to communicate their treatment wishes effectively and have not previously documented their desires in the form of advance directives. Existing theoretical models offer an incomplete explanation of end-of-life treatment decisions in haemodialysis patients. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, mechanical ventilation) in people with kidney failure undergoing haemodialysis. Grounded theory was used. Theoretical sampling led to selection of 20 haemodialysis patients (11 men and nine women with a mean age of 56) who attended three dialysis outpatient centres in central Texas. They were interviewed about end-of-life treatment plans and the use of advance directives (i.e. living wills and durable powers of attorney for health care). Interviews, transcripts and field notes from the first 12 patients were analysed by making constant comparisons. The remaining eight interviews were used for validation purposes. Data collection and analysis spanned the years 1997-2000. When prompted to think about and discuss end-of-life treatments, haemodialysis patients chose to focus on living rather than dying. A substantive theory of 'personal preservation' was developed. This consists of three phases: knowing the odds for survival, defining individuality (beating the odds, discovering meaning, being optimistic and having faith in a higher force) and personal preservation (being responsible and taking chances). The theory of personal preservation furthers understanding of illness behaviour and the process by which patients make decisions about end-of-life treatments. It can be used to sensitize health care professionals to patients' desires and to enhance patient-professional communication.

  2. Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors.

    Science.gov (United States)

    Arland, Lesley C; Hendricks-Ferguson, Verna L; Pearson, Joanne; Foreman, Nicholas K; Madden, Jennifer R

    2013-04-01

    To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors. From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors. Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p management and decrease required hospital admissions for children with brain tumors. © 2013, Wiley Periodicals, Inc.

  3. Structural health monitoring tools for late and end of life management of offshore wind turbines

    DEFF Research Database (Denmark)

    McGugan, Malcolm; McKirdy, Scott

    2016-01-01

    The late and end of life stages in an offshore wind turbines (OWT) life cycle have unique features that must be considered. The initial focus on risks associated with start-up issues due to design, manufacturing or process elements gives way to a stable period of operation and maintenance...... margins and the predominance of low redundancy structures, accurate structural health monitoring can play a strong role in safe management and enable increased operating time at end of life and decommissioning. Late life operations of offshore wind farms can pose significant challenges, balancing...

  4. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science.

    Science.gov (United States)

    Grady, Patricia A

    Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations. Published by Elsevier Inc.

  5. The enactment stage of end-of-life decision-making for children.

    Science.gov (United States)

    Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

    2018-01-11

    Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular

  6. Clinical review: Ethics and end-of-life care for critically ill patients in China

    OpenAIRE

    Li, Li Bin

    2013-01-01

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides cult...

  7. The ‘French exception’: the right to continuous deep sedation at the end of life

    Science.gov (United States)

    Horn, Ruth

    2018-01-01

    In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the ‘French response’ to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS. This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context. PMID:29056584

  8. Exploring end-of-life care for South Asian kidney patients: interviewer reflections.

    Science.gov (United States)

    Wilkinson, Emma; Waqar, Muhammad; Gill, Balbir; Hoque, Pina; Jetha, Champa; Bola, Kulwinder Kaur; Mahmood, Riffat; Mahmood, Sultan; Saujani, Rita; Randhawa, Gurch

    2017-03-16

    The reduction of inequalities in access to quality care has been a central tenet of UK health policy. Ethnic minorities may experience additional inequalities because of language and other cultural barriers. This article reports interviewer reflections of conducting interviews with South Asian kidney patients about their experiences of end-of-life care. It explores themes which emerged from the analysis of a focus group held with eight bilingual research interviewers. The relevance of these themes to understanding inequalities and access to end-of-life care is discussed; together with the potential for the research process to contribute to service improvement.

  9. Pre-analysis of Phenix End-of-Life Thermal-hydraulic tests with the MARS-LMR Code

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Kwon, Young Min; Chang, Won Pyo; Suk, Su Dong; Lee, Yong Bum

    2009-01-01

    A prototype SFR, PHENIX has been operated by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) since 1973. Through the successful operation for 35 years, PHENIX has achieved its original objective to demonstrate a fast breeder reactor technology and also played an important role as an irradiation facility for innovative fuels and materials. Since its first operation, PHENIX has accumulated about 4,300 equivalent full power days (EFPDs) of operational experience and it reached its final shutdown in 2009. Before the decommissioning of PHENIX, the CEA started a PHENIX end-of-life (EOL) test program and opened it for international collaboration to share the valuable information from the test. The KAERI joined this program to utilize the unique opportunity to validate its SFR system analysis code, MARS-LMR which will be a basic tool in future SFR development

  10. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life.

    Science.gov (United States)

    Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis

    2012-12-03

    The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries

  11. Determination of end-of-life-failure fractions of HTGR-fuel particles by postirradiation annealing and beta autoradiography

    International Nuclear Information System (INIS)

    Thiele, B.A.; Herren, M.

    1978-11-01

    Fission-product contamination of the helium coolant of High-Temperature Gas-Cooled Reactors (HTGR) is strongly influenced by the end-of-life (EOL) failed-particle fraction. Knowledge of the EOL-failure fraction is the basis for model calculations to predict the total fission product release from the reactor core. After disintegration of irradiation fuel rods, fuel particles are placed in individual holes of a graphite tray. During a 5-h heat treatment at 1000 0 C in a helium atmosphere failed particles leak fission products, especially the volatile cesium, into the graphite. After unloading a β-autoradiograph of the tray is made. Holes that housed defective particles are identified from black spots on the β-sensitive film. The EOL-failure fraction is the ratio of defective particles to the total number of particles tested. The technique is called PIAA, PostIrradiation Annealing and Autoradiography. The PIAA technique was applied to particles of a Trisocoated highly-enriched UO 2 fissile batch irradiated to a burnup of 35% FIMA at an irradiation temperature of 1250 0 C. Visual examination showed all particles to be intact. From 11 to 47% of the particles had failed, as determined by PIAA. Further, postirradiation examination showed that localized corrosion of the silicon carbide coating by fission-product rare-earth chlorides had occurred

  12. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.

    Science.gov (United States)

    Houben, Carmen H M; Spruit, Martijn A; Schols, Jos M G A; Wouters, Emiel F M; Janssen, Daisy J A

    2015-06-01

    Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  13. Medical futility and end-of-life care | Sidler | South African Medical ...

    African Journals Online (AJOL)

    treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. South African ...

  14. Bereaved relatives' perspectives of the patient's oral intake towards the end of life: a qualitative study.

    NARCIS (Netherlands)

    Raijmakers, N.J.H.; Clark, J.B.; Zuylen, L. van; Allan, S.G.; Heide, A. van der

    2013-01-01

    Background: Patients approaching death often have a decreasing oral intake, which can be distressing for relatives. Little is known about the relatives' experiences with and perceptions of oral intake at the end of life. Aim:This study aims to contribute to a more thorough understanding of

  15. Medical futility in children's nursing: making end-of-life decisions.

    Science.gov (United States)

    Brien, Irene O; Duffy, Anita; Shea, Ellen O

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

  16. What parents want from doctors in end-of-life decision-making for children.

    Science.gov (United States)

    Sullivan, J; Monagle, P; Gillam, L

    2014-03-01

    End-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents' views and experiences of end-of-life decision-making. A qualitative method with a semistructured interview design was used. Parent participants were living in the community. Twenty-five bereaved parents. Parents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral. Understanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.

  17. Raising end of life care issues for patients with learning disabilities.

    Science.gov (United States)

    Sander, Ruth

    2012-11-30

    This qualitative study explored the views of three learning disability nurses, and three district nurses, caring for people with learning disabilities at the end of their lives. Although they saw some good practice, the nurses identified several difficulties associated with end of life care.

  18. Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

    2012-01-01

    Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

  19. The use of theory in qualitative approaches to research: application in end-of-life studies.

    Science.gov (United States)

    Wu, Hung-Lan; Volker, Deborah L

    2009-12-01

    This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008. The term 'theory' continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study. Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs.

  20. Learning end-of-life care within a constructivist model: Undergraduate nursing students’ experiences

    Directory of Open Access Journals (Sweden)

    Anna E. van der Wath

    2015-11-01

    Full Text Available Background: Although nursing education aims to equip nursing students to provide care to dying patients and their families, nurses often feel ill-prepared to cope with the emotional labour involved in end-of-life care. Objectives: The aim of the study was to explore and describe nursing students’ experiences of end-of-life care through experiential learning within a constructivist educational model. Method: A qualitative, descriptive design was used. As part of introducing experiential learning, innovative educational practices were initiated during a second year level undergraduate nursing module on end-of-life care. Qualitative data on second-year nursing students’ experiences were collected through written reflections and analysed using open coding. Results: The themes that emerged revealed participants’ sensory and emotional experiences during the learning opportunities. Participants reflected on what they learnt and clarified their values related to death and dying. They indicated how they would apply the new meanings constructed in clinical practice. Conclusion: A constructivist educational model of experiential learning holds potential to enhance value clarification and nursing students’ sensory and emotional awareness of death and dying. Experiential learning is recommended to develop nursing students’ competency inproviding end-of-life care.

  1. When Safe Oral Feeding Is Threatened: End-of-Life Options and Decisions

    Science.gov (United States)

    Groher, Michael E.; Groher, Tammy Peutz

    2012-01-01

    Managing one's dysphagia at the end-of-life is challenging for the patient and the medical care team. Decisions surrounding oral feeding safety and the use of artificially administered hydration and nutrition require the medical care team to provide its best advice, taking into consideration the patient's health-related goals and the impact the…

  2. Learning About End-of-Life Care in Nursing-A Global Classroom Educational Innovation.

    Science.gov (United States)

    Bailey, Cara; Hewison, Alistair; Orr, Shelly; Baernholdt, Marianne

    2017-11-01

    Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation. The global classroom enhanced the educational experience for students. Teaching needs to be inclusive, focused, and engaging; the virtual platform must be stable and support individual learning, and learning needs to be collaborative and authentic. These findings can be used to inform the integration of similar approaches to end-of-life care education in other health care professional preparation programs. [J Nurs Educ. 2017;56(11):688-691.]. Copyright 2017, SLACK Incorporated.

  3. End of life care in chronic obstructive pulmonary disease: in search of a good death

    Directory of Open Access Journals (Sweden)

    Anna Spathis

    2008-03-01

    Full Text Available Anna Spathis, Sara BoothPalliative Care Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UKAbstract: Chronic obstructive pulmonary disease (COPD is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation. There is increasing evidence that the end of life needs of those with advanced COPD are not being met by existing services. Many barriers hinder the provision of good end of life care in COPD, including the inherent difficulties in determining prognosis. This review provides an evidence-based approach to overcoming these barriers, summarising current evidence and highlighting areas for future research. Topics include end of life needs, symptom control, advance care planning, and service development to improve the quality of end of life care.Keywords: chronic obstructive pulmonary disease (MeSH, palliative care (MeSH, dyspnoea (MeSH, advance care planning (MeSH

  4. Dying means suffocating: perceptions of people living with severe COPD facing the end of life.

    Science.gov (United States)

    Hall, Sylvie; Legault, Alan; Côté, José

    2010-09-01

    The purpose of this research was to describe the perceptions of people living with severe chronic obstructive pulmonary disease (COPD) with respect to the end of life. For this descriptive exploratory qualitative study, semi-structured interviews were conducted with six participants suffering from severe COPD hospitalized in the past year following an exacerbation episode. The data were analyzed using the method developed by Miles and Huberman (2003), which comprises three main steps: data reduction, data display, and conclusion drawing/verification. The analysis yielded four themes that reflect the perceptions of participants with respect to the end of life, namely: living and seeing oneself decline, living and preparing to die, dying of COPD means suffocating, and dying in hospital surrounded by family and friends. What emerges from the study is that persons living with severe COPD wish to die without suffocating, in hospital, surrounded by family and friends, all the while hoping to go on living. This study contributes to a more comprehensive understanding of the end-of-life experience. It shows the importance of accompanying these persons properly towards the end of life and at the moment of dying. The study proposes a series of avenues for future research and makes recommendations for practice.

  5. Quantitative assessment of material composition of end-of-life ships using onboard documentation

    NARCIS (Netherlands)

    Jain, K.P.; Pruyn, J.F.J.; Hopman, J.J.

    2016-01-01

    Ship recycling yards around the world offer a price to the ship owners for buying an obsolete vessel to demolish and recycle based on the ship's end-of-life weight. The offer price is mainly based on the type of ship and the estimated quantity of steel available. The steel weight estimation, in

  6. Export, metal recovery and the mobile phone end-of-life ecosystem

    NARCIS (Netherlands)

    Bollinger, L.A.; Blass, V.

    2012-01-01

    Against a background of rapidly growing mobile phone consumption in developing and emerging economies, falling use times and looming metal scarcity, finding better ways to deal with end-of-life (EoL) phones is imperative. The current dynamic in which large numbers of EoL phones are exported from

  7. Caring for people at the end of life: Iranian oncology nurses′ experiences

    Directory of Open Access Journals (Sweden)

    Sedigheh Iranmanesh

    2009-01-01

    Conclusion: The study suggests that the nurses′ success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.

  8. Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care.

    Science.gov (United States)

    American Association of Colleges of Nursing, Washington, DC.

    A group of health care ethicists and palliative care experts convened by the American Association of Colleges of Nursing developed a set of competencies that should be achieved through nursing curricula. The purpose of the 15 competency statements is to assist nurse educators in incorporating end-of-life content into nursing curricula. Every…

  9. A Framework for Categorizing Social Interactions Related to End-of-Life Care in Nursing Homes

    Science.gov (United States)

    Bern-Klug, Mercedes

    2009-01-01

    Purpose: Almost half of people age 85 and older who die annually in the United States die as nursing home residents, yet because it is not always clear who is close to death, not all residents who might benefit from end-of-life care receive it. The purpose of this study is to develop a framework for organizing social interactions related to…

  10. Health Care Decisions at the End of Life: Theological and Ethical Foundations for Decision Making.

    Science.gov (United States)

    Allegretti, Joseph G.

    This paper provides a framework for making sense of perplexing problems surrounding issues of death and dying by exploring the theological and ethical background to health care decision making at the end of life. The paper first examines several of the basic principles that theologians and secular ethicists employ when analyzing such questions.…

  11. [State policy at the end of life. The transformation of medical deontology].

    Science.gov (United States)

    Serrano Ruiz-Calderón, José Miguel

    2012-01-01

    The contemporary state invades privacy in ways that affect even the end of life process. It develops public policies that can affect medical ethics. This limitation of power leaves the doctor's attention to the profession and may become a convenient code.

  12. Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

    Science.gov (United States)

    Fakhri, Shoaib; Engelberg, Ruth A; Downey, Lois; Nielsen, Elizabeth L; Paul, Sudiptho; Lahdya, Alexandria Z; Treece, Patsy D; Curtis, J Randall

    2016-09-01

    Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire. To understand factors that facilitate end-of-life care discussions that guide interventions to improve care. We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians. Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  13. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

    NARCIS (Netherlands)

    Block, L.; Deschepper, R.; Bilsen, J.J.; Bossuyt, N.; Casteren, van V.; Deliens, L.H.J.

    2009-01-01

    BACKGROUND: This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002).

  14. Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

    Science.gov (United States)

    Campbell, Cathy L.; Williams, Ishan C.; Orr, Tamara

    2013-01-01

    Significance African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care. Design A qualitative, descriptive design was used in this pilot study. Methods Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care). Findings End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making. Discussion Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols. PMID:23645999

  15. [The nursing role and ethical dimension of end of life care].

    Science.gov (United States)

    Daydé, Marie-Claude

    2016-02-01

    Supporting people in situations of precarity at the end of life is often fraught with complex problems, where one form of vulnerability amplifies another. This complexity requires interdisciplinary support, around the nursing care, to reflect together on the meaning of the action taken in an ethical approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Experiences and attitudes towards end-of-life decisions amongst Danish physicians

    DEFF Research Database (Denmark)

    Folker, Anna Paldam; Holtug, Nils; Jensen, Annette B

    1996-01-01

    In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered...

  17. Talking about end-of-life care in a timely manner

    NARCIS (Netherlands)

    Smeenk, Frank W. J. M.; Schrijver, Laurien A; van Bavel, Hennie C. J.; van de Laar, Eric F. J.

    2017-01-01

    In 2014, a group of physicians of the Catharina Hospital in Eindhoven (The Netherlands) started a project called “Talking about end-of-life care in a timely manner”. Just like others in the country, the Eindhoven group noticed that regularly, very frail elderly people were admitted to hospital in

  18. Positive emotion communication: Fostering well-being at end of life.

    Science.gov (United States)

    Terrill, Alexandra L; Ellington, Lee; John, Kevin K; Latimer, Seth; Xu, Jiayun; Reblin, Maija; Clayton, Margaret F

    2018-04-01

    Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. The end-of-life phase of high-grade glioma patients: a systematic review

    NARCIS (Netherlands)

    Sizoo, Eefje M.; Pasman, H. Roeline W.; Dirven, Linda; Marosi, Christine; Grisold, Wolfgang; Stockhammer, Günther; Egeter, Jonas; Grant, Robin; Chang, Susan; Heimans, Jan J.; Deliens, Luc; Reijneveld, Jaap C.; Taphoorn, Martin J. B.

    2014-01-01

    High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end of life

  20. Research design in end-of-life research: state of science.

    Science.gov (United States)

    George, Linda K

    2002-10-01

    The volume of research on end-of-life care, death, and dying has exploded during the past decade. This article reviews the conceptual and methodological adequacy of end-of-life research to date, focusing on limitations of research to date and ways of improving future research. A systematic search was conducted to identify the base of end-of-life research. Approximately 400 empirical articles were identified and are the basis of this review. Although much has been learned from research to date, limitations in the knowledge base are substantial. The most fundamental problems identified are conceptual and include failure to define dying; neglect of the distinctions among quality of life, quality of death, and quality of end-of-life care. Methodologically, the single greatest problem is the lack of longitudinal studies that cover more than the time period immediately before death. Gaps in the research base include insufficient attention to psychological and spiritual issues, the prevalence of psychiatric disorder and the effectiveness of the treatment of such disorders among dying persons, provider and health system variables, social and cultural diversity, and the effects of comorbidity on trajectories of dying.

  1. End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

    NARCIS (Netherlands)

    Gysels, M.H.; Pell, C.; Straus, L.; Pool, R.

    2011-01-01

    Background End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL

  2. Culture and end of life care: a scoping exercise in seven European countries

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.; Meñaca, A.; Andrew, E.; Toscani, F.; Finetti, S.; Pasman, H.R.; Higginson, I.; Harding, R.; Pool, R.

    2012-01-01

    Aim: Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence

  3. Diversity in Defining End of Life Care: An Obstacle or the Way Forward?

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.C.; Menaca, A.; Higginson, I.J.; Harding, R.; Pool, R.

    2013-01-01

    Aim:The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

  4. The End-of-Life Phase of High-Grade Glioma Patients: Dying With Dignity?

    NARCIS (Netherlands)

    Sizoo, E.M.; Taphoorn, M.J.B.; Uitdehaag, B.M.J.; Heimans, J.J.; Deliens, L.; Reijneveld, J.C.; Pasman, H.R.W.

    2013-01-01

    Background. In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with

  5. Symptoms and medication management in the end of life phase of high-grade glioma patients

    NARCIS (Netherlands)

    Koekkoek, J.A.F.; Dirven, L.; Sizoo, E.M.; Pasman, H.R.W.; Heimans, J.J.; Postma, T.J.; Deliens, L.; Grant, R.; McNamara, S.; Stockhammer, G.; Medicus, E.; Taphoorn, M.J.B.; Reijneveld, J.C.

    2014-01-01

    During the end of life (EOL) phase of high-grade glioma (HGG) patients, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible. In this study, we evaluated the prevalence of symptoms and medication management in HGG patients during the EOL phase. We

  6. Culture and End of Life Care: A Scoping Exercise in Seven European Countries

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.C.; Menaca, A.; Andrew, E.; Toscani, F.; Finetti, S.; Pasman, H.R.W.; Higginson, I.; Harding, R.; Pool, R.

    2012-01-01

    Aim: Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence

  7. Diversity in defining end of life care: an obstacle or the way forward?

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.; Meñaca, A.; Higginson, I.J.; Harding, R; Pool, R.

    2013-01-01

    Aim: The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

  8. Involvement of nurses in end-of-life discussions for severely disabled children

    NARCIS (Netherlands)

    Zaal-Schuller, I. H.; Willems, D. I.; Ewals, F.; van Goudoever, J. B.; de Vos, M. A.

    2018-01-01

    In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research

  9. Trends in End-of-Life Decision Making in Patients With and Without Cancer

    NARCIS (Netherlands)

    Pardon, K.; Chambaere, K.; Pasman, H.R.W.; Deschepper, R.; Rietjens, J.; Deliens, L.

    2013-01-01

    Purpose: Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer

  10. End-of-life decision-making for children with severe developmental disabilities: The parental perspective

    NARCIS (Netherlands)

    Zaal-Schuller, I. H.; de Vos, M. A.; Ewals, F. V. P. M.; van Goudoever, J. B.; Willems, D. L.

    2016-01-01

    The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and

  11. End of Life Strategies Among Patients with Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Gershon, Andrea S; Maclagan, Laura C; Luo, Jin; To, Teresa; Kendzerska, Tetyana; Stanbrook, Matthew B; Bourbeau, Jean; Etches, Jacob; Aaron, Shawn D

    2018-06-11

    The burden of advanced COPD is high globally; however, little is known about how often end of life strategies are used by this population. To describe trends in the use of end of life care strategies by people with advanced COPD in Ontario, Canada. A population-based repeated cross-sectional study examining end of life care strategies in individuals with advanced COPD was conducted. Annual proportions of individuals who received formal palliative care, long-term oxygen therapy or opioids from 2004 to 2014 were determined. Results were age- and sex- standardized as well as stratified by age, sex, socioeconomic status, urban/rural residence and immigrant status. Measurement/Main Results: There were 151,912 persons with advanced COPD in Ontario between 2004 and 2014. Use of formal palliative care services increased 1% per year from 5.3% in 2004 to 14.3% in 2014 (p value for trend COPD using end of life strategies, although increasing, remains low. Efforts should focus on increasing access to such strategies as well as educating patients and providers of their benefits.

  12. The end-of-life phase of high-grade glioma patients: dying with dignity?

    NARCIS (Netherlands)

    Sizoo, Eefje M.; Taphoorn, Martin J. B.; Uitdehaag, Bernard; Heimans, Jan J.; Deliens, Luc; Reijneveld, Jaap C.; Pasman, H. Roeline W.

    2013-01-01

    In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as

  13. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey.

    Science.gov (United States)

    Chambaere, Kenneth; Rietjens, Judith A C; Smets, Tinne; Bilsen, Johan; Deschepper, Reginald; Pasman, H Roeline W; Deliens, Luc

    2012-06-18

    A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs) and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the 'slippery slope' hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927) of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. While the rates of non-treatment decisions (NTD) and administration of life ending drugs without explicit request (LAWER) did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS) and euthanasia/assisted suicide (EAS), as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The slippery slope hypothesis cannot be confirmed either in general or

  14. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    Directory of Open Access Journals (Sweden)

    Chambaere Kenneth

    2012-06-01

    Full Text Available Abstract Background A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the ‘slippery slope’ hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. Method We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927 of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. Results While the rates of non-treatment decisions (NTD and administration of life ending drugs without explicit request (LAWER did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS and euthanasia/assisted suicide (EAS, as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Conclusion Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The

  15. Final summary report on the Peach Bottom End-of-Life Program

    International Nuclear Information System (INIS)

    Steward, K.P.

    1978-07-01

    HTGR design methods verifications have been performed under the Peach Bottom End-of-Life Program by comparison of actual with predicted physics, thermal, fission product, and materials behavior in Peach Bottom. These design methods verifications have utilized the data determined from nondestructive fuel and circuit gamma scanning on-site, from laboratory examinations of samples removed from the primary circuit, and from a complementary program of Peach Bottom fuel element postirradiation examinations at Oak Ridge National Laboratory. Fifty-five driver fuel elements were axially gamma scanned to determine fission product distributions for use in burnup calculations, power profile determinations, and fission product release and redistribution studies. The cesium plateout distribution in the primary circuit was subsequently mapped by gamma scanning the ducting at 12 locations, axially traversing 79 steam generator tubes with Cd Te detectors from the water side, and internally scanning two vertical runs of ducting. Component removal involved trepanning of the primary circuit ducting, obtaining access to the steam generator internals, and removing over 100 superheater, evaporator, and economizer tubing samples. During this phase, macroscopic examinations of the steam generator and ducting internals were performed. Subsequent laboratory examinations of removed samples included radiochemical tests to substantiate in-situ gamma scans and to determine 90 Sr distributions; metallurgical tests to evaluate surface films, microstructural changes, and residual mechanical properties; and tritium permeation tests to provide data for improving HTGR tritium release predictions. The condition and metallurgical integrity of all components examined were found to be excellent, with minimal coolant/substrate interaction and entirely acceptable residual mechanical properties. The suitability of the materials used in the construction of the Peach Bottom HTGR was thereby confirmed

  16. Palliative sedation in end-of-life care and survival: a systematic review.

    Science.gov (United States)

    Maltoni, Marco; Scarpi, Emanuela; Rosati, Marta; Derni, Stefania; Fabbri, Laura; Martini, Francesca; Amadori, Dino; Nanni, Oriana

    2012-04-20

    Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival. A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed. Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

  17. A preliminary categorization of end-of-life electrical and electronic equipment as secondary metal resources

    International Nuclear Information System (INIS)

    Oguchi, Masahiro; Murakami, Shinsuke; Sakanakura, Hirofumi; Kida, Akiko; Kameya, Takashi

    2011-01-01

    Highlights: → End-of-life electrical and electronic equipment (EEE) as secondary metal resources. → The content and the total amount of metals in specific equipment are both important. → We categorized 21 EEE types from contents and total amounts of various metals. → Important equipment types as secondary resources were listed for each metal kind. → Collectability and possible collection systems of various EEE types were discussed. - Abstract: End-of-life electrical and electronic equipment (EEE) has recently received attention as a secondary source of metals. This study examined characteristics of end-of-life EEE as secondary metal resources to consider efficient collection and metal recovery systems according to the specific metals and types of EEE. We constructed an analogy between natural resource development and metal recovery from end-of-life EEE and found that metal content and total annual amount of metal contained in each type of end-of-life EEE should be considered in secondary resource development, as well as the collectability of the end-of-life products. We then categorized 21 EEE types into five groups and discussed their potential as secondary metal resources. Refrigerators, washing machines, air conditioners, and CRT TVs were evaluated as the most important sources of common metals, and personal computers, mobile phones, and video games were evaluated as the most important sources of precious metals. Several types of small digital equipment were also identified as important sources of precious metals; however, mid-size information and communication technology (ICT) equipment (e.g., printers and fax machines) and audio/video equipment were shown to be more important as a source of a variety of less common metals. The physical collectability of each type of EEE was roughly characterized by unit size and number of end-of-life products generated annually. Current collection systems in Japan were examined and potentially appropriate collection

  18. Patient-reported assessment of quality care at end of life: development and validation of Quality Care Questionnaire-End of Life (QCQ-EOL).

    Science.gov (United States)

    Yun, Young Ho; Kim, Soo-Hyun; Lee, Kyoung-Min; Park, Sang Min; Lee, Chang Geol; Choi, Youn Seon; Lee, Won Sup; Kim, Si-Young; Heo, Dae Seog

    2006-09-01

    Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.

  19. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

    Science.gov (United States)

    Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

    2013-09-01

    Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

  20. Nurses' autonomy in end-of-life situations in intensive care units.

    Science.gov (United States)

    Paganini, Maria Cristina; Bousso, Regina Szylit

    2015-11-01

    The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude

  1. Perceived risks around choice and decision making at end-of-life: a literature review.

    Science.gov (United States)

    Wilson, F; Gott, M; Ingleton, C

    2013-01-01

    the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

  2. The role of the bioethicist in family meetings about end of life care.

    Science.gov (United States)

    Watkins, Liza T; Sacajiu, Galit; Karasz, Alison

    2007-12-01

    There has been little study of the content of bioethicists' communication during family meeting consultations about end of life care. In the literature, two roles for bioethicists are usually described: the "consultant" role, in which bioethicists define and support ethical principles such as those enshrined in the "rational choice" model; and the "mediator" role, which focuses on the enhancement of communication in order to reduce conflict. In this study, we use observational data to explore how bioethicists support the practice of decision making during family meetings about end of life care. In a study conducted in the Bronx, New York, USA, researchers observed and recorded 24 decision-making meetings between hospital staff and family members of elderly patients identified as being in the last stages of illness, who were unable or unwilling to make the decision for themselves. Bioethics consultants were present during five of those meetings. Although bioethicists referred to the "rational choice" decision-making hierarchy, we did not see the systematic exploration described in the literature. Rather, our data show that bioethicists tended to employ elements of the rational model at particular turning points in the decision-making process in order to achieve pragmatic goals. As mediators, bioethicists worked to create consensus between family and staff and provided invaluable sympathy and comfort to distressed family members. We also found evidence of a context-dependent approach to mediation, with bioethicists' contributions generally supporting staff views about end of life care. Bioethicists' called to consult on family meetings about end of life care do not appear to adhere to a strict interpretation of the official guidelines. In order to negotiate the difficult terrain of end of life decision making, our data show that bioethicists often add a third role, "persuader", to official roles of "consultant" and "mediator".

  3. Intensity of Care at the End of Life Among Older Adults in Korea.

    Science.gov (United States)

    Kim, Su Hyun; Kang, Sangwook; Song, Mi-Kyung

    2018-01-01

    To examine the intensity of care at the end of life among older adults in Korea and to identify the individual and institutional factors associated with care intensity. This secondary data analysis included a sample of 6278 decedents aged 65 years or older who were identified from the 2009 to 2010 Korean National Health Insurance Service-National Sample Cohort Claims data. We examined the medical care received by the cohort in the last 30 days of their lives. Overall, 36.5% of the sample received at least 1 intensive care procedure in the last 30 days of their lives; 26.3% of patients experienced intensive care unit admission, with an average stay of 7.45 days, 19.5% received mechanical ventilation, 12.3% received cardiopulmonary resuscitation, and 15.5% had a feeding tube placement. A statistical analysis using a multiple logistic regression model with random effects showed that younger age, higher household income, primary diagnoses of diseases (ischemic heart disease, infectious disease, chronic lung disease, or chronic heart disease), and characteristics of care setting (large hospitals and facilities located in metropolitan areas) were significantly associated with the likelihood of receiving high-intensity care at the end of life. A substantial number of older adults in Korea experienced high-intensity end-of-life care. Both individual and institutional factors were associated with the likelihood of receiving high-intensity care. Gaining an understanding of the intensity of care at the end of life and the impact of the determinants would advance efforts to improve quality of care at the end of life for older adults in Korea.

  4. MEMS based shock pulse detection sensor for improved rotary Stirling cooler end of life prediction

    Science.gov (United States)

    Hübner, M.; Münzberg, M.

    2018-05-01

    The widespread use of rotary Stirling coolers in high performance thermal imagers used for critical 24/7 surveillance tasks justifies any effort to significantly enhance the reliability and predictable uptime of those coolers. Typically the lifetime of the whole imaging device is limited due to continuous wear and finally failure of the rotary compressor of the Stirling cooler, especially due to failure of the comprised bearings. MTTF based lifetime predictions, even based on refined MTTF models taking operational scenario dependent scaling factors into account, still lack in precision to forecast accurately the end of life (EOL) of individual coolers. Consequently preventive maintenance of individual coolers to avoid failures of the main sensor in critical operational scenarios are very costly or even useless. We have developed an integrated test method based on `Micro Electromechanical Systems', so called MEMS sensors, which significantly improves the cooler EOL prediction. The recently commercially available MEMS acceleration sensors have mechanical resonance frequencies up to 50 kHz. They are able to detect solid borne shock pulses in the cooler structure, originating from e.g. metal on metal impacts driven by periodical forces acting on moving inner parts of the rotary compressor within wear dependent slack and play. The impact driven transient shock pulse analyses uses only the high frequency signal <10kHz and differs therefore from the commonly used broadband low frequencies vibrational analysis of reciprocating machines. It offers a direct indicator of the individual state of wear. The predictive cooler lifetime model based on the shock pulse analysis is presented and results are discussed.

  5. Changes in Properties of Cement and Lime Mortars When Incorporating Fibers from End-of-Life Tires

    Directory of Open Access Journals (Sweden)

    Lluís Gil

    2016-02-01

    Full Text Available This paper studies the addition of fibers from end-of-life tires to commercial mortar mixtures. Two different types of mortar, one lime-plastic and other cement-fluid, are mixed with different percentage of fibers ranging from 0% to 1%. The changes in bulk density, consistency, compressive and flexural strength, dynamic Young modulus and water absorption are studied. According to the results, consistency is the property that shows more relevant changes for an addition of 0.25% fibers. Consistency is related to workability and affects the water absorption and the Young modulus values. On the contrary, bulk density and mechanical properties did not change with the addition of fibers. The results prove that this fiber, considered a waste from recycling of end-of-life tires, can be used in commercial mixtures without losing strength. On the other hand, mortar workability limits the amount of fibers that can be included in the mixture and this parameter determines the performance of the mortar.

  6. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    Science.gov (United States)

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  7. End-of-life conversations and care: an asset-based model for community engagement.

    Science.gov (United States)

    Matthiesen, Mary; Froggatt, Katherine; Owen, Elaine; Ashton, John R

    2014-09-01

    Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach

  8. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology.

    Science.gov (United States)

    Hammami, Muhammad M; Hammami, Safa; Amer, Hala A; Khodr, Nesrine A

    2016-01-01

    Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females' end-of-life choices. A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology. The mean age of the females in the sample was 30.3 years (range, 19-55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: "physical and emotional privacy concerned, family caring" (younger, lower religiosity), "whole person" (higher religiosity), "pain and informational privacy concerned" (lower life quality), "decisional privacy concerned" (older, higher life quality), and "life quantity concerned, family dependent" (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%-50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample. Consistent with the previously reported findings in Saudi males, transcendence and dying in the hospital were the extreme end-of-life priority and dis

  9. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

    Science.gov (United States)

    Hammami, Muhammad M; Hammami, Safa; Amer, Hala A; Khodr, Nesrine A

    2016-01-01

    Background Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices. Methods A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology. Results The mean age of the females in the sample was 30.3 years (range, 19–55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity), “whole person” (higher religiosity), “pain and informational privacy concerned” (lower life quality), “decisional privacy concerned” (older, higher life quality), and “life quantity concerned, family dependent” (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%–50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample. Conclusion Consistent with the previously reported findings in Saudi males, transcendence and dying in

  10. Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis.

    Science.gov (United States)

    Black, Isra; Helgason, Ásgeir Rúnar

    2018-03-21

    Morbidity arising from unprepared bereavement is a problem that affects close personal relations of individuals at the end-of-life. The bereavement studies literature demonstrates that a lack of preparedness for a loved one's death is a risk factor for secondary psychological morbidity among survivors. Short awareness time of death negatively correlates to preparedness for bereavement. The absence of disclosure of end-of-life diagnosis and prognosis to close personal relations ('death talk') between patients and loved ones, or health professionals and loved ones, may contribute to short awareness time of death. To increase awareness time of death, we might attempt to increase patient first-personal disclosure of end-of-life diagnosis and prognosis to loved-ones, and/or patient consent to health professional disclosure of the same. Interventions based on motivational interviewing in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient's consent, may offer a part solution to the problem of unprepared bereavement. This paper evaluates the ethical permissibility of such interventions. We consider two ethical objections to using motivational interviewing in this way: first, that it is inappropriate for practitioners to seek disclosure as an outcome in this setting; second, that aiming at disclosure risks manipulating individuals into death talk. While it need not be impermissible to direct individuals toward disclosure of end-of-life diagnosis/prognosis, the objection from manipulation implies that it is pro tanto ethically preferable to use motivational interviewing in a non-directive mode in death talk conversations. However, insofar as non-directive motivational interviewing requires more advanced skills, and thus may be more difficult to learn and to practise, we advance that it may be ethically permissible, all things considered, to employ directional, or specific outcome

  11. [Decision-making processes in nursing and activities at the end of life in intensive care–An international comparative study].

    Science.gov (United States)

    Kohlen, Helen; McCarthy, Joan; Szylit Buosso, Regina; Gallagher, Ann; Andrews, Tom

    2015-12-01

    Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses’ decision-making processes and nursing activities in different countries are scarcely studied. Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described? The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit. Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis. The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was ’negotiated reorienting’: The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses’ core practices are ’consensus seeking’ and ’emotional holding’ (sub-categories). In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.

  12. Parent Perspectives of Neonatal Intensive Care at the End-of-Life.

    Science.gov (United States)

    Currie, Erin R; Christian, Becky J; Hinds, Pamela S; Perna, Samuel J; Robinson, Cheryl; Day, Sara; Meneses, Karen

    2016-01-01

    This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life.

    Science.gov (United States)

    Jansen, Lynn A; Sulmasy, Daniel P

    2002-06-04

    In the recent medical ethics literature, several authors have recommended terminal sedation and refusal of hydration and nutrition as important, morally acceptable, and relatively uncontroversial treatment options for end-of-life suffering. However, not all authors use these terms to refer to the same practices. This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature. Although some of these practices are ethically appropriate responses to end-of-life suffering, others (at least as they are currently described in the medical ethics literature) are not. This paper identifies and discusses the principles that morally distinguish these practices from one another and specifically describes different features of medical practices and moral principles that affect the moral acceptability of various medical treatments. These distinctions reveal the complexity of the issues surrounding terminal sedation and refusal of hydration and nutrition, a complexity that has not been adequately addressed in recent discussions.

  14. Hypnosis for Symptom Control in Cancer Patients at the End-of-Life: A Systematic Review.

    Science.gov (United States)

    Montgomery, Guy H; Sucala, Madalina; Baum, Tessa; Schnur, Julie B

    2017-01-01

    Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep disturbances, pain, appetite loss, and dyspnea. EMBASE, MEDLINE, COCHRANE, PsychINFO, and SCOPUS databases were searched from inception through November 7, 2016. No studies met the inclusion criteria. It appears that hypnosis has never been rigorously tested as a means to ameliorate the most common symptoms in individuals with cancer at the end of their lives. This finding is troubling, as it strongly implies that a population most in need has been largely neglected. However, a clear future research direction is revealed that may have significant clinical impact.

  15. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

    Directory of Open Access Journals (Sweden)

    Hammami MM

    2016-05-01

    Full Text Available Muhammad M Hammami,1,2 Safa Hammami,1 Hala A Amer,1 Nesrine A Khodr1 1Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Background: Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices.Methods: A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology.Results: The mean age of the females in the sample was 30.3 years (range, 19–55 years. Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity, “whole person” (higher religiosity, “pain and informational privacy concerned” (lower life quality, “decisional privacy concerned” (older, higher life quality, and “life quantity concerned, family dependent” (high life quality, low life satisfaction. Out of the

  16. Identifying care actions to conserve dignity in end-of-life care.

    Science.gov (United States)

    Brown, Hilary; Johnston, Bridget; Ostlund, Ulrika

    2011-05-01

    Community nurses have a central role in the provision of palliative and end-of-life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity.

  17. [End-of-life-care and euthanasia: medical assistance in dying or help to die].

    Science.gov (United States)

    Müller-Busch, H Christof

    2008-01-01

    The debate on euthanasia that has been started all over Europe, but especially in Germany has been particularly complicated by unclear and inconsistent definitions. Medical decisions in end-of-life care gain increasing importance not only for the time of death but also for the kind and quality of the dying process. Though legal regulations can help to diminish doubts about the permissibility of various measures in end-of-life care, teaching and knowledge of ethical principles, communication skills, respect, transparency and knowledge of palliative care options seem to be the most important factors in accompanying the dying professionally and with dignity and even in achieving a consented compromise when aid in hastening death is asked for.

  18. The rational choice model in family decision making at the end of life.

    Science.gov (United States)

    Karasz, Alison; Sacajiu, Galit; Kogan, Misha; Watkins, Liza

    2010-01-01

    Most end-of-life decisions are made by family members. Current ethical guidelines for family decision making are based on a hierarchical model that emphasizes the patient's wishes over his or her best interests. Evidence suggests that the model poorly reflects the strategies and priorities of many families. Researchers observed and recorded 26 decision-making meetings between hospital staff and family members. Semi-structured follow-up interviews were conducted. Transcriptions were analyzed using qualitative techniques. For both staff and families, consideration of a patient's best interests generally took priority over the patient's wishes. Staff generally introduced discussion of the patient's wishes for rhetorical purposes, such as persuasion. Competing moral frameworks, which de-emphasized the salience of patients' autonomy and "right to choose," played a role in family decision making. The priority given to the patients' wishes in the hierarchical model does not reflect the priorities of staff and families in making decisions about end-of-life care.

  19. Continuous subcutaneous levetiracetam in the management of seizures at the end of life: a case report.

    Science.gov (United States)

    Wells, Geoffrey Howard; Mason, Louise D; Foreman, Emma; Chambers, John

    2016-03-01

    We report the case of a man who developed seizures on a background of recurrent metastatic squamous cell carcinoma with intracranial involvement. Initial seizure control with enteral levetiracetam was achieved, and when enteral and intravenous (i.v.) access was no longer available, a continuous subcutaneous infusion (CSCI) of levetiracetam successfully controlled his seizures without the need for sedating anticonvulsants. As a result, end-of-life care was able to be given with the patient retaining the ability to communicate with his family and healthcare staff. This report adds to the sparse but growing evidence base for the use of subcutaneous levetiracetam to manage seizures in palliative and end-of-life care. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Patients' perspective on deactivation of the implantable cardioverter-defibrillator near the end of life

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Chaitsing, Rismy; Szili-Torok, Tamas

    2013-01-01

    (67%) completed the survey. Most patients (68%) were aware that it is possible to turn the ICD off, and 95% believed it is important to inform patients about the possibility. Of the patients completing the survey, 84% indicated a choice for or against deactivation. Psychological morbidity......Recent guidelines have emphasized the importance of discussing the issue of deactivation near the end of life with patients with an implantable cardioverter-defibrillator (ICD). Few studies have examined the patient perspective and patients' wishes. We examined patients' knowledge and wishes...... for information; and the prevalence and correlates of a favorable attitude toward deactivation. Three cohorts of ICD patients (n = 440) extracted from our institutional database were asked to complete a survey that included a vignette about deactivation near the end of life. Of the 440 patients approached, 294...

  1. The 'French exception': the right to continuous deep sedation at the end of life.

    Science.gov (United States)

    Horn, Ruth

    2018-03-01

    In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. The end of life decisions -- should physicians aid their patients in dying?

    Science.gov (United States)

    Sharma, B R

    2004-06-01

    Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

  3. Rethinking Suffering: Allowing for Suffering that is Intrinsic at End of Life.

    Science.gov (United States)

    Rattner, Maxxine; Berzoff, Joan

    2016-01-01

    The dilemma so central to the work of providers of palliative and end-of-life care is the paradox of their professional and ethical duty to try to relieve suffering and the limitations of so doing. While the capacity to sit with suffering at the end of life is critical to clinical work, the idea that some intrinsic suffering cannot necessarily always be relieved may model for patients and families that suffering can be borne. Clinicians who encounter unrelievable suffering may feel a sense of failure, helplessness, moral distress, and compassion fatigue. While tolerating suffering runs counter to the aims of palliative care, acknowledging it, bearing it, and validating it may actually help patients and families to do the same. "Sitting with suffering" signals a paradigm shift within the discipline of palliative care, as it asks clinicians to rethink their role in being able to relieve some forms of psychosocial suffering intrinsic to dying.

  4. Irradiated fuel performance evaluation technology development

    International Nuclear Information System (INIS)

    Koo, Yang Hyun; Bang, J. G.; Kim, D. H.

    2012-01-01

    Alpha version performance code for dual-cooled annular fuel under steady state operation, so called 'DUOS', has been developed applying performance models and proposed methodology. Furthermore, nonlinear finite element module which could be integrated into transient/accident fuel performance code was also developed and evaluated using commercial FE code. The first/second irradiation and PIE test of annular pellet for dual-cooled annular fuel in the world have been completed. In-pile irradiation test DB of annular pellet up to burnup of 10,000 MWd/MTU through the 1st test was established and cracking behavior of annular pellet and swelling rate at low temperature were studied. To do irradiation test of dual-cooled annular fuel under PWR's simulating steady-state conditions, irradiation test rig/rod design/manufacture of mock-up/performance test have been completed through international collaboration program with Halden reactor project. The irradiation test of large grain pellets has been continued from 2002 to 2011 and completed successfully. Burnup of 70,000 MWd/MTU which is the highest burnup among irradiation test pellets in domestic was achieved

  5. Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions

    OpenAIRE

    Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

    2015-01-01

    Background: Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. TheCaring Decisionshandbook and website were developed to fill these gaps. Aim: We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. Design: A targeted...

  6. Mechanical characterization of sportive tracks made with materials recycled from end-of-life tyres

    OpenAIRE

    Morales-Gámiz, F. J.; Escriba, S.; García-Villena, S. A.; Bermejo, J. M.; Saiz, L.

    2015-01-01

    Congreso celebrado en la Escuela de Arquitectura de la Universidad de Sevilla desde el 24 hasta el 26 de junio de 2015. The European Framework Directive 2008/98/EC on waste established as priority reuse and recycling before other recovery alternatives. In this normative reference, one the main waste flows identified are the end-of-life tyres, as a material whose mechanical properties could provide advantage in the construction of new structures. This paper presents the mechanical character...

  7. End-of-Life vehicle recovery in china: Consideration and innovation following the EU ELV directive

    Science.gov (United States)

    Chen, Ming; Zhang, Fan

    2009-03-01

    Implementation of the EU’s end-of-life vehicle (ELV) directive eight years ago had a profound influence on China’s automotive industry, leading to the consideration of concepts such as extended producer responsibility. It also provided some impetus for ELV recycling industry developments within China. This article provides insight into current thinking within China about ELV recycling as well as vehicle recovery activities.

  8. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  9. Hospice or community network? Choices in end-of-life care in Jamaica.

    Science.gov (United States)

    Mendoza, Roger Lee

    2017-09-01

    Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

  10. Truncated Autonomy: Neocortical Selves, Reverse Reductionism and End-of-Life Care

    OpenAIRE

    Wackers, Ger

    2016-01-01

    Published version. Source at http://dx.doi.org/10.5772/66044 In professional guidelines for palliative sedation in end-of life care, a particular notion of conscious life experience is associated with specific cognitivist notion of frontal lobe autonomy. Drawing on Turner and Fauconnier’s work in cognitive linguistics I argue in this chapter that even our most central notions like human subjectivity and autonomy are conceptual blends. This chapter explores the origins and eme...

  11. Matters of spirituality at the end of life in the pediatric intensive care unit.

    Science.gov (United States)

    Robinson, Mary R; Thiel, Mary Martha; Backus, Meghan M; Meyer, Elaine C

    2006-09-01

    Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including insight and wisdom; reliance on values; and virtues such as hope, trust, and love. Many parents drew on and relied on their spirituality to guide them in end-of-life decision-making, to make meaning of the loss, and to sustain them emotionally. Despite the dominance of technology and medical discourse in the ICU, many parents experienced their child's end of life as a spiritual journey. Staff members, hospital chaplains, and community clergy are encouraged to be explicit in their hospitality to parents' spirituality and religious faith, to foster a culture of acceptance and integration of spiritual perspectives, and to work collaboratively to deliver spiritual care.

  12. Making the case for talking to patients about the costs of end-of-life care.

    Science.gov (United States)

    Donley, Greer; Danis, Marion

    2011-01-01

    Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. © 2011 American Society of Law, Medicine & Ethics, Inc.

  13. Family members' informal roles in end-of-life decision making in adult intensive care units.

    Science.gov (United States)

    Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

    2012-01-01

    To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

  14. Family communication and decision making at the end of life: a literature review.

    Science.gov (United States)

    Wallace, Cara L

    2015-06-01

    Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

  15. Danish general practitioners? self-reported competences in end-of-life care

    OpenAIRE

    Winthereik, Anna; Neergaard, Mette; Vedsted, Peter; Jensen, Anders

    2016-01-01

    Objective General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics. Design Population-based questionnaire study. Setting Central Denmark Region with approximately 1.3 million inhabitants. Subjects All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail. Main outcome measures Responses to 18 items concerning four aspects: provision of EOL care to ...

  16. Nurses' care practices at the end of life in intensive care units in Bahrain.

    Science.gov (United States)

    O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L

    2017-12-01

    The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

  17. Physician perspectives on legal processes for resolving end-of-life disputes.

    Science.gov (United States)

    Chidwick, Paula; Sibbald, Robert

    2011-01-01

    In order to understand how to effectively approach end-of-life disputes, this study surveyed physicians' attitudes towards one process for resolving end-of-life disputes, namely, the Consent and Capacity Board of Ontario. In this case, the process involved examining interpretation of best interests between substitute decision-makers and medical teams. Physicians who made "Form G" applications to the Consent and Capacity Board of Ontario that resulted in a decision posted on the open-access database, Canadian Legal Information Institute (CanLii), were identified and surveyed. This purposive sample led to 13 invitations to participate and 12 interviews (92% response rate). Interviews were conducted using a prescribed interview guide. No barriers to the Consent and Capacity Board process were reported. Applications were made when physicians reached an impasse with the family and further treatment was perceived to be "unethical." The most significant challenge reported was the delay when appeals were launched. Appeals extended the process for an indefinite period of time making it so lengthy it negated any perceived benefits of the process. Benefits included that a neutral third party, namely the Consent and Capacity Board, was able to assess best interests. Also, when decisions were timely, further harm to the patient was minimized. Physicians reported this particular approach, namely the Consent and Capacity Board has a mechanism that is worthwhile, patient centred, process oriented, orderly and efficient for resolving end-of-life disputes and, in particular, determining best interests. However, unless the appeal process can be adjusted to respond to the ICU context there is a risk of not serving the best interest of patients. Physicians would recommend framing end-of-life treatment plans in the positive instead of negative, for example, propose palliative care and no escalation of treatment as opposed to withdrawal.

  18. Privacy at end of life in ICU: A review of the literature.

    Science.gov (United States)

    Timmins, Fiona; Parissopoulos, Stelios; Plakas, Sotirios; Naughton, Margaret T; de Vries, Jan Ma; Fouka, Georgia

    2018-06-01

    To explore the issues surrounding privacy during death in ICU. While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs have not been extensively explored. A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU. Keywords used in the search were "ICU," "Privacy," "Death" and "Dying." A combination of these terms using Boolean operators "or" or "and" revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software. The analysis of the studies revealed eight themes, and this study presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: "Privacy in ICU," "ICU environment" and "End-of-Life Care". Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end-of-life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford. It is best if end-of-life care in the ICU is planned and coordinated, where possible. Nurses need to become more self-reflective and aware in relation to end-of-life situations in ICU in order to develop privacy practices that are responsive to family and patient needs. © 2018 John Wiley & Sons Ltd.

  19. End-of-life decision-making for children with severe developmental disabilities: The parental perspective.

    Science.gov (United States)

    Zaal-Schuller, I H; de Vos, M A; Ewals, F V P M; van Goudoever, J B; Willems, D L

    2016-01-01

    The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

    Science.gov (United States)

    Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

    2017-08-01

    The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

  1. Ketamine PCA for treatment of end-of-life neuropathic pain in pediatrics.

    Science.gov (United States)

    Taylor, Matthew; Jakacki, Regina; May, Carol; Howrie, Denise; Maurer, Scott

    2015-12-01

    Control of neuropathic pain (NP) for children at end of life is challenging. Ketamine improves control of NP, but its use in children is not well described. We describe a retrospective case review of 14 children with terminal prognoses treated with ketamine patient-controlled analgesia (PCA) for management of opioid-refractory NP at the end of life. Median ketamine dose was 0.06 mg/kg/h (range 0.014-0.308 mg/kg/h) with a 0.05 mg/kg (range 0.03-0.5mg/kg) demand dose available every 15 minutes (range 10-60 minutes). All patients noted subjective pain relief with ketamine, and 79% had no adverse effects. Benzodiazepines limited neuropsychiatric side effects. Ketamine treatment arrested dose escalation of opioids in 64% of patients, and 79% were discharged to home hospice. Ketamine PCA is an effective, well-tolerated therapy for opioid-refractory NP in pediatric end-of-life care. © The Author(s) 2014.

  2. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

  3. Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions.

    Science.gov (United States)

    Xafis, Vicki; Watkins, Andrew; Wilkinson, Dominic

    2016-04-01

    This paper considers clinician/parent communication difficulties noted by parents involved in end-of-life decision-making in the light of linguistic theory. Grice's Cooperative Principle and associated maxims, which enable effective communication, are examined in relation to communication deficiencies that parents have identified when making end-of-life decisions for the child. Examples from the literature are provided to clarify the impact of failing to observe the maxims on parents and on clinician/parent communication. Linguistic theory applied to the literature on parental concerns about clinician/parent communication shows that the violation of the maxims of quantity, quality, relation, and manner as well as the stance that some clinicians adopt during discussions with parents impact on clinician/parent communication and lead to distrust, anger, sadness, and long-term difficulties coping with the experience of losing one's child. Parents have identified communication deficiencies in end-of-life discussions. Relating these communication deficiencies to linguistic theory provides insight into communication difficulties but also solutions. Gaining an understanding of basic linguistic theory that underlies human interactions, gaining insight into the communication deficiencies that parents have identified, and modifying some communication behaviours in light of these with the suggestions made in this article may lead to improved clinician/parent communication. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  5. Can the NICE "end-of-life premium" be given a coherent ethical justification?

    Science.gov (United States)

    Cookson, Richard

    2013-12-01

    In 2009 the UK National Institute for Health and Clinical Excellence (NICE) announced that its health technology appraisal committees would henceforth give special additional weight to health gains from life-extending end-of-life treatments. This was a response to mounting concern from NICE's stakeholders that effective new drugs for end-stage cancer often fail NICE's standard test of cost effectiveness. This change of policy may be justifiable on procedural grounds as the result of a democratic political process responding to stakeholder concerns. However, according to the "accountability for reasonableness" framework proposed by the philosopher Norman Daniels and endorsed by NICE, there also needs to be transparency about the substantive ethical grounds for public health care resource allocation decisions. In that spirit, I analyze eleven potentially relevant justifications for the NICE "end-of-life premium," drawn from the economics and philosophy literature: (1) rule of rescue, (2) fair chances, (3) ex post willingness to pay, (4) caring externality, (5) financial protection, (6) symbolic value, (7) diminishing marginal value of future life years, (8) concentration of benefits, (9) dread, (10) time to set your affairs in order, and (11) severity of illness. I conclude that none of them yields a coherent ethical justification for the NICE end-of-life premium.

  6. Exhaust All Measures: Ethical Issues in Pediatric End-of-Life Care.

    Science.gov (United States)

    Thieleman, Kara J; Wallace, Cara; Cimino, Andrea N; Rueda, Heidi A

    2016-01-01

    The death of a child may have a profound impact on parents, family members, and health care providers who provided care for the child. Unique challenges are faced by parents of seriously ill children as they must serve as the legal authority for health care decisions of children under age 18, although the child's wishes must also be considered. Social workers must balance core social work values, bioethical values, and psychosocial issues presented by such situations. While studies have been conducted with physicians and nurses regarding ethical issues in pediatric end-of-life care settings, little is known about how social workers experience these conflicts. This article utilizes two vignettes to illustrate potential ethical issues in this setting and applies the National Association of Social Workers Standards for Palliative and End of Life Care (NASW, 2004 ) to explore options for their resolution. These vignettes provide descriptions of possible reactions in this setting and can be used as a basis for further exploration of ethics in pediatric end-of-life care from a social work perspective.

  7. Facing death, gazing inward: end-of-life and the transformation of clinical subjectivity in Thailand.

    Science.gov (United States)

    Stonington, Scott

    2011-06-01

    In this article, I describe a new form of clinical subjectivity in Thailand, emerging out of public debate over medical care at the end of life. Following the controversial high-tech death of the famous Buddhist monk Buddhadasa, many began to denounce modern death as falling prey to social ills in Thai society, such as consumerism, technology-worship, and the desire to escape the realities of existence. As a result, governmental and non-governmental organizations have begun to focus on the end-of-life as a locus for transforming Thai society. Moving beyond the classic outward focus of the medical gaze, they have begun teaching clinicians and patients to gaze inward instead, to use the suffering inherent in medicine and illness to face the nature of existence and attain inner wisdom. In this article, I describe the emergence of this new gaze and its major conceptual components, including a novel idea of what it means to be 'human,' as well as a series of technologies used to craft this humanity: confession, "facing suffering," and untying "knots" in the heart. I also describe how this new subjectivity has begun to change the long-stable Buddhist concept of death as taking place at a moment in time, giving way for a new concept of "end-of-life," an elongated interval to be experienced, studied, and used for inner wisdom.

  8. Family-centered end-of-life care in the ICU.

    Science.gov (United States)

    Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung; Gergis, Mary A

    2013-08-01

    Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process. Copyright 2013, SLACK Incorporated.

  9. Vigilant at the end of life: family advocacy in the nursing home.

    Science.gov (United States)

    Shield, Renee R; Wetle, Terrie; Teno, Joan; Miller, Susan C; Welch, Lisa C

    2010-05-01

    Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes. The authors conducted 54 qualitative telephone interviews of close family or friends of individuals who had spent at least 48 hours in the last month of life in a nursing home. Respondents had earlier participated in a national survey that found 587 of 1578 decedents (37.2%) received end-of-life nursing home care. In qualitative interviews respondents described the last year of life, focusing on the nursing home experience. Interviews were analyzed by a multidisciplinary team to identify key themes of areas of concern. An important interview theme revealed families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care. They noted staff members who did not fully inform them about what to expect in the dying process. Respondents reported burden and gratification in care they themselves provided, which sometimes entailed collaboration with staff. Interviews also identified ways hospice care impacted families, including helping to relieve family burden. End-of-life advocacy takes on increased urgency when those close to the dying resident have concerns about basic care and do not understand the dying course. Enhancing communication, preparing families at the end of life, and better understanding of hospice are likely to increase family trust in nursing home care, improve the care of dying residents, and help reduce family burden.

  10. Hybrid disassembly system for cellular telephone end-of-life treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kniebel, M.; Basdere, B.; Seliger, G. [Technical Univ. Berlin, Inst. for Machine Tools and Factory Management, Dept. of Assembly Technology and Factory Management, Berlin (Germany)

    2004-07-01

    Concern over the negative environmental impacts associated with the production, use, and end-of-life (EOL) of cellular telephones is particularly high due to large production volumes and characteristically short time scales of technological and stylistic obsolescence. Landfilled or incinerated cellular telephones create the potential for release of toxic substances. The European legislation has passed the directive on Waste of Electrical and Electronic Equipment (WEEE) to regulate their collection and appropriate end-of-life treatment. Manufacturers must conduct material recycling or remanufacturing processes to recover resources. While recovery rates can hardly be met economically by material recycling, remanufacturing and reusing cellular phones is developing into a reasonable alternative. Both end-of-life options require disassembly processes for WEEE compliant treatment. Due to the high number of different cell phone variants and their typical design that fits components into tight enclosing spaces, cellular phone disassembly becomes a challenging task. These challenges and the expected high numbers of phones to be returned in the course of the WEEE urges for automated disassembly. A hybrid disassembly system has been developed to ensure the mass-treatment of obsolete cellular phones. It has been integrated into a prototypical remanufacturing factory for cellular phones that has been planned based on market data. (orig.)

  11. Stealing on insensibly: end of life politics in the United States.

    Science.gov (United States)

    Brown, Lawrence D

    2012-10-01

    Because the United States often seems (and seems eager to present itself as) the home of the technological imperative and of determination to brand all challenges to it in end-of-life care as a descent into death panels, the prospects look unpromising for progress in US public policies that would expand the range of choices of medical treatments available to individuals preparing for death. Beneath this obdurate and intermittently hysterical surface, however, the diffusion across US states and communities of living wills, advanced directives, palliative care, hospice services and debates about assisted suicide is gradually strengthening not so much 'personal autonomy' as the authority, cultural and formal, of individuals and their loved ones not merely to shape but to lead the inevitably 'social' conversations on which decisions about care at the end of life depend. In short, the nation appears to be (in terms taken from John Donne's mediations on death) 'stealing on insensibly'--making incremental progress toward the replacement of clinical and other types of dogma with end-of-life options that honor the preferences of the dying.

  12. Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment.

    Science.gov (United States)

    Schubart, Jane R; Green, Michael J; Van Scoy, Lauren J; Lehman, Erik; Farace, Elana; Gusani, Niraj J; Levi, Benjamin H

    2015-12-01

    People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment. We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT). This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes). We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT. Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.

  13. Balancing hope and despair at the end of life: The contribution of organ and tissue donation.

    Science.gov (United States)

    Walker, Wendy; Sque, Magi

    2016-04-01

    Concern for the grieving family can moderate the intentions of critical care staff to advocate deceased organ and tissue donation. Conversely, benevolent actions may provoke distress through missed opportunities to save or transform lives. This article provides insight into the perceived benefits of organ and tissue donation for grieving families who experienced end-of-life care in the intensive care unit. Data were collected via semistructured, face-to-face or telephone interviews with 43 participants from 31 donor families. Audio recordings were transcribed verbatim and subjected to qualitative content analysis. The study findings affirmed the importance of person-centered end-of-life care. Donor families shared examples of good-quality care and communication that contained the hallmarks of compassion, respect, dignity, and choice. We uncovered a trajectory of hope and despair in which the option of organ and tissue donation appeared to give meaning to the life and death of the deceased person and was comforting to some families in their bereavement. Our study findings underlined the significance of donation decision making for grieving families. Organ and tissue donation has the potential to balance hope and despair at the end of life when the wishes of the dying, deceased, and bereaved are fulfilled. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Clinical review: Ethics and end-of-life care for critically ill patients in China.

    Science.gov (United States)

    Li, Li Bin

    2013-12-04

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides culture, come into play in determining a person's ethical attitudes or behaviors, such as experience, education, religion, individual attributes, and economic considerations. Chinese doctors face ethical problems similar to those of their Western counterparts; however, since Chinese society is different from that of Western countries in cultural traditions, customs, religious beliefs, and ethnic backgrounds, there is a great difference between China and the Western world in regard to ethics at the end of life, and there is also a huge controversy within China.

  15. Ethics and end of life care: the Liverpool Care Pathway and the Neuberger Review.

    Science.gov (United States)

    Wrigley, Anthony

    2015-08-01

    The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication and ethical decision-making, without the added demand to end the Liverpool Care Pathway, would have resulted in a genuine advance in end of life care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Drug treatment at the end of life: an epidemiologic study in nursing homes.

    Science.gov (United States)

    Jansen, Kristian; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-12-01

    To examine drug treatment in nursing home patients at the end of life, and identify predictors of palliative drug therapy. A historical cohort study. Three urban nursing homes in Norway. All patients admitted from January 2008 and deceased before February 2013. Drug prescriptions, diagnoses, and demographic data were collected from electronic patient records. Palliative end-of-life drug treatment was defined on the basis of indication, drug, and formulation. 524 patients were included, median (range) age at death 86 (19-104) years, 59% women. On the day of death, 99.4% of the study population had active prescriptions; 74.2% had palliative drugs either alone (26.9%) or concomitantly with curative/preventive drugs (47.3%). Palliative drugs were associated with nursing home, length of stay > 16 months (AOR 2.10, 95% CI 1.12-3.94), age (1.03, 1.005-1.05), and a diagnosis of cancer (2.12, 1.19-3.76). Most initiations of palliative drugs and withdrawals of curative/preventive drugs took place on the day of death. Palliative drug therapy and drug therapy changes are common for nursing home patients on the last day of life. Improvements in end-of-life care in nursing homes imply addressing prognostication and earlier response to palliative needs.

  17. Parental Physical Proximity in End-of-Life Care in the PICU.

    Science.gov (United States)

    Falkenburg, Jeannette L; Tibboel, Dick; Ganzevoort, Ruard R; Gischler, Saskia; Hagoort, Jacobus; van Dijk, Monique

    2016-05-01

    Health professionals in PICUs support both child and parents when a child's death is imminent. Parents long to stay connected to their dying child but the high-tech environment and treatment implications make it difficult to stay physically close. This study explores in what sense physical aspects of end-of-life care in the PICU influence the parent-child relationship. Retrospective, qualitative interview study. Level 3 PICU in Erasmus Medical Center in the Netherlands. Thirty-six parents of 20 children who had died in this unit 5 years previously. Parents vividly remembered the damage done to the child's physical appearance, an inevitable consequence of medical treatment. They felt frustrated and hurt when they could not hold their child. Yet they felt comforted if facilitated to be physically close to the dying child, like lying with the child in one bed, holding the child in the hour of death, and washing the child after death. End-of-life treatment in the PICU presents both a barrier and an opportunity for parents to stay physically connected to their child. Parents' experiences suggest that aspects of physicality in medical settings deserve more attention. Better understanding of the significance of bodily aspects-other than pain and symptom management-improves end-of-life support and should be part of the humane approach to families.

  18. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    NARCIS (Netherlands)

    Chambaere, K.; Rietjens, J.A.C.; Smets, T.; Bilsen, J.; Deschepper, R.; Pasman, H.R.W.; Deliens, L.

    2012-01-01

    Background: A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of

  19. 'Older peoples' attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001-2009

    NARCIS (Netherlands)

    Buiting, H.M.; Deeg, D.J.H.; Knol, D.L.; Ziegelmann, J.P.; Pasman, H.R.W.; Widdershoven, G.A.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study

  20. The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

    NARCIS (Netherlands)

    Reyniers, T.; Houttekier, D.; Pasman, H.R.; Stichele, R.V.; Cohen, J.; Deliens, L.

    2014-01-01

    CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician’s role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or

  1. 76 FR 47596 - Notice of Scientific Summit; The Science of Compassion-Future Directions in End-of-Life and...

    Science.gov (United States)

    2011-08-05

    ...; The Science of Compassion--Future Directions in End-of-Life and Palliative Care SUMMARY: Notice is... science at the end-of-life. On August 11-12, the summit will feature keynote presentations, three plenary...), Department of Health and Human Services, will convene a scientific summit titled ``The Science of Compassion...

  2. Attitudes of Dutch nurses towards their involvement in end-of-life decisions with a possible life-shortening effect.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J. de; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Nurses are often involved in end-of-life decision making as they play an important role in caring for terminally ill patients. Aim: To investigate nurses’ attitudes towards their involvement in end-of-life decisions with a possible lifeshortening effect, and a possible relationship with

  3. End-of-life content in treatment guidelines for life-limiting diseases.

    Science.gov (United States)

    Mast, Kimberly R; Salama, Marybeth; Silverman, Gabriel K; Arnold, Robert M

    2004-12-01

    Clinical guidelines are systematically developed statements that influence medical practice, education, and funding. Guidelines represent the consensus of leaders, often based on systematic reviews of the literature, regarding the "state of the art." To assess the degree to which end-of-life care is integrated into nationally developed guidelines for chronic, noncurable, life-limiting diseases. Four compendia were reviewed: The Healthcare Standards Directory ECRI, 2001; the Clinical Practice Guidelines Directory, 2000 edition; the National Guidelines Clearinghouse, (guideline.gov); and the National Library of Medicine's MEDLINE database on the OVID platform for guidelines on nine chronic diseases (chronic obstructive pulmonary disease, end-stage liver disease, amyotrophic lateral sclerosis, congestive heart failure, dementia, cerebrovascular accident, end-stage renal disease, cancer [breast, colon, prostate, lung], and human immunodeficiency virus). They were assessed by two reviewers for end-of-life content in 15 domains (e.g., epidemiology of death, symptom management, spiritual, family roles, and settings of care), the presence of eight specific terms dealing with palliative care, integration of palliative care information into the guideline, and descriptive variables. Not available. Each guideline was examined and rated on a 0-2 scale (0, absent content; 1, minimal content; 2, helpful content) using 15 end-of-life content domains. Scores from domains were summed and classified into 3 categories: 4 or less, minimal; 5-12, moderate; and more than 12, significant content. Ten percent of guidelines had significant palliative care content, 64% had minimal content, and 26% had moderate content. The least addressed domains dealt with spirituality, ethics, advocacy and family roles. When guidelines that dealt solely with prevention, acute exacerbations or complications of an illness, or specific treatment modalities were excluded 28% and 16% of these general guidelines

  4. Intensity of treatment in Swiss cancer patients at the end-of-life

    Directory of Open Access Journals (Sweden)

    Bähler C

    2018-03-01

    Full Text Available Caroline Bähler,1 Andri Signorell,1 Eva Blozik,1,2 Oliver Reich1 1Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland; 2Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany Purpose: Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods: The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4% died of cancer. Intensity of treatment and health care utilization (including transitions at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results: In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion: Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity

  5. MARS-LMR modeling for the post-test analysis of Phenix End-of-Life natural circulation

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim

    2011-01-01

    For a successful design and analysis of Sodium cooled Fast Reactor (SFR), it is required to have a reliable and well-proven system analysis code. To achieve this purpose, KAERI is enhancing the modeling capability of MARS code by adding the SFR-specific models such as pressure drop model, heat transfer model and reactivity feedback model. This version of MARS-LMR will be used as a basic tool in the design and analysis of future SFR systems in Korea. Before wide application of MARS-LMR code, it is required to verify and validate the code models through analyses for appropriate experimental data or analytical results. The end-of-life test of Phenix reactor performed by the CEA provided a unique opportunity to have reliable test data which is very valuable in the validation and verification of a SFR system analysis code. The KAERI joined this international program of the analysis of Phenix end-of-life natural circulation test coordinated by the IAEA from 2008. The main test of natural circulation was completed in 2009. Before the test the KAERI performed the pre-test analysis based on the design condition provided by the CEA. Then, the blind post-test analysis was also performed based on the test conditions measured during the test before the CEA provide the final test results. Finally, the final post-test analysis was performed recently to predict the test results as accurate as possible. This paper introduces the modeling approach of the MARS-LMR used in the final post-test analysis and summarizes the major results of the analysis

  6. Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life.

    Science.gov (United States)

    Dzeng, Elizabeth; Colaianni, Alessandra; Roland, Martin; Chander, Geetanjali; Smith, Thomas J; Kelly, Michael P; Barclay, Stephen; Levine, David

    2015-05-01

    Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). To explore how physicians' approaches to DNR decision making at the end of life are shaped by institutional cultures and policies surrounding patient autonomy. We performed semistructured in-depth qualitative interviews of 58 internal medicine physicians from 4 academic medical centers (3 in the United States and 1 in the United Kingdom) by years of experience and medical subspecialty from March 7, 2013, through January 8, 2014. Hospitals were selected based on expected differences in hospital culture and variations in hospital policies regarding prioritization of autonomy vs best interest. This study identified the key influences of institutional culture and policies on physicians' attitudes toward patient autonomy in DNR decision making at the end of life. A hospital's prioritization of autonomy vs best interest as reflected in institutional culture and policy appeared to influence the way that physician trainees conceptualized patient autonomy. This finding may have influenced the degree of choice and recommendations physician trainees were willing to offer regarding DNR decision making. Trainees at hospitals where policies and culture prioritized autonomy-focused approaches appeared to have an unreflective deference to autonomy and felt compelled to offer the choice of resuscitation neutrally in all situations regardless of whether they believed resuscitation to be clinically appropriate. In contrast, trainees at hospitals where policies and culture prioritized best-interest-focused approaches appeared to be more comfortable recommending against resuscitation in situations where survival was unlikely. Experienced physicians at all sites similarly did not exclusively allow their actions to be defined by policies and institutional culture and were

  7. A Critical Review of Research on Reuse of Mechanically Recycled FRP Production and End-of-Life Waste for Construction

    Directory of Open Access Journals (Sweden)

    Ardavan Yazdanbakhsh

    2014-06-01

    Full Text Available For the last three decades, fiber reinforced polymer (FRP composite materials have been widely used in major engineering industries. Managing FRP waste is becoming an important issue due to the growth in the production of FRP composite materials. In this article, the issue of FRP waste management is discussed and the commonly used methods for the handling of FRP waste are reviewed. One potentially viable use of FRP waste is in the partial replacement of fillers or aggregates in cementitious materials (particularly portland cement mortar and concrete. A number of important prior investigations performed on the use of FRP waste in concrete and mortar are reviewed. The results from most of those investigations suggest that FRP aggregates significantly reduce the strength of cementitious materials with little significant effect on durability. Recommendations for future research in this area are provided for producing stronger mortars and concretes incorporating FRP production and end-of-life waste.

  8. "End-of-Life Care? I'm not Going to Worry About That Yet." Health Literacy Gaps and End-of-Life Planning Among Elderly Dialysis Patients.

    Science.gov (United States)

    Ladin, Keren; Buttafarro, Katie; Hahn, Emily; Koch-Weser, Susan; Weiner, Daniel E

    2018-03-19

    Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston. Themes were interpreted in the context of Nutbeam's health literacy framework. Despite high mortality risk in this population, only 13% of patients had discussed EOL preferences with physicians, half had discussed EOL with their social network, and 25% of participants explicitly stated that they had never considered EOL preferences. Less than 30% of participants could correctly define terminology commonly used in EOL conversations. Analyses yielded 5 themes: (1) Misunderstanding EOL terminology; (2) Nephrologists reluctant to discuss EOL; (3) Patients conforming to socially constructed roles; (4) Discordant expectations and dialysis experiences; and (5) Reconciling EOL values and future care. Patients had limited understanding of EOL terminology, lacked of opportunities for meaningful EOL discussion with providers and family, resulting in uncertainty about future care. Limited health literacy presents a substantial barrier to communication and could lead to older adults committing to an intensive pattern of care without adequate information. Clinicians should consider health literacy when discussing dialysis initiation.

  9. Refinement of a Conceptual Model for Adolescent Readiness to Engage in End-of-Life Discussions.

    Science.gov (United States)

    Bell, Cynthia J; Zimet, Gregory D; Hinds, Pamela S; Broome, Marion E; McDaniel, Anna M; Mays, Rose M; Champion, Victoria L

    Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions. The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited. We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness. Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions. Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation. Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.

  10. Cross-current leaching of indium from end-of-life LCD panels.

    Science.gov (United States)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana; Ubaldini, Stefano; De Michelis, Ida; Kopacek, Bernd; Vegliò, Francesco; Beolchini, Francesca

    2015-08-01

    Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2M sulfuric acid at 80°C for 10min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85-90%, and with 6 steps it was about 50-55%. Indium concentration in the leachate was about 35mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO2 (with 10 steps we assessed that the emission of about 90kg CO2-Eq. could be avoided) thanks to the recovery of indium. This new strategy represents a useful approach for secondary production of indium from waste LCD panels. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. After you: conversations between patients and healthcare professionals in planning for end of life care

    Directory of Open Access Journals (Sweden)

    Almack Kathryn

    2012-09-01

    Full Text Available Abstract Background This study explores with patients, carers and health care professionals if, when and how Advance Care Planning conversations about patients’ preferences for place of care (and death were facilitated and documented. Methods The study adopted an exploratory case study design using qualitative interviews, across five services delivering palliative care to cancer and non-cancer patients within an urban and rural English region. The study recruited 18 cases made up of patients (N = 18; 10 men; 8 women; median age 75; nominated relatives (N = 11; 7 women; 4 men; median age 65 and healthcare professionals (N = 15 caring for the patient. Data collection included: 18 initial interviews (nine separate interviews with patients and 9 joint interviews with patients and relatives and follow up interviews in 6 cases (involving a total of 5 patients and 5 relatives within one year of the first interview. Five group interviews were conducted with 15 healthcare professionals; 8 of whom also participated in follow up interviews to review their involvement with patients in our study. Results Patients demonstrated varying degrees of reticence, evasion or reluctance to initiate any conversations about end of life care preferences. Most assumed that staff would initiate such conversations, while staff were often hesitant to do so. Staff-identified barriers included the perceived risks of taking away hope and issues of timing. Staff were often guided by cues from the patient or by intuition about when to initiate these discussions. Conclusions This study provides insights into the complexities surrounding the initiation of Advance Care Planning involving conversations about end of life care preferences with patients who are identified as having palliative care needs, in particular in relation to the risks inherent in the process of having conversations where mortality must be acknowledged. Future research is needed to examine how to

  12. Impact of Treatment Subsidies and Cash Payouts on Treatment Choices at the End of Life.

    Science.gov (United States)

    Finkelstein, Eric; Malhotra, Chetna; Chay, Junxing; Ozdemir, Semra; Chopra, Akhil; Kanesvaran, Ravindran

    To examine the extent to which financial assistance, in the form of subsidies for life-extending treatments (LETs) or cash payouts, distorts the demand for end-of-life treatments. A discrete choice experiment was administered to 290 patients with cancer in Singapore to elicit preferences for LETs and only palliative care (PC). Responses were fitted to a latent class conditional logistic regression model. We also quantified patients' willingness to pay to avoid and willingness to accept a less effective LET or PC-only. We then simulated the effects of various LET subsidy and cash payout policies on treatment choices. We identified three classes of patients according to their preferences. The first class (26.1% of the sample) had a strong preference for PC and were willing to give up life expectancy gains and even pay for receiving only PC. The second class (29.8% of the sample) had a strong preference for LETs and preferred to extend life regardless of cost or quality of life. The final class (44.1% of the sample) preferred LETs to PC, but actively traded off costs and length and quality of life when making end-of-life treatment choices. Policy simulations showed that LET subsidies increase demand for LETs at the expense of demand for PC, but an equivalent cash payout was not shown to distort demand. Patients with cancer have heterogeneous end-of-life preferences. LET subsidies and cash payouts have differing effects on the use of LETs. Policymakers should be mindful of these differences when designing health care financing schemes for patients with life-limiting illnesses. Copyright © 2016. Published by Elsevier Inc.

  13. Moral distress in end-of-life care in the intensive care unit.

    Science.gov (United States)

    St Ledger, Una; Begley, Ann; Reid, Joanne; Prior, Lindsay; McAuley, Danny; Blackwood, Bronagh

    2013-08-01

    To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit. Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown. A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011). In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on 'Healthtalkonline' by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012). This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy. © 2012 Blackwell Publishing Ltd.

  14. Life cycle and nano-products: end-of-life assessment

    International Nuclear Information System (INIS)

    Asmatulu, Eylem; Twomey, Janet; Overcash, Michael

    2012-01-01

    Understanding environmental impacts of nanomaterials necessitates analyzing the life cycle profile. The initial emphasis of nanomaterial life cycle studies has been on the environmental and health effects of nanoproducts during the production and usage stages. Analyzing the end-of-life (eol) stage of nanomaterials is also critical because significant impacts or benefits for the environment may arise at that particular stage. In this article, the Woodrow Wilson Center’s Project on Emerging Nanotechnologies (PEN) Consumer Products Inventory (CPI) model was used, which contains a relatively large and complete nanoproduct list (1,014) as of 2010. The consumer products have wide range of applications, such as clothing, sports goods, personal care products, medicine, as well as contributing to faster cars and planes, more powerful computers and satellites, better micro and nanochips, and long-lasting batteries. In order to understand the eol cycle concept, we allocated 1,014 nanoproducts into the nine end-of-life categories (e.g., recyclability, ingestion, absorption by skin/public sewer, public sewer, burning/landfill, landfill, air release, air release/public sewer, and other) based on probable final destinations of the nanoproducts. This article highlights the results of this preliminary assessment of end-of-life stage of nanoproducts. The largest potential eol fate was found to be recyclability, however little literature appears to have evolved around nanoproduct recycling. At lower frequency is dermal and ingestion human uptake and then landfill. Release to water and air are much lower potential eol fates for current nanoproducts. In addition, an analysis of nano-product categories with the largest number of products listed indicated that clothes, followed by dermal-related products and then sports equipment were the most represented in the PEN CPI (http://www.nanotechproject.org/inventories/consumer/browse

  15. Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice.

    Science.gov (United States)

    Kramer, Betty J; Boelk, Amy Z

    2015-08-01

    Despite the palliative care mandate to view family as the unit of care, and the high prevalence and detrimental consequences of conflict at the end of life, little research has been conducted with hospice families to understand what contributes to family conflict. Using a recently generated explanatory matrix of family conflict at the end of life, this study sought to identify the correlates and predictors of family conflict. As part of a larger mixed methods cross-sectional study, a 100-item survey was administered to 161 hospice family caregivers enrolled in a Medicare/Medicaid certified non-profit hospice organization located in the Midwest U.S. Although overall levels of conflict were relatively low, 57% of hospice caregivers reported experiencing some family conflict at the end of life. Contextual variables associated with family conflict included a history of family conflict, female gender, younger caregiver age, presence of children in the home, and less advance care planning discussions. Significant main effects in the prediction of family conflict in the final hierarchical multiple regression model included prior family conflict, caregiver age, caregiver gender, advance care planning discussions, family "coming out of the woodwork," communication constraints, and family members asserting control. The model explained 59% of the variance in family conflict. Results support the multidimensional theoretical model of family conflict specifying the importance of the family context, key conditions that set the stage for conflict, and essential contributing factors. Implications for routine assessment and screening to identify families at risk and recommendations for future research are highlighted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Life cycle and nano-products: end-of-life assessment

    Energy Technology Data Exchange (ETDEWEB)

    Asmatulu, Eylem; Twomey, Janet; Overcash, Michael, E-mail: mrovercash@earthlink.net [Wichita State University, Department of Industrial and Manufacturing Engineering (United States)

    2012-03-15

    Understanding environmental impacts of nanomaterials necessitates analyzing the life cycle profile. The initial emphasis of nanomaterial life cycle studies has been on the environmental and health effects of nanoproducts during the production and usage stages. Analyzing the end-of-life (eol) stage of nanomaterials is also critical because significant impacts or benefits for the environment may arise at that particular stage. In this article, the Woodrow Wilson Center's Project on Emerging Nanotechnologies (PEN) Consumer Products Inventory (CPI) model was used, which contains a relatively large and complete nanoproduct list (1,014) as of 2010. The consumer products have wide range of applications, such as clothing, sports goods, personal care products, medicine, as well as contributing to faster cars and planes, more powerful computers and satellites, better micro and nanochips, and long-lasting batteries. In order to understand the eol cycle concept, we allocated 1,014 nanoproducts into the nine end-of-life categories (e.g., recyclability, ingestion, absorption by skin/public sewer, public sewer, burning/landfill, landfill, air release, air release/public sewer, and other) based on probable final destinations of the nanoproducts. This article highlights the results of this preliminary assessment of end-of-life stage of nanoproducts. The largest potential eol fate was found to be recyclability, however little literature appears to have evolved around nanoproduct recycling. At lower frequency is dermal and ingestion human uptake and then landfill. Release to water and air are much lower potential eol fates for current nanoproducts. In addition, an analysis of nano-product categories with the largest number of products listed indicated that clothes, followed by dermal-related products and then sports equipment were the most represented in the PEN CPI (http://www.nanotechproject.org/inventories/consumer/browse

  17. Aging Prisoners’ Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    Science.gov (United States)

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated primarily for murder. Design and Methods: Inmates over the age of 45 who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7; SD = 10.68). Results: We found a 3-way interaction indicating that the effect of parole expectation on desire for life-sustaining treatment varied by race/ethnicity and treatment. Minority inmates desired cardiopulmonary resuscitation or feeding tubes only if they believed that they would be paroled. The model predicting desire for palliative care was not significant. Future days of desired life were related to prospective health condition, fear of death, negative affect, and trust in prison health care. Caucasian inmates expressed a desire for more days of life out of prison, whereas minority inmates did not differ in days of desired life either in or out of prison. Minorities wanted more days of life than Caucasians but only if they believed that they would be paroled. Implications: End-of-life care for the burgeoning inmate population is costly, and active life-sustaining treatments may not be desired under certain conditions. Specifically, expectation of parole but not current functional ability interacts with future illness condition in explaining inmates’ desire for active treatment or days of desired life in the future. PMID:21593007

  18. End-of-life decision-making and terminal sedation among very old patients.

    Science.gov (United States)

    De Gendt, Cindy; Bilsen, Johan; Mortier, Freddy; Vander Stichele, Robert; Deliens, Luc

    2009-01-01

    About half of the persons who die in developed countries are very old (aged 80 years or older) and this proportion is still rising. In general, there is little information available concerning the circumstances and quality of the end of life of this group. This study aims (1) to describe the incidence and characteristics of medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) and terminal sedation among very old patients who died nonsuddenly, (2) to describe the characteristics of the preceding decision-making process, and (3) to compare this with the deaths of younger patients. A sample of 5,005 death certificates was selected from all deaths in Flanders (Belgium) in the second half of 2001 (before euthanasia was legalized). Questionnaires were mailed to the certifying physicians. Response rate was 58.9%. An ELD was made for 53.6% very old (aged 80+) patients who died nonsuddenly (vs. 63.3% for the younger patients). Use of life-ending drugs occurred among 1.1% (six times less frequently than in younger patients), with no euthanasia cases, pain and symptom alleviation with a possible life-shortening effect among 27.3% (two times less frequently), and withholding or withdrawing life-prolonging treatments among 25.2% (slightly more frequently). Terminal sedation occurred among 6.9% of the cases, two times less frequently than for the younger patients. ELDs were not often discussed with very old patients. Among competent patients this was less than compared with younger patients. ELDs are less common for very old than for younger patients. Physicians seem to have a more reluctant attitude towards the use of lethal drugs, terminal sedation and participation in decision-making when dealing with very old patients. Advance care planning should increase the involvement of very old competent and noncompetent patients in end-of-life decision-making. (c) 2008 S. Karger AG, Basel.

  19. Evaluation end-of-life power generation of a satellite solar array

    International Nuclear Information System (INIS)

    Taherbaneh, Mohsen; Ghafooifard, H.; Rezaie, A.H.; Rahimi, K.

    2011-01-01

    Research highlights: → We present detailed design description and necessary considerations for solar panels utilized in a specific space mission. → All sources of losses and degradation of the solar panels are fully taken into account. → We introduce a comprehensive novel approach to investigate the electrical behavior of the solar panels. → We use a simple model to calculate the operating temperature range of the solar panels. → We also calculate Mission End-of-Life electrone fluence using SPENVIS. -- Abstract: Knowing the power generated by of solar arrays in a space missions shall satisfy mission requirements; prediction of the power generated by a solar array used in a space mission is very important and necessary. In this research, a detailed design description and necessary considerations for solar panels utilized in a specific space mission is presented. All sources of losses and degradation of solar panels are fully taken into account. This research emphasizes on investigation, analysis and verification of a manufactured solar assembly for a satellite before launch. Solar panels' generated power should be estimated at the end of the mission. For this purpose, radiation values and temperature operating range are specified for the mission. Panels' temperature operating rate is determined through considering a simple model and different spins for the satellite. Mission end-of-life 1 MeV equivalent dose is calculated by SPENVIS suite software. Finally, a comprehensive novel approach is introduced to investigate the electrical behavior of the solar panels. This approach can be implemented in MATLAB environment to obtain output power characteristics of the solar panels for each specific mission. The results are in full accordance with the mission requirements either in beginning-of-life or end-of-life. Therefore, the power prediction of the designed solar array for the mentioned satellite completely satisfies its mission requirements.

  20. Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

    Science.gov (United States)

    Coyle, Nessa; Manna, Ruth; Shen, Megan; Banerjee, Smita C; Penn, Stacey; Pehrson, Cassandra; Krueger, Carol A; Maloney, Erin K; Zaider, Talia; Bylund, Carma L

    2015-12-01

    Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

  1. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

    Science.gov (United States)

    Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

    2014-01-01

    Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

  2. Recycling of Gallium from End-of-Life Light Emitting Diodes

    Directory of Open Access Journals (Sweden)

    Nagy S.

    2017-06-01

    Full Text Available Nowadays Light Emitting Diodes (LEDs are widely utilized. They are applied as backlighting in Liquid Crystal Displays (LCD and TV sets or as lighting equipments in homes, cars, instruments and street-lightning. End of life equipments are containing more and more LEDs. The recovery of valuable materials – such as Ga, Au, Cu etc. – from the LEDs is essential for the creating the circular economy. First task is the development of a proper recycling technology. Most of the researchers propose fully chemical or thermal-chemical pathway for the recycling of LEDs.

  3. Recycling strategy of the end-of-life rolling stock in China

    Science.gov (United States)

    Guo, L.; Wang, X. W.; Lin, Y.; Shen, X. F.; Liu, Y. Q.

    2018-03-01

    China's high-speed railway industry is growing fast, the side effect is that plenty of rolling stock come to the end of life each year. However, there are not relevant standards nor regulations for the recycling of rolling stock in China, which causes pollution and a waste of resources. In this paper, the basic meaning and characteristics of the circular economy is reviewed and applied to the rolling stock industry. The recycling steps are elaborated in detail according to the characteristics of rolling stock. The result proves that circular economy has both the theoretical and practical meaning in the rolling stock recycling industry in China.

  4. Working with Russian-Jewish immigrants in end-of-life care settings.

    Science.gov (United States)

    Newhouse, Leonid

    2013-01-01

    This article examines Russian-Jewish immigrant clients' attitudes toward death and dying in the context of today's health care system. Aspects of individuals' collective past--such as the traumatic history of their country of origin; cultural prohibitions against discussing pain, suffering, and death; and the lack of familiarity with palliative care that are likely to affect their decisions about end-of-life care--are discussed. Case vignettes are provided, with a discussion on how best to engage these clients in therapeutic work.

  5. Cross-current leaching of indium from end-of-life LCD panels

    Energy Technology Data Exchange (ETDEWEB)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Ubaldini, Stefano [Institute of Environmental Geology and Geoengineering IGAG, National Research Council, Via Salaria km 29300, 00015 Montelibretti, Rome (Italy); De Michelis, Ida [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Kopacek, Bernd [ISL Kopacek KG, Beckmanngasse 51, 1140 Wien (Austria); Vegliò, Francesco [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Beolchini, Francesca, E-mail: f.beolchini@univpm.it [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy)

    2015-08-15

    Graphical abstract: Display Omitted - Highlights: • End-of-life LCD panels represent a source of indium. • Several experimental conditions for indium leaching have been assessed. • Indium is completely extracted with 2 M sulfuric acid at 80 °C for 10 min. • Cross-current leaching improves indium extraction and operating costs are lowered. • Benefits to the environment come from reduction of CO{sub 2} emissions and reagents use. - Abstract: Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2 M sulfuric acid at 80 °C for 10 min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100 ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85–90%, and with 6 steps it was about 50–55%. Indium concentration in the leachate was about 35 mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO{sub 2} (with 10 steps we assessed that the emission of about 90 kg CO{sub 2}-Eq. could be avoided) thanks to the recovery of indium

  6. United States Acculturation and Cancer Patients’ End-of-Life Care

    Science.gov (United States)

    Wright, Alexi A.; Stieglitz, Heather; Kupersztoch, Yankel M.; Paulk, M. Elizabeth; Kim, Yookyung; Katz, Ingrid T.; Munoz, Francisco; Jimenez, Rachel B.; Mutchler, Jan; Rivera, Lorna; Back, Anthony L.; Prigerson, Holly G.

    2013-01-01

    Background Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care. Methods and Findings In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, Punit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12). Conclusion The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more

  7. Palliative Care and the Humanities: Centralizing the Patient at the End of Life.

    Science.gov (United States)

    Franke, Richard J

    2016-03-01

    Palliative care is a quickly growing facet of modern medicine. While scientific advancements have broken new ground for the possibilities of end-of-life care, sensitive treatment of the patient as an individual has lagged behind and has frequently led to an unsatisfactory experience for patients, families, and the medical community at large. This essay argues that centralizing patients during the terminal phases of treatment by using humanistic perspectives has the potential to bring new meaning and improved effectiveness to patients and physicians alike.

  8. Framing Effects on End-of-Life Preferences Among Latino Elders.

    Science.gov (United States)

    Vélez Ortiz, Daniel; Martinez, Rubén O; Espino, David V

    2015-01-01

    This study compared how the presentation of end-of-life (EOL) choices influences responses by Latino and White older adults relative to resuscitation preferences. The authors apply prospect theory, which deals with decision making based on how choices are framed. Participants were presented with differently ordered questions framing a resuscitation scenario and asked to rate their preferences. Results show that Latino participants were significantly influenced by the framing order of treatment options with regard to resuscitation while Whites were not. Health professionals need to be aware that the ways they present EOL options are likely to affect the choices of Latino older adults. Further research is needed with Latino subgroups.

  9. [Plato's philosophy and the bioethical debate on the end of life: intersections in public health].

    Science.gov (United States)

    Siqueira-Batista, Rodrigo; Schramm, Fermin Roland

    2004-01-01

    This article discusses bioethical aspects of medical futility, focusing on some of its intersections in public health. Starting from a demarcation of finitude in the core of the philosophical and bioethical debate on the end of life, we confront the contemporary criticism regarding medical futility with the ideas of Plato (427-347 B.C.), a philosopher who proposed significant considerations on numerous features of the medicine of his time. We thus explore novel theoretic references to guide the disputes related to this essential problem, the implications of which are decisive to health and life.

  10. The importance of communication in sustaining hope at the end of life.

    Science.gov (United States)

    Hawthorn, Maureen

    How can health professionals, especially those working in busy environments, foster hope and communicate effectively and therapeutically with patients at the end of their lives? Many authors agree that failure to comprehend the essence of what patients are communicating, either verbally or non-verbally, can adversely affect the level of support that health professionals can offer, and risks increasing patients' suffering and isolation, leaving them feeling hopeless. Anxiety and fear frequently invoke hopelessness and often cause patients to reject advice and important information given by clinicians. This article focuses on the importance of therapeutic communication in sustaining hope for patients at the end of life.

  11. Symptoms and suffering at the end of life in children with cancer: an Australian perspective.

    Science.gov (United States)

    Heath, John A; Clarke, Naomi E; Donath, Susan M; McCarthy, Maria; Anderson, Vicki A; Wolfe, Joanne

    2010-01-18

    To examine the symptoms, level of suffering, and care of Australian children with cancer at the end of life. In a study conducted at the Royal Children's Hospital, Melbourne, parents of children who had died of cancer over the period 1996-2004 were interviewed between February 2004 and August 2006. Parents also completed and returned self-report questionnaires. Proportions of children suffering from and treated for various symptoms; proportion of children receiving cancer-directed therapy at the end of life; proportion of children whose treatment of symptoms was successful; location of death. Of 193 eligible families, 96 (50%) were interviewed. All interviews were conducted in person, and occurred a mean of 4.5 years (SD, 2.1 years) after the child's death. Eighty-four per cent of parents reported that their child had suffered "a lot" or "a great deal" from at least one symptom in their last month of life--most commonly pain (46%), fatigue (43%) and poor appetite (30%). Children who received cancer-directed therapy during the end-of-life period (47%) suffered from a greater number of symptoms than those who did not receive treatment (P = 0.03), but the severity of symptoms did not differ between these groups. Of the children treated for specific symptoms, treatment was successful in 47% of those with pain, 18% of those with fatigue and 17% of those with poor appetite. Of the 61 families who felt they had time to plan where their child would die, 89% preferred to have their child die at home. The majority of children (61%) died at home. Of those who died in hospital, less than a quarter died in the intensive care unit. Relatively high rates of death at home and low rates of unsuccessful medical interventions suggest a realistic approach at the end of life for Australian children dying of cancer. However, many suffer from unresolved symptoms, and greater attention should be paid to palliative care for these children.

  12. End of life and life after death - issues to be addressed

    Directory of Open Access Journals (Sweden)

    Poojar Sridhar

    2012-01-01

    Full Text Available Being an Oncologist, I have seen many patients suffering from cancer. It pains a lot looking at them fighting the battle of life, though knowing that they would lose miserably and surrender meekly as majority of the patients report to the hospital at an advanced stage of disease and only palliative care may be the option. There is an urgent need to create - Cancer Awareness in the villages and also about the end of life care in all terminally ill patients. 20 patients in the terminal phase were questioned regarding end of life care. The common questions they asked are, why has God punished me like this? Why me on earth? Should I die so early? Why should I leave my near and dear ones and go far away, from the point of no return? Do I ever see them again? With deep sorrow and sigh, they suffer till the last breath, having the feeling of insecurity as what would happen to their dear ones. In the terminal phase, the patients wishes must be respected and their needs must be fulfilled. The health care professionals should plan an appropriate care for each patient. Most of them feel that the best place to be in end of life is the home. Research has shown that Hospice care may improve the quality of life of a patient who is dying and of the patient′s family. Communication about end of life care and decision making during the final moments of a person′s life are very important. The patients suffering are mainly due to the physical, psychological, social and spiritual issues. Death of a terminally ill patient should never be a sudden loss. All healthcare professionals, Social workers and Non-Governmental Organisations must install the life after death of the person, who has struggled for every breath and assure that he/she shall rest in peace and shall smile seeing their near and dear ones living with dignity and pride in the society. Ultimately, the patient must have dignity in dying.

  13. The experiences of pediatric social workers providing end-of-life care.

    Science.gov (United States)

    Muskat, Barbara; Brownstone, David; Greenblatt, Andrea

    2017-07-01

    Pediatric social workers working in acute care hospital settings may care for children and their families in end-of-life circumstances. This qualitative study is part of a larger study focusing on the experiences of health care providers working with dying children. This study consisted of 9 semi-structured interviews of acute care pediatric social workers who work with dying children and their families. Themes included the role of social work with dying children, the impact of their work and coping strategies. Authors suggest a hospital-worker partnership in supporting staff and promotion of supportive resources.

  14. Performance of irradiated silicon microstrip detectors

    International Nuclear Information System (INIS)

    Catacchini, E.; Civinini, C.; D'Alessandro, R.; Focardi, E.; Lenzi, M.; Meschini, M.; Parrini, G.; Pieri, M.

    1999-01-01

    Silicon microstrip devices to be installed in Large Hadron Collider (LHC) tracking detectors will have to operate in a high radiation environment. We report on performance studies of silicon microstrip detectors irradiated with neutrons or protons, up to fluences comparable to the first ten years of running at LHC. Obtained results show that irradiated detectors can still be operated with satisfactory signal-to-noise ratio,and in the case of inhomogeneously type inverted detector a very good position resolution is achieved regardless of the zone crossed by the particle

  15. [Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

    Science.gov (United States)

    Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

    2009-02-01

    The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

  16. Mechanical performance of irradiated beryllium pebbles

    Energy Technology Data Exchange (ETDEWEB)

    Scaffidi-Argentina, F.; Dalle-Donne, M.; Werle, H. [Forschungszentrum Karlsruhe GmbH Technik und Umwelt (Germany). Inst. fuer Neutronenphysik und Reaktortechnik

    1998-01-01

    For the Helium Cooled Pebble Bed (HCPB) Blanket, which is one of the two reference concepts studied within the European Fusion Technology Programme, the neutron multiplier consists of a mixed bed of about 2 and 0.1-0.2 mm diameter beryllium pebbles. Beryllium has no structural function in the blanket, however microstructural and mechanical properties are important, as they might influence the material behavior under neutron irradiation. The EXOTIC-7 as well as the `Beryllium` experiments carried out in the HFR reactor in Petten are considered as the most detailed and significant tests for investigating it. This paper reviews the present status of beryllium post-irradiation examinations performed at the Forschungszentrum Karlsruhe with samples from these irradiation experiments, emphasizing the effects of irradiation of essential material properties and trying to elucidate the processes controlling the property changes. The microstructure, the porosity distribution, the impurity content, the behavior under compression loads and the compatibility of the beryllium pebbles with lithium orthosilicate (Li{sub 4}SiO{sub 4}) during the in-pile irradiation are presented and critically discussed. Qualitative information on ductility and creep obtained by hardness-type measurements are also supplied. (author)

  17. Impacts of care-giving and sources of support: a comparison of end-of-life and non-end-of-life caregivers in Canada.

    Science.gov (United States)

    Williams, Allison M; Wang, Li; Kitchen, Peter

    2016-03-01

    This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life (EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non-EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey (GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non-EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non-EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non-EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

  18. Dire deadlines: coping with dysfunctional family dynamics in an end-of-life care setting.

    Science.gov (United States)

    Holst, Lone; Lundgren, Maren; Olsen, Lutte; Ishøy, Torben

    2009-01-01

    Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. The hospice triad--the patient, the staff member and the family member--forms the basis for communication and intervention in a hospice. Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.

  19. [End-of-life care in a Spanish Pediatric Intensive Care Unit: staff and parental evaluation].

    Science.gov (United States)

    Tagarro García, A; Dorao Martínez-Romillo, P; Moraleda, S; López, P; Moreno, T; San-José, B; Martínez Biarge, M; Tapia Moreno, R; Ruza-Tarrío, F

    2008-04-01

    To evaluate end-of-life care in a Paediatric Intensive Care Unit (PICU). Retrospective study developed in a PICU. 41 workers from the PICU and parents of 26 deceased children (from 2001 to 2005). A questionnaire was designed to investigate end-of-life care. An age parents were with their children at the time of death; 64 % of all parents consider this "positive", and 13 % consider it "negative". Forty per cent of staff stated that it is "positive" for parents to be by the side of their child at the time of death, and 52 % do not know. Seventy-three per cent of staff, but only 29 % of parents want further professional psychological support for parents. Twenty per cent of children died following withdrawal of life support. The most important factors for this decision were the possibility of survival and quality of life. The majority (73 %) of caregivers express the view that often, this decision should be taken earlier. Analysis of staff opinions underlines the importance of the way news is communicated, the timing of withdrawal of life support, and the need for psychological support. Parents emphasized the role of the family during time spent in a PICU and during the last moments.

  20. [Typologies of Madrid's citizens (Spain) at the end-of-life: cluster analysis].

    Science.gov (United States)

    Ortiz-Gonçalves, Belén; Perea-Pérez, Bernardo; Labajo González, Elena; Albarrán Juan, Elena; Santiago-Sáez, Andrés

    2018-03-06

    To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. Five clusters stand out. Cluster 1: a group who preferred not to answer numerous questions (5%). Cluster 2: in favour of receiving palliative care and euthanasia (40%). Cluster 3: would oppose assisted suicide and would not ask for spiritual assistance (15%). Cluster 4: would like to receive palliative care and assisted suicide (16%). Cluster 5: would oppose assisted suicide and would ask for spiritual assistance (24%). The following four clusters stood out. Clusters 2 and 4 would like to receive palliative care, euthanasia (2) and assisted suicide (4). Clusters 4 and 5 regularly practiced their faith and their family members did not receive palliative care. Clusters 3 and 5 would be opposed to euthanasia and assisted suicide in particular. Clusters 2, 4 and 5 had not completed an advance directive document (2, 4 and 5). Clusters 2 and 3 seldom practiced their faith. This study could be taken into consideration to improve the quality of end-of-life care choices. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Experience with an end-of-life practice at a university hospital.

    Science.gov (United States)

    Campbell, M L; Frank, R R

    1997-01-01

    To describe a 10-yr experience with an end-of-life practice in a hospital. A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team. Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital. Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice. None. Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting. A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

  2. Thermo-Catalytic Pyrolysis of Waste Plastics from End of Life Vehicle

    Directory of Open Access Journals (Sweden)

    Miskolczi Norbert

    2016-01-01

    Full Text Available Pyrolysis of waste plastics is widely used recycling method. Owing to the end-of-life vehicles regulations, 95% of passenger cars and vehicles must reused/recovered after the dismantling. Pyrolysis of waste polyethylene and polypropylene obtained from end-of-life vehicles was investigated in a continuously stirred batch reactor using 500 and 600°C temperatures. To ensure the pyrolysis reactions the tested catalysts (5% of ZSM-5, HZSM-5, Ni-ZSM-5 and Fe-ZSM-5 were added directly to the mixtures of raw materials. Products of pyrolysis were separated into gases, pyrolysis oil and heavy oil, which was further analyzed by gas-chromatography, Fourier transformed infrared spectroscopy and other standardized methods. Based on the results it was concluded, that the catalysts significantly increase the yields of volatile products, and modify their composition. Especially the alkane/alkene ratio, the methane concentration and the concentration of branched hydrocarbon could be affected by the applied catalysts. Ni-ZSM-5 catalyst had the highest activity in methane production, while HZSM-5 catalyst proved effective in isomerization reactions. Using H-ZSM-5, Ni-ZSM-5, and Fe-ZSM-5 catalyst notably decreased average molecular weight of pyrolysis oils and significantly higher aromatic content was observed.

  3. Parental Perspectives of Communication at the End of Life at a Pediatric Oncology Institution.

    Science.gov (United States)

    Snaman, Jennifer M; Torres, Carlos; Duffy, Brian; Levine, Deena R; Gibson, Deborah V; Baker, Justin N

    2016-03-01

    The interaction of health care providers and hospital staff with patients and families at the end of life affects the parental grief experience. Both verbal and nonverbal communication are key components of this interaction. The study objective was to explore the communication between hospital staff members and patients and families at the time of patients' health decline near the end of life. Twelve bereaved parents participated in a focus group. Semantic content analysis was used to analyze the transcript. Parents' responses to the prompt about typical ways the medical team communicated yielded 109 codes, which were grouped into 12 themes. The most common themes were "patient inclusion" and "explanation of medical plan," both used in 17% of responses. Responses to the prompt about positive and negative aspects of communication generated 208 codes, yielding 15 different themes. The most common theme about positive communication was the "strong relationship between family and staff." The theme "variations in care with a negative impact" was used most frequently in describing negative communication. This study helps to identify techniques that should be used by clinicians as they work with children with cancer and their families, particularly including patients in treatment decisions, ongoing relationship building, communicating with caring and empathy, using an interdisciplinary team for additional support, and pairing bad news with a plan of action.

  4. Reducing environmental burdens of solid-state lighting through end-of-life design

    International Nuclear Information System (INIS)

    Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C

    2010-01-01

    With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

  5. Reducing environmental burdens of solid-state lighting through end-of-life design

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C, E-mail: cth@cmu.ed [Green Design Institute, Carnegie Mellon University (United States)

    2010-01-15

    With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

  6. Older Adults Making End of Life Decisions: An Application of Roy's Adaptation Model

    Directory of Open Access Journals (Sweden)

    Weihua Zhang

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient’s perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning.

  7. Communication skills training for dialysis decision-making and end-of-life care in nephrology.

    Science.gov (United States)

    Schell, Jane O; Green, Jamie A; Tulsky, James A; Arnold, Robert M

    2013-04-01

    Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh (n=22). Pre- and post-workshop surveys evaluated efficacy of the curriculum and measured changes in perceived preparedness on the basis on workshop training. Overall, 14% of fellows were white and 50% were male. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86% and 100%. Only 36% (8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skills were important to being a "great nephrologist." Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5-1.14; Pdecision-making and end-of-life care.

  8. Barriers and facilitators to end-of-life communication in advanced chronic organ failure.

    Science.gov (United States)

    Van den Heuvel, Liza Amc; Spruit, Martijn A; Schols, Jos Mga; Hoving, Ciska; Wouters, Emiel Fm; Janssen, Daisy Ja

    2016-05-01

    The aim of this quantitative, cross-sectional study was to identify barriers and facilitators to end-of-life communication experienced by family caregivers of patients with advanced chronic organ failure and to examine agreement in barriers and facilitators between family caregivers and patients. Patients and family caregivers were interviewed using the barriers and facilitators questionnaire. Agreement was determined using intraclass correlation coefficients for continuous variables and Cohen's kappa for categorical variables. A total of 158 patients and family caregiver dyads were included. The most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate. Differences in barriers and facilitators between patients and family caregivers ask for an individual approach to facilitate end-of-life communication.

  9. Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education.

    Science.gov (United States)

    Bergman, Jonathan; Ballon-Landa, Eric; Lerman, Steven E; Kwan, Lorna; Bennett, Carol J; Litwin, Mark S

    2016-09-01

    Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p improvements. Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care. © The Author(s) 2015.

  10. How a Mutation that Slows Aging Can Also Disproportionately Extend End-of-Life Decrepitude

    Directory of Open Access Journals (Sweden)

    Katie Podshivalova

    2017-04-01

    Full Text Available Summary: The goal of aging research is to extend healthy, active life. For decades, C. elegans daf-2 insulin/insulin-like growth factor 1 (IGF-1 receptor mutants have served as a model for extended lifespan and youthfulness. However, a recent report suggested that their longevity is associated with an undesirable phenotype: a disproportionately long period of decrepitude at the end of life. In the human population, such an outcome would be a burden to society, bringing into question the relevance of daf-2 mutants as a model for life extension. However, here we report that, following an extended period of movement, daf-2 mutants survive longer in a decrepit state because of a beneficial trait: they are resistant to colonization of the digestive tract by dietary bacteria, a condition that leads to premature death in the wild-type and prevents their manifestation of decrepitude. If bacterial colonization is prevented, then daf-2 mutants lead both chronologically and proportionately healthier lives relative to the wild-type. : Podshivalova et al. show that long-lived C. elegans insulin/IGF-1 receptor mutants remain active longer but then resist bacterially induced mortality, allowing them to survive into a state of end-of-life decrepitude. Thus, changes that slow aging and also prevent an age-associated catastrophe can extend both the youthful and infirm periods of life. Keywords: aging, lifespan, healthspan, daf-2, mortality, IGF-1, pathogenesis

  11. Identifying changes in the support networks of end-of-life carers using social network analysis.

    Science.gov (United States)

    Leonard, Rosemary; Horsfall, Debbie; Noonan, Kerrie

    2015-06-01

    End-of-life caring is often associated with reduced social networks for both the dying person and for the carer. However, those adopting a community participation and development approach, see the potential for the expansion and strengthening of networks. This paper uses Knox, Savage and Harvey's definitions of three generations social network analysis to analyse the caring networks of people with a terminal illness who are being cared for at home and identifies changes in these caring networks that occurred over the period of caring. Participatory network mapping of initial and current networks was used in nine focus groups. The analysis used key concepts from social network analysis (size, density, transitivity, betweenness and local clustering) together with qualitative analyses of the group's reflections on the maps. The results showed an increase in the size of the networks and that ties between the original members of the network strengthened. The qualitative data revealed the importance between core and peripheral network members and the diverse contributions of the network members. The research supports the value of third generation social network analysis and the potential for end-of-life caring to build social capital. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Enhancing student communication during end-of-life care: A pilot study.

    Science.gov (United States)

    Bloomfield, Jacqueline G; O'Neill, Bernadette; Gillett, Karen

    2015-12-01

    Quality end-of-life care requires effective communication skills, yet medical and nursing students report limited opportunities to develop these skills, and that they lack confidence and the related competence. Our purpose was to design, implement, and evaluate an educational intervention employing simulated patient actors to enhance students' abilities to communicate with dying patients and their families. A study employing a mixed-methods design was conducted with prequalification nursing and medical students recruited from a London university. The first phase involved focus groups with students, which informed the development of an educational intervention involving simulated patient actors. Questionnaires measuring students' perceptions of confidence and competence levels when communicating with dying patients and their families were administered before and after the intervention. The themes from focus groups related to responding to grief and anger, difficulties dealing with emotions, knowing the "right thing" to say, and a lack of experience. A significant increase (p students to communicate with dying patients and their families. The opportunity to develop communication skills was valued. Integration of educational interventions employing simulated patient actors into nursing and medical curricula may assist in improving the care provided to patients at the end of life.

  13. Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report.

    Science.gov (United States)

    Marks, Adam D; Keefer, Patricia; Saul, D'Anna

    2013-12-01

    For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.

  14. Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives.

    Science.gov (United States)

    Bateman, Lori Brand; Clair, Jeffrey Michael

    2015-01-01

    Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

  15. Choice and compassion at the end of life: A critical analysis of recent English policy discourse.

    Science.gov (United States)

    Borgstrom, Erica; Walter, Tony

    2015-07-01

    End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done. Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity. Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Measuring comfort in caregivers and patients during late end-of-life care.

    Science.gov (United States)

    Novak, B; Kolcaba, K; Steiner, R; Dowd, T

    2001-01-01

    The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

  17. Roman concept of mental capacity to make end-of-life decisions.

    Science.gov (United States)

    Mendelson, Danuta

    2007-01-01

    When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62-c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

  18. Methotrimeprazine for the management of end-of-life symptoms in infants and children.

    Science.gov (United States)

    Hohl, Christopher M; Stenekes, Simone; Harlos, Michael S; Shepherd, Erin; McClement, Susan; Chochinov, Harvey Max

    2013-01-01

    This retrospective chart review assessed the efficacy, dose, and safety of methotrimeprazine in palliating end-of-life symptoms in children and infants. A retrospective chart review was conducted of 18 hospitalized pediatric patients who were treated with methotrimeprazine in their last two weeks of life. Data collected included age, diagnosis, symptoms, methotrimeprazine dose, route, efficacy, and any documented adverse effects. Patients' ages ranged from 16 days to 17 years. Underlying conditions included malignancies, trauma, and various neurodegenerative and congenital diseases. All patients (n = 18) were treated for symptoms of agitation, delirium, or restlessness. Most patients also experienced respiratory secretions/congestion (n = 15), pain (n = 13), and/ or dyspnea (n = 9). Less common symptoms included nausea/emesis (n = 5) and spasticity (n = 1). Methotrimeprazine dosages ranged from 0.02 mg/kg/dose to 0.5 mg/kg/dose. Routes of administration included intravenous (n = 13), oral/gastrostomy tube (n = 6), or subcutaneous (n = 4). Sedation (n = 6) was the only documented adverse effect, although when agitation was present, this was potentially an intended and perceived-to-be-beneficial effect. Methotrimeprazine, an old drug with diverse receptor activity and multiple routes of administration, appears to be an effective tool in treating complicated end-of-life symptoms in children and infants. This study provides a foundation for analysis with prospective and comparative trials, which may further quantify its benefit.

  19. Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK.

    Science.gov (United States)

    Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina A; Da Silva Gane, Maria; Stoves, John; Warwick, Graham; Akhtar, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken

    2014-09-01

    South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  20. Irradiation performance of HTGR recycle fissile fuel

    International Nuclear Information System (INIS)

    Homan, F.J.; Long, E.L. Jr.

    1976-08-01

    The irradiation performance of candidate HTGR recycle fissile fuel under accelerated testing conditions is reviewed. Failure modes for coated-particle fuels are described, and the performance of candidate recycle fissile fuels is discussed in terms of these failure modes. The bases on which UO 2 and (Th,U)O 2 were rejected as candidate recycle fissile fuels are outlined, along with the bases on which the weak-acid resin (WAR)-derived fissile fuel was selected as the reference recycle kernel. Comparisons are made relative to the irradiation behavior of WAR-derived fuels of varying stoichiometry and conclusions are drawn about the optimum stoichiometry and the range of acceptable values. Plans for future testing in support of specification development, confirmation of the results of accelerated testing by real-time experiments, and improvement in fuel performance and reliability are described

  1. The role and timing of palliative medicine consultation for women with gynecologic malignancies: association with end of life interventions and direct hospital costs.

    Science.gov (United States)

    Nevadunsky, Nicole S; Gordon, Sharon; Spoozak, Lori; Van Arsdale, Anne; Hou, Yijuan; Klobocista, Merieme; Eti, Serife; Rapkin, Bruce; Goldberg, Gary L

    2014-01-01

    Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission Whitney U, Kaplan-Meier, and Student's T testing. 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0-3) versus 2 (range 0-6) p=0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0-28,019) versus untimely, $7729 (0-52,720), p=0.01. Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs. © 2013. Published by Elsevier Inc. All rights reserved.

  2. Nitride fuels irradiation performance data base

    International Nuclear Information System (INIS)

    Brozak, D.E.; Thomas, J.K.; Peddicord, K.L.

    1987-01-01

    An irradiation performance data base for nitride fuels has been developed from an extensive literature search and review that emphasized uranium nitride, but also included performance data for mixed nitrides [(U,Pu)N] and carbonitrides [(U,Pu)C,N] to increase the quantity and depth of pin data available. This work represents a very extensive effort to systematically collect and organize irradiation data for nitride-based fuels. The data base has many potential applications. First, it can facilitate parametric studies of nitride-based fuels to be performed using a wide range of pin designs and operating conditions. This should aid in the identification of important parameters and design requirements for multimegawatt and SP-100 fuel systems. Secondly, the data base can be used to evaluate fuel performance models. For detailed studies, it can serve as a guide to selecting a small group of pin specimens for extensive characterization. Finally, the data base will serve as an easily accessible and expandable source of irradiation performance information for nitride fuels

  3. Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

    Science.gov (United States)

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

    End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

  4. Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J.E. de; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELD) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  5. Attitudes of nursing staff towards involvement in medical end-of-life decisions: A national survey study

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; de Veer, A.J.E.; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELDs) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  6. Developing the science of end-of-life and palliative care research: National Institute of Nursing Research summit.

    Science.gov (United States)

    Csikai, Ellen L

    2011-01-01

    A rare opportunity to examine accomplishments and identify ways to advance research in end-of-life and palliative care was offered by the National Institute of Nursing Research (NINR) through a summit meeting held in August 2011. The Science of Compassion: Future Directions in End-of-Life and Palliative Care brought together nationally recognized leaders in end-of-life and palliative care research, including grantees of NINR, as well as more than 700 attendees from all disciplines. It was an exciting affirmation of the importance of moving forward in the field. Presented in this article is a summary of the summit and a call to action for end-of-life and palliative care social workers to engage in seeking funding to conduct needed research and to ensure our unique perspective is represented.

  7. Swiss doctors' attitudes towards end-of-life decisions and their determinants: a comparison of three language regions.

    Science.gov (United States)

    Fischer, Susanne; Bosshard, Georg; Faisst, Karin; Tschopp, Alois; Fischer, Johannes; Bär, Walter; Gutzwiller, Felix

    2006-06-10

    To investigate attitudes to end-of-life decisions, and the influence of cultural factors and of doctors' personal characteristics on these attitudes. As part of a European research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among doctors in the German-, French- and Italian-speaking areas of Switzerland. A written questionnaire was sent to a random sample of nine different types of specialist; it presented 14 statements on end-of-life decisions and doctors were asked whether they agreed or disagreed with them. The response rate was 64%. 1360 questionnaires were studied. The results show general agreement with statements on the alleviation of pain and other symptoms with possible life-shortening effect, as well as on non-treatment decisions. The language region was a strong determinant of agreement on some attitudes towards end-of-life decisions. Agreement on the use of lethal drugs and alleviation of pain and other symptoms with possible life-shortening effect was higher among French-speaking than among German- and Italian-speaking doctors. For nontreatment decisions, agreement was higher in the German-speaking region than in the French- and Italian-speaking regions of the country. Italian-speaking doctors were strongly opposed to any kind of end-of-life decision. Religious believers and those who attended a larger number of terminal patients tended to disagree more often with end-of-life decisions than the other doctors. In end-of-life decision-making, Switzerland represents "Europe in miniature". The impact on end-of-life decisions of cultural factors and the number of terminal patients attended needs further consideration.

  8. Exploring the changing multidimensional experiences of frail older people towards the end of life: a narrative study

    OpenAIRE

    Lloyd, Anna Elizabeth

    2015-01-01

    Background Palliative care services have widened beyond cancer in recent years, yet frail older adults rarely receive such services. There is a need to understand the dynamic multidimensional end-of-life experiences of this group in order to assess how or if a palliative approach could be beneficial. Physical end-of-life trajectories for frail older people have been described but there remains little person centred research that describes changing experiences across physical...

  9. Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review.

    Science.gov (United States)

    Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Phillips, Christine B; Wiles, Robert B; Wilson, Donna M

    2017-12-01

    End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.

  10. Interventions at the end of life – a taxonomy for ‘overlapping consensus’ [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    David Clark

    2017-02-01

    Full Text Available Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments.  It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context. Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed.

  11. End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

    Science.gov (United States)

    Keim-Malpass, Jessica; Lindley, Lisa C

    2017-08-01

    Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

  12. Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors' Experience.

    Science.gov (United States)

    Bahus, Marianne K; Førde, Reidun

    2016-09-01

    With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

  13. Planning for Future Care and the End of Life: A Qualitative Analysis of Gay, Lesbian, and Heterosexual Couples.

    Science.gov (United States)

    Thomeer, Mieke Beth; Donnelly, Rachel; Reczek, Corinne; Umberson, Debra

    2017-12-01

    Two key components of end-of-life planning are (1) informal discussions about future care and other end-of-life preferences and (2) formal planning via living wills and other legal documents. We leverage previous work on the institutional aspects of marriage and on sexual-minority discrimination to theorize why and how heterosexual, gay, and lesbian married couples engage in informal and formal end-of-life planning. We analyze qualitative dyadic in-depth interviews with 45 midlife gay, lesbian, and heterosexual married couples ( N = 90 spouses). Findings suggest that same-sex spouses devote considerable attention to informal planning conversations and formal end-of-life plans, while heterosexual spouses report minimal formal or informal planning. The primary reasons same-sex spouses give for making end-of-life preparations are related to the absence of legal protections and concerns about discrimination from families. These findings raise questions about future end-of-life planning for same- and different-sex couples given a rapidly shifting legal and social landscape.

  14. Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

    Science.gov (United States)

    Wilson, Kimberley; Kortes-Miller, Katherine; Stinchcombe, Arne

    2018-03-01

    Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

  15. A critical analysis of the End of Life Choice Bill 2013.

    Science.gov (United States)

    Richmond, David E

    2014-07-04

    This paper aims to alert medical practitioners to the legal and ethical problems that passage of the End of Life Choice Bill (which seeks to legalise euthanasia and physician-assisted suicide) would have for them in New Zealand. Although sponsor MP Maryan Street withdrew the Bill on political grounds in October 2013, she has pledged to reintroduce the Bill after the next Parliamentary elections and remains committed to its objectives. A clause by clause analysis of the Bill was undertaken from a clinical perspective, following the sequence of requesting, validating, providing and reporting episodes of euthanasia or physician-assisted suicide rather than following the administrative sequence in which the Bill has been drawn up for Parliamentary debate. Where possible, the experience of other jurisdictions where these end of life options are legal has been drawn upon to enable inferences to be drawn as to the likely effects of the legislation. The analysis supporting this paper reveals that the legislation would: make it possible for virtually any person over the age of 18 to request and receive euthanasia provided they took care in the way they phrased the request, expose medical practitioners who attempted to deter applicants too vigorously to the possibility of legal action on the grounds of attempting to frustrate the applicant's wishes, compromise the ability of practitioners to opt out on conscience grounds, allow the easy circumvention of reporting requirements for each event, provide minimal protection against some people suffering euthanasia without consent or request, and exempt medical practitioners providing euthanasia services from prosecution for any action in the provision of such services, even if they were negligent. The branch of medical practice that specialises in killing people would be the least regulated of all. If passed into legislation, the End of Life Choice Bill will create the most momentous changes to clinical practice and the regulation

  16. Irradiation and performance evaluation of DUPIC fuel

    International Nuclear Information System (INIS)

    Bae, Ki Kwang; Yang, M. S.; Song, K. C.

    2000-05-01

    The objectives of the project is to establish the performance evaluation system for the experimental verification of DUPIC fuel. The scope and content for successful accomplishment of the phase 1 objectives is established as follows : irradiation test of DUPIC fuel at HANARO using a noninstrument capsule, study on the characteristics of DUPIC pellets, development of the analysis technology on the thermal behaviour of DUPIC fuel, basic design of a instrument capsule. The R and D results of the phase 1 are summarized as follows : - Performance analysis technology development of DUPIC fuel by model development for DUPIC fuel, review on the extendability of code(FEMAXI-IV, FRAPCON-3, ELESTRESS). - Study on physical properties of DUPIC fuel by design and fabrication of the equipment for measuring the thermal property. - HANARO irradiation test of simulated DUPIC fuel by the noninstrument capsule development. - PIE and result analysis

  17. Irradiation and performance evaluation of DUPIC fuel

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ki Kwang; Yang, M S; Song, K C [and others

    2000-05-01

    The objectives of the project is to establish the performance evaluation system for the experimental verification of DUPIC fuel. The scope and content for successful accomplishment of the phase 1 objectives is established as follows : irradiation test of DUPIC fuel at HANARO using a noninstrument capsule, study on the characteristics of DUPIC pellets, development of the analysis technology on the thermal behaviour of DUPIC fuel, basic design of a instrument capsule. The R and D results of the phase 1 are summarized as follows : - Performance analysis technology development of DUPIC fuel by model development for DUPIC fuel, review on the extendability of code(FEMAXI-IV, FRAPCON-3, ELESTRESS). - Study on physical properties of DUPIC fuel by design and fabrication of the equipment for measuring the thermal property. - HANARO irradiation test of simulated DUPIC fuel by the noninstrument capsule development. - PIE and result analysis.

  18. Performance of a proton irradiation chamber

    International Nuclear Information System (INIS)

    Agosteo, S.; Borsato, E.; Dal Corso, F.; Fazzi, A.; Gonella, F.; Introini, M.V.; Lippi, I.; Lorenzoli, M.; Modenese, L.; Montecassiano, F.; Pegoraro, M.; Pola, A.; Varoli, V.; Zotto, P.

    2012-01-01

    A Proton Irradiation Chamber aiming to perform radiation tests of electronic components was developed. The precision on the measurement of the ion currents was pushed beyond the resolution of the picoammeter by means of a series of collimators on the beam showing a linear correlation among the currents measured on them and the smaller, not measurable, current on the target. As an example of the obtained results the tests done on a Si microdosimeter and a power p-MOS are reported.

  19. Performance of a proton irradiation chamber

    Energy Technology Data Exchange (ETDEWEB)

    Agosteo, S. [INFN, Sezione di Milano, via Celoria 16, 20133 Milano (Italy); Politecnico di Milano, Dipartimento di Energia, Sezione di Ingegneria Nucleare-CeSNEF, via Ponzio 34/3 20133 Milano (Italy); Borsato, E. [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Universita di Padova, Dipartimento di Fisica, via Marzolo 8, 35131 Padova (Italy); Dal Corso, F. [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Fazzi, A. [INFN, Sezione di Milano, via Celoria 16, 20133 Milano (Italy); Politecnico di Milano, Dipartimento di Energia, Sezione di Ingegneria Nucleare-CeSNEF, via Ponzio 34/3 20133 Milano (Italy); Gonella, F. [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Introini, M.V. [INFN, Sezione di Milano, via Celoria 16, 20133 Milano (Italy); Politecnico di Milano, Dipartimento di Energia, Sezione di Ingegneria Nucleare-CeSNEF, via Ponzio 34/3 20133 Milano (Italy); Lippi, I. [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Lorenzoli, M. [INFN, Sezione di Milano, via Celoria 16, 20133 Milano (Italy); Politecnico di Milano, Dipartimento di Energia, Sezione di Ingegneria Nucleare-CeSNEF, via Ponzio 34/3 20133 Milano (Italy); Modenese, L.; Montecassiano, F.; Pegoraro, M. [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Pola, A.; Varoli, V. [INFN, Sezione di Milano, via Celoria 16, 20133 Milano (Italy); Politecnico di Milano, Dipartimento di Energia, Sezione di Ingegneria Nucleare-CeSNEF, via Ponzio 34/3 20133 Milano (Italy); Zotto, P., E-mail: pierluigi.zotto@pd.infn.it [INFN, Sezione di Padova, via Marzolo 8, 35131 Padova (Italy); Universita di Padova, Dipartimento di Fisica, via Marzolo 8, 35131 Padova (Italy)

    2012-02-01

    A Proton Irradiation Chamber aiming to perform radiation tests of electronic components was developed. The precision on the measurement of the ion currents was pushed beyond the resolution of the picoammeter by means of a series of collimators on the beam showing a linear correlation among the currents measured on them and the smaller, not measurable, current on the target. As an example of the obtained results the tests done on a Si microdosimeter and a power p-MOS are reported.

  20. Metal fuel manufacturing and irradiation performance

    International Nuclear Information System (INIS)

    Pedersen, D.R.; Walters, L.C.

    1992-01-01

    The advances in metal fuel by the Integral Fast Reactor Program at Argonne National Laboratory are the subject of this paper. The Integral Fast Reactor (IFR) is an advanced liquid-metal-cooled reactor concept being developed at Argonne National Laboratory. The advances stressed in the paper include fuel irradiation performance, and improved passive safety. The goals and the safety philosophy of the Integral Fast Reactor Program are stressed

  1. Manifold dynamics in the Earth-Moon system via isomorphic mapping with application to spacecraft end-of-life strategies

    Science.gov (United States)

    Pontani, Mauro; Giancotti, Marco; Teofilatto, Paolo

    2014-12-01

    application of manifold dynamics to defining suitable, convenient end-of-life strategies for spacecraft orbiting the Earth. Seven distinct options are identified, and lead to placing the spacecraft into the final disposal orbit, which is either (a) a lunar capture orbit, (b) a lunar impact trajectory, (c) a stable lunar periodic orbit, or (d) an outer orbit, never approaching the Earth or the Moon. Two remarkable properties that relate the velocity variations with the spacecraft energy are employed for the purpose of identifying the optimal locations, magnitudes, and directions of the velocity impulses needed to perform the seven transfer trajectories. The overall performance of each end-of-life strategy is evaluated in terms of time of flight and propellant budget.

  2. Overview of statistical methods, models and analysis for predicting equipment end of life

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    Utility equipment can be operated and maintained for many years following installation. However, as the equipment ages, utility operators must decide whether to extend the service life or replace the equipment. Condition assessment modelling is used by many utilities to determine the condition of equipment and to prioritize the maintenance or repair. Several factors are weighted and combined in assessment modelling, which gives a single index number to rate the equipment. There is speculation that this index alone may not be adequate for a business case to rework or replace an asset because it only ranks an asset into a particular category. For that reason, a new methodology was developed to determine the economic end of life of an asset. This paper described the different statistical methods available and their use in determining the remaining service life of electrical equipment. A newly developed Excel-based demonstration computer tool is also an integral part of the deliverables of this project.

  3. An Ethics of Permission: A Response to the California End of Life Option Act.

    Science.gov (United States)

    Nelson, Craig

    2016-01-01

    An ethics of permission can be helpful in framing a response to the ethical differences surrounding the California End of Life Option Act. Law does not define morality, and reaching a moral understanding demands thorough reflection. An ethics of permission examines the ethical demands of a permissive law for both clinician and patient. Serving the good of the patient, respecting professional conscience, and following the law are three ethical elements. Although developing an ethics of permission includes these three elements, these elements do not exhaust all the moral implications involved. An ethics of permission also includes the importance of exercising professional tolerance in the honoring of clinicians who choose to participate or refuse to participate. In addition, an ethics of permission also provides insight in implementing just and fair behavior among medical professionals.

  4. End of life environmental assessment of micro technologies: the need for the carrot or the stick?

    DEFF Research Database (Denmark)

    De Grave, Arnaud; Gentil, Emmanuel; Hansen, Hans Nørgaard

    2010-01-01

    The paper presents the importance of understanding the environmental implications of the end of life of micro technology. A brief overview of different management approaches of micro waste is shown, such as landfill, incineration, recycling, reuse and prevention is given. However, the management...... of waste is subject to a number of directives and regulations (in Europe) or a “stick” forcing the industry to minimise the environmental impacts of micro waste. In contrast, there are strong drivers, the “carrot” that can stimulate the industry to design micro technology following EcoDesign principle....... On one hand the industry is faced with legal sticks to minimise the impacts of waste, on the other hand the industry is offered a number of carrots that could present strong financial and environmental advantages compared to other products providing the same service....

  5. Equality for followers of South Asian religions in end-of-life care.

    Science.gov (United States)

    Samanta, Jo

    2013-06-01

    Significant minority populations confer richness and diversity to British society. Responsive end-of-life care is a universal need that has ascended the public agenda following myriad reports of inadequate provision. Nevertheless, the potential exists for unwitting discrimination when caring for terminally ill patients on the basis of their religion or faith. Recent implementation of the Equality Act 2010, together with the government and professional initiatives, promises to positively impact upon this area of contemporary relevance and concern, although the extent to which facilitative policies can truly enhance patient care will depend upon how these are translated into care at the bedside. The contributions of health professionals will be central in meeting the challenges and seizing the opportunities for meeting the religion and faith interests of patients of South Asian descent.

  6. Life Course Stage and Social Support Mobilization for End-of-Life Caregivers.

    Science.gov (United States)

    LaValley, Susan A; Gage-Bouchard, Elizabeth A

    2018-04-01

    Caregivers of terminally ill patients are at risk for anxiety, depression, and social isolation. Social support from friends, family members, neighbors, and health care professionals can potentially prevent or mitigate caregiver strain. While previous research documents the importance of social support in helping end-of-life caregivers cope with caregiving demands, little is known about differences in social support experiences among caregivers at different life course stages. Using life course theory, this study analyzes data from in-depth interviews with 50 caregivers of patients enrolled in hospice services to compare barriers to mobilizing social support among caregivers at two life course stages: midlife caregivers caring for parents and older adult caregivers caring for spouses/partners. Older adult caregivers reported different barriers to mobilizing social support compared with midlife caregivers. Findings enhance the understanding of how caregivers' life course stage affects their barriers to mobilization of social support resources.

  7. Using sociodrama and psychodrama to teach communication in end-of-life care.

    Science.gov (United States)

    Baile, Walter F; De Panfilis, Ludovica; Tanzi, Silvia; Moroni, Matteo; Walters, Rebecca; Biasco, Guido

    2012-09-01

    End-of-life discussions can be stressful and can elicit strong emotions in the provider as well as the patient and family. In palliative care, understanding and effectively addressing emotions is a key skill that can enhance professional competency and patient/family satisfaction with care. We illustrate how in coursework for a Master's degree in palliative medicine we used dramatic "action methods" derived from sociodrama and psychodrama in the portrayal of two challenging cases to train providers in the emotional aspects of caring for patients with advanced cancer. We describe the specific techniques of constructing and enacting case scenarios using warm-ups, role-creation, doubling and role-reversal. In particular, we illustrate how these techniques and others were used to reveal and address the "hidden" emotions, attitudes, and values that were central to the communication dilemma. Finally, we present an evaluation completed by the 26 participants who attended the course.

  8. Unravelling the Tensions Between Chronic Disease Management and End-of-Life Planning.

    Science.gov (United States)

    Thorne, Sally; Roberts, Della; Sawatzky, Richard

    2016-01-01

    An increasing appreciation for the burden that chronic conditions represent for people and for societies has triggered an evolving body of popular and professional conceptualizations of the nature of the chronic disease challenge. In this discussion article, we trace the trajectory of thinking about chronic illness care, surfacing underlying assumptions and drivers that have shaped current dominant models of service delivery. We note significant gaps in these conceptualizations, especially with respect to the reality that many chronic conditions are life limiting. Contrasting chronic disease theorizing with the conversations that have arisen around end-of-life care for other kinds of health conditions, we argue for a shift in our thinking to accommodate the implications of life limitation in our service delivery planning. We see significant leadership potential in optimizing the role nurses can play across the chronic disease trajectory by integrating the healthy optimism of self-care management with the profound compassion of a person-centered palliative approach.

  9. The death of Ivan Ilych: A blueprint for intervention at the end of life.

    Science.gov (United States)

    Papadimos, Thomas J; Stawicki, Stanislaw Pa

    2011-07-01

    Medical practice and the field of humanities frequently intersect. It is uncanny how problems presented or described in literature that are several hundred years old still present themselves to us on a regular basis. Often, our answers to these dilemmas are not perfect, but we continue our attempts at providing solutions through an enlightened evolution of our thought and approaches. Leo Tolstoy's novella, The Death of Ivan Ilych, is a classic piece of literature that allows a view of the dying process in an ordinary human being, and presents us with an opportunity to observe, not only the intersection of medicine and humanities, but also that of critical care and palliative medicine. Here Tolstoy, through his keen observation of the human condition at the end of life, allows us an opportunity to view a 19(th) century perspective that has an all too familiar persistence that needs a 21(st) century intervention.

  10. [Is there any deontology of accompanying people at the end of life?].

    Science.gov (United States)

    Glorion, B

    1999-01-01

    The thought on ethics, enhances by accompanying patients or human-beings reaching end of life, belong to major themes which have for years been dealt with by philosophers and monks. The physicians, who by nature accompany and live with their patient this life period a sometimes close relationship, have conceived within deontology a wonderful expression of what ethics inspired them. Reading articles 37 and 38 of the Code of Ethics brings a clear, precise and qualified answer to the question raised by the title. We easily find out the main principles which would be the guideline to the doctor's behaviour coping with this situation: providing suitable and continue cares to maintain the quality of a life which comes to end, respecting dignity. Relieving suffers, morally assisting, comforting the family, knowing to limit the cares reasonably. The sensitive and human expression sums up pretty well the particularities essential to all (physicians, health professionals or volunteers) who have accepted this heavy task.

  11. End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

    Science.gov (United States)

    Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M

    2015-05-01

    End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business. © The Author(s) 2014.

  12. End-of-Life in Disney and Pixar Films: An opportunity for Engaging in Difficult Conversation.

    Science.gov (United States)

    Tenzek, Kelly E; Nickels, Bonnie M

    2017-01-01

    This study expanded upon previous scholarship by examining end-of-life (EOL) depictions and messages of death within Disney and Pixar animated films. We argue Disney and Pixar depictions of EOL and death can provide critical opportunities for discussing death and dying processes with children and adults alike. A content analysis of 57 movies resulted in a total of 71 character deaths. These instances of death became the discourse used for analysis. The EOL discourse was coded based on five categories (character status, depiction of death, death status, emotional reaction, and causality). After quantitative analysis, the films were qualitatively analyzed. Four themes emerged from analysis, unrealistic moments, managing EOL, intentions to kill, and transformation and spiritual connection. Discussion of results, limitations, and directions for future research are included.

  13. Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison.

    Science.gov (United States)

    Stensland, Meredith; Sanders, Sara

    2016-01-01

    Prisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care-including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.

  14. Palliative care and end-of-life care for polypathological patients.

    Science.gov (United States)

    Martinez-Litago, E; Martínez-Velasco, M C; Muniesa-Zaragozano, M P

    2017-12-01

    Patients with advanced chronic diseases receive fragmented care, which entails high resource consumption and a poor quality of life. Uncertainty in the prognosis and scarce investigation into the importance of symptomatic control in this patient group hinders a proper therapeutic approach. Palliative care teams optimise the use of resources through comprehensive patient care, the optimization of the patient's environment, communication, the preparation of early care plans and the creation of coordinated healthcare circuits, which improve the quality of the patient's care in advanced stages of the disease. In the end-of-life phase, the therapeutic approach is focused on symptomatic control, selecting treatments according to the cause, comorbidities and the patient's wishes. To control refractory symptoms, palliative sedation is considered an indispensable option. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. Fighting for Dear Life: Christians and Aggressive End-of-Life Care.

    Science.gov (United States)

    Shinall, Myrick C

    2014-01-01

    Patients or their family members sometimes give religious reasons for requesting life-sustaining technologies that have little hope of restoring health. This poses an ethical challenge for clinicians and a potential strain on limited health-care resources. Among Christians, one explanation for a preference for aggressive, life-prolonging care is the influence of the idea of martyrdom, which became the normative form of dying in early Christianity. The ancient discourse of martyrdom and the modern discourse of aggressive medical care both share a martial orientation and commend an ethos of combat. This paper examines ancient Christian martyrdom discourse to illuminate its affinity with the discourse of aggressive medical care. The ethos of martyrdom has shaped Christian attitudes toward death such that preference for aggressive medical care at the end of life is understandable.

  16. How a mutation that slows aging can also disproportionately extend end-of-life decrepitude

    Science.gov (United States)

    Podshivalova, Katie; Kerr, Rex A.; Kenyon, Cynthia

    2017-01-01

    Summary The goal of aging research is to extend healthy, active life. For decades, C. elegans daf-2 insulin/IGF-1 receptor mutants have served as a model for extended lifespan and youthfulness. However, a recent report suggested that their longevity is associated with an undesirable phenotype: a disproportionately long period of decrepitude at the end of life. In a human population, such an outcome would be a burden to society, bringing into question the relevance of daf-2 mutants as a model for life extension. However, here we report that, following an extended period of movement, daf-2 mutants survive longer in a decrepit state because of a beneficial trait: they are resistant to colonization of the digestive tract by dietary bacteria, a condition that leads to premature death in wild type and prevents their manifestation of decrepitude. If bacterial colonization is prevented, daf-2 mutants lead chronologically and proportionately healthier lives relative to wild type. PMID:28423308

  17. Ethical dilemmas in the care of cancer patients near the end of life.

    Science.gov (United States)

    Ong, W Y; Yee, C M; Lee, A

    2012-01-01

    By definition, an ethical dilemma involves the need to choose from among two or more morally acceptable options or between equally unacceptable courses of action, when one choice prevents selection of the other. Advances in medicine, increasing economic stress, rise of patient self-determination and differing values between healthcare workers and patients are among the many factors contributing to the frequency and complexity of ethical issues in healthcare. In the cancer patient near the end of life, common ethical dilemmas include those dealing with artificial nutrition and hydration, truth-telling and disagreements over management plans. It would stand the clinician in good stead to be aware of these issues and have an approach toward dealing with such problems. In addition, organisations have a responsibility to ensure that systems are in place to minimise its occurrence and ensure that staff are supported through the process of resolving dilemmas and conflicts that may arise.

  18. Hardships of end-of-life care with court-appointed guardians.

    Science.gov (United States)

    Hastings, Kylie B

    2014-02-01

    In the United States, the court-appointed guardians do not have the ability to make decisions regarding end-of-life (EOL) care for their clients. Additionally, the process of initiating EOL care measures can be slow and cumbersome, despite an existing process of getting approval for such care. This process has the potential to prolong suffering and delay imperative decisions. This article reviews the hardships that patients, court-appointed guardians, and health care staff endure while moving through the oppressive process of obtaining EOL care orders through the court. This article also proposes ways of tuning up the laws, regulations, and communications to make it easier and faster to obtain orders regarding EOL care to preserve the dignity of our patients and loved ones. "A guardianship is a legal relationship created when a person or institution named in a will or assigned by the court to take care of minor children or incompetent adults."

  19. Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.

    Science.gov (United States)

    Jox, Ralf J; Schaider, Andreas; Marckmann, Georg; Borasio, Gian Domenico

    2012-09-01

    Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment.

  20. Rural versus urban differences in end-of-life care for lung cancer patients in Germany.

    Science.gov (United States)

    Walter, Julia; Tufman, Amanda; Leidl, Reiner; Holle, Rolf; Schwarzkopf, Larissa

    2018-07-01

    To assess rural-urban differences in healthcare utilization and supportive care at the end-of-life in German lung cancer patients. We identified 12,929 patients with incident lung cancer in 2009 from claims data and categorized them to four district types (major city, urban, rural, remote rural). We compared site of death, unplanned hospitalizations, hospital days, outpatient doctor, general practitioner (GP) and home visits, structured palliative care, therapy with antidepressants, pain relief medication and chemotherapy, and therapeutic puncturing in the last 30 and 14 days of life using mixed models with logistic link function for binary outcomes and log link function for count data. We adjusted all models by age, sex, comorbidities, metastases location and presence of multiple tumors at diagnosis, survival in months, and type of tumor-directed treatment. We found significant differences in two of the outcomes measured. The likelihood of > 14 hospital days in the last 30 days was significantly higher in rural districts than in remote rural districts (1.27 [1.05, 1.52], p = 0.0003). The number of visits to the GP in the last 30 days of life was significantly lower in urban districts than in remote rural districts (β = - 0.19 [- 0.32, - 0.06], p = <0.0001). No other endpoints were associated with regional differences. Triggering factors for high and low utilization of healthcare were mostly age, comorbidities, and prior anticancer treatment. Healthcare utilization and supportive care did not differ significantly between different district types. Results reject the hypothesis of regional inequity in end-of-life care of lung cancer patients in Germany.

  1. Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life.

    Science.gov (United States)

    Henderson, Carrie M; FitzGerald, Michael; Hoehn, K Sarah; Weidner, Norbert

    2017-02-01

    Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ 2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

  2. Dignity and Distress towards the End of Life across Four Non-Cancer Populations

    Science.gov (United States)

    Chochinov, Harvey Max

    2016-01-01

    Objective The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. Design A prospective, multi-site approach was used. Setting Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. Participants Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. Main Outcome Measure In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). Results Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4–11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. Conclusion People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs. PMID:26808530

  3. Uncovering an invisible network of direct caregivers at the end of life: a population study.

    Science.gov (United States)

    Burns, Catherine M; Abernethy, Amy P; Dal Grande, Eleanora; Currow, David C

    2013-07-01

    Most palliative care research about caregivers relies on reports from spouses or adult children. Some recent clinical reports have noted the assistance provided by other family members and friends. This population study aims to define the people who actually provide care at the end of life. A South Australian study conducted an annual randomized health population survey (n=23,706) over a 7 year period. A sample was obtained of self-identifying people who had someone close to them die and 'expected' death in the last 5 years (n=7915). Data were standardised to population norms for gender, 10-year age group, socioeconomic status, and region of residence. People of all ages indicated they provided 'hands on' care at the end of life. Extended family members (not first degree relatives) and friends accounted for more than half (n=1133/2028; 55.9%) of identified hands-on caregivers. These people came from the entire age range of the adult community. The period of time for which care was provided was shorter for this group of caregivers. People with extended family or friends providing care, were much more likely to be supported to die at home compared to having a spousal carer. This substantial network of caregivers who are mainly invisible to the health team provide the majority of care. Hospice and palliative care services need to create specific ways of identifying and engaging this cohort in order to ensure they are receiving adequate support in the role. Relying on 'next-of-kin' status in research will not identify them.

  4. "It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication.

    Science.gov (United States)

    Romotzky, V; Galushko, M; Düsterdiek, A; Obliers, R; Albus, C; Ostgathe, C; Voltz, R

    2015-06-01

    This study aims to assess and improve communication education for medical students in palliative care (PC) with the use of simulated patients (SP) in Germany. More specifically, to explore how students evaluate the use of SP for end-of-life communication training and which fears and barriers arise. A pilot course was implemented. Qualitative content analysis was used to analyse transcribed recordings of the course. Pre- and post-course questionnaires containing open-ended questions ascertained students' motivation for participating, their preparation within their degree programme and whether they felt they had learned something important within the course. Seventeen medical students in their third to fourth year of education (age 22-31) participated in the five-session course and answered the questionnaires (pre n = 17, post n = 12). Students felt insufficiently prepared and insecure. Discussing end-of-life issues was experienced as challenging and emotionally moving. Within the conversations, although students sometimes showed blocking behaviour in reaction to emotional impact, they valued the consideration of emotional aspects as very important. The course was overall highly appreciated and valued as being helpful. The communication situation with the SP was perceived as authentic. Ten out of 12 students confirmed to have learned something important (post course). Our results indicate an urgent need for better communication training for medical students. Due to the fact that bedside teaching in PC is not feasible for all students, training with standardized SP can be a way to generate an authentic learning situation. Techniques to address fears and blocking behaviour should, however, also be considered.

  5. Defining dignity in end-of-life care in the emergency department.

    Science.gov (United States)

    Fernández-Sola, Cayetano; Cortés, María Mar Díaz; Hernández-Padilla, José Manuel; Torres, Cayetano José Aranda; Terrón, José María Muñoz; Granero-Molina, José

    2017-02-01

    Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013-2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.

  6. End-of-life dreams and visions: a longitudinal study of hospice patients' experiences.

    Science.gov (United States)

    Kerr, Christopher W; Donnelly, James P; Wright, Scott T; Kuszczak, Sarah M; Banas, Anne; Grant, Pei C; Luczkiewicz, Debra L

    2014-03-01

    End-of-life dreams and visions (ELDVs) have been well documented throughout history and across cultures. The impact of pre-death experiences on dying individuals and their loved ones can be profoundly meaningful. Our aim was to quantify the frequency of dreams/visions experienced by patients nearing the end of life, examine the content and subjective significance of the dreams/visions, and explore the relationship of these factors to time/proximity to death. This mixed-methods study surveyed patients in a hospice inpatient unit using a semi-structured interview. Sixty-six patients admitted to a hospice inpatient unit between January 2011 and July 2012 provided informed consent and participated in the study. The semi-structured interviews contained closed and open-ended questions regarding the content, frequency, and comfort/distress of dreams/visions. Fifty-nine participants comprised the final sample. Most participants reported experiencing at least one dream/vision. Almost half of the dreams/visions occurred while asleep, and nearly all patients indicated that they felt real. The most common dreams/visions included deceased friends/relatives and living friends/relatives. Dreams/visions featuring the deceased (friends, relatives, and animals/pets) were significantly more comforting than those of the living, living and deceased combined, and other people and experiences. As participants approached death, comforting dreams/visions of the deceased became more prevalent. ELDVs are commonly experienced phenomena during the dying process, characterized by a consistent sense of realism and marked emotional significance. These dreams/visions may be a profound source of potential meaning and comfort for the dying, and therefore warrant clinical attention and further research.

  7. Medical end-of-life practices among Canadian physicians: a pilot study.

    Science.gov (United States)

    Marcoux, Isabelle; Boivin, Antoine; Mesana, Laura; Graham, Ian D; Hébert, Paul

    2016-01-01

    Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study. In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes. Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1% (n = 76). Most respondents (64 [84%]) completed the mail questionnaire. All the criteria for success were met. It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study

  8. Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

    Science.gov (United States)

    Cerana, Maria Agustina; Park, Minjeong; Hess, Kenneth; Bruera, Eduardo

    2016-01-01

    Background. It is unclear how oncologists’ attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists’ EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care using a score derived from the Jackson et al. qualitative conceptual framework (0 = uncomfortable and 8 = highly comfortable with EOL care). We determined the association between this score and clinicians’ report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range, 5–7). A higher EOL score was significantly associated with solid tumor oncology (median 7 vs. 6 for hematologic oncology; p = .003), a greater willingness to refer patients with newly diagnosed cancer to specialist palliative care (median, 7 vs. 6; p = .01), greater comfort with symptom management (median, 6 vs. 5; p = .01), and provision of counseling (median, 7 vs. 4; p EOL care was associated with higher rates of specialist palliative care referral and self-reported primary palliative care delivery. More support and education are needed for oncologists who are less comfortable with EOL care. Implications for Practice: In the present survey of oncology specialists, most reported that they were comfortable with end-of-life (EOL) care, which was in turn, associated with greater provision of primary palliative care and higher rates of referral to specialist palliative care. The results of the present study highlight the need for more support and education for oncologists less comfortable with EOL care because their patients might receive lower levels of both primary and secondary

  9. Are end-of-life practices in Norway in line with ethics and law?

    Science.gov (United States)

    Førde, R; Aasland, O G

    2014-10-01

    End-of-life decisions, including limitation of life prolonging treatment, may be emotionally, ethically and legally challenging. Euthanasia and physician-assisted suicide (PAS) are illegal in Norway. A study from 2000 indicated that these practices occur infrequently in Norway. In 2012, a postal questionnaire addressing experience with limitation of life-prolonging treatment for non-medical reasons was sent to a representative sample of 1792 members of the Norwegian Medical Association (7.7% of the total active doctor population of 22,500). The recipients were also asked whether they, during the last 12 months, had participated in euthanasia, PAS or the hastening of death of non-competent patients. Seventy-one per cent of the doctors responded. Forty-four per cent of the respondents reported that they had terminated treatment at the family's request not knowing the patient's own wish, doctors below 50 and anaesthesiologists more often. Anaesthesiologists more often reported to have terminated life-prolonging treatment because of resource considerations. Six doctors reported having hastened the death of a patient the last 12 months, one by euthanasia, one by PAS and four had hastened death without patient request. Male doctors and doctors below 50 more frequently reported having hastened the death of a patient. Forgoing life-prolonging treatment at the request of the family may be more frequent in Norway that the law permits. A very small minority of doctors has hastened the death of a patient, and most cases involved non-competent patients. Male doctors below 50 seem to have a more liberal end-of-life practice. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  10. Attitudes towards end-of-life decisions and the subjective concepts of consciousness: an empirical analysis.

    Directory of Open Access Journals (Sweden)

    Lorella Lotto

    Full Text Available BACKGROUND: People have fought for their civil rights, primarily the right to live in dignity. At present, the development of technology in medicine and healthcare led to an apparent paradox: many people are fighting for the right to die. This study was aimed at testing whether different moral principles are associated with different attitudes towards end-of-life decisions for patients with a severe brain damage. METHODOLOGY: We focused on the ethical decisions about withdrawing life-sustaining treatments in patients with severe brain damage. 202 undergraduate students at the University of Padova were given one description drawn from four profiles describing different pathological states: the permanent vegetative state, the minimally conscious state, the locked-in syndrome, and the terminal illness. Participants were asked to evaluate how dead or how alive the patient was, and how appropriate it was to satisfy the patient's desire. PRINCIPAL FINDINGS: We found that the moral principles in which people believe affect not only people's judgments concerning the appropriateness of the withdrawal of life support, but also the perception of the death status of patients with severe brain injury. In particular, we found that the supporters of the Free Choice (FC principle perceived the death status of the patients with different pathologies differently: the more people believe in the FC, the more they perceived patients as dead in pathologies where conscious awareness is severely impaired. By contrast, participants who agree with the Sanctity of Life (SL principle did not show differences across pathologies. CONCLUSIONS: These results may shed light on the complex aspects of moral consensus for supporting or rejecting end-of-life decisions.

  11. Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands.

    Science.gov (United States)

    Brouwer, Marije; Maeckelberghe, Els; DE Weerd, Willemien; Verhagen, Eduard

    2018-07-01

    In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is

  12. A neutron irradiator to perform nuclear activation

    International Nuclear Information System (INIS)

    Zamboni, C. B.; Zahn, G.S.; Figueredo, A. M. G.; Madi, T. F.; Yoriyaz, H.; Lima, R. B.; Shtejer, K.; Dalaqua Jr, L.

    2001-01-01

    The development of appropriate nuclear instrumentation to perform neutron activation analyze (NAA), using thermal and fast neutrons, can be useful to investigate materials outside the reactor premises. Considering this fact, a small size neutron irradiator prototype was developed at IPEN facilities (Instituto de Pesquisas Energeticas e Nucleares - Brazil). Basically, this prototype consists of a cylinder of 1200 mm long and 985 mm diameter (filled with paraffin) with two Am-Be sources (600GBq each) arranged in the longitudinal direction of its geometric center. The material to be irradiated is positioned at a radial direction of the cylinder between the two Am-Be sources. The main advantage of this irradiator is a very stable neutron flux eliminating the use of standard material (measure of the induced activity in the sample by comparative method). This way the process became agile, practical and economic, but quantities at mg levels of samples are necessary to achieve good sensitivity, when the material has a low microscopy neutron cross section. As fast and thermal neutron can be used, the flux distribution, for both, were calculated and the prototype performance is discussed

  13. Alloy development for irradiation performance: program strategy

    International Nuclear Information System (INIS)

    Bloom, E.E.; Stiegler, J.O.; Wiffen, F.W.; Dalder, E.N.C.; Reuther, T.C.; Gold, R.E.; Holmes, J.J.; Kummer, D.L.; Nolfi, F.V.

    1978-01-01

    The objective of the Alloy Development for Irradiation Performance Program is the development of structural materials for use in the first wall and blanket region of fusion reactors. The goal of the program is a material that will survive an exposure of 40 MWyr/m 2 at a temperature which will allow use of a liquid-H 2 O heat transport system. Although the ultimate aim of the program is development of materials for commercial reactors by the end of this century, activities are organized to provide materials data for the relatively low performance interim machines that will precede commercial reactors

  14. Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care.

    Science.gov (United States)

    Boulanger, Augustin; Chabal, Théo; Fichaux, Marie; Destandau, Mireille; La Piana, Jean Marc; Auquier, Pascal; Baumstarck, Karine; Salas, Sébastien

    2017-01-21

    In February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are "obviously inappropriate" in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient's situation. Artificial feeding and hydration are considered as treatment. The aim of this report is to investigate individuals receiving palliative care about their opinion about euthanasia, about advance directives, about the right to deep and continuous sedation, and the right to stopping artificial feeding and hydration. The study was an opinion survey conducted among patients treated in two different palliative care institutions: a palliative care unit at the University Hospital (Timone, Marseille, France) and a non-profit association palliative care home ("La Maison", Gardanne, France). Face-to-face interviews were performed by two investigators. The survey included sociodemographics, clinical data, and opinions about euthanasia, deep and continuous sedation, stopping artificial feeding and hydration, and advance directives. Forty patients were interviewed. The mean age was 59.8 years (standard deviation 12). Fifty three percent reported opposition to legalized euthanasia. Eighty three percent were in favour of the right to deep and continuous sedation in patients with refractory pain, 75% when it concerns a patient unable to express their wishes, and 68% when the patient decides to stop vital treatment. Fifty eight percent reported that artificial nutrition and hydration should be considered as care. Fifty eight percent of the patients interviewed would like to see doctors follow the express wishes contained in advance care directives and 53% that advance directives should be subject to

  15. Effect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls.

    Science.gov (United States)

    Chitnis, X A; Georghiou, T; Steventon, A; Bardsley, M J

    2013-12-01

    To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death. Retrospective analysis using matched controls and administrative data. Community-based care in England. 29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history. Home-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care. Proportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care. Intervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, pnursing for longer. Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.

  16. Traditional expectations versus US realities: first- and second-generation Asian Indian perspectives on end-of-life care.

    Science.gov (United States)

    Sharma, Rashmi K; Khosla, Nidhi; Tulsky, James A; Carrese, Joseph A

    2012-03-01

    Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US. To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care. Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life. Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region. Content analysis of focus group transcripts. First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities. Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for

  17. Factors associated with end-of-life by home-visit nursing-care providers in Japan.

    Science.gov (United States)

    Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

    2017-06-01

    Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

  18. Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

    Science.gov (United States)

    Bergstraesser, Eva; Zimmermann, Karin; Eskola, Katri; Luck, Patricia; Ramelet, Anne-Sylvie; Cignacco, Eva

    2015-08-01

    To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. ClinicalTrials.gov Identifier: NCT01983852. © 2015 John Wiley & Sons Ltd.

  19. General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.

    Science.gov (United States)

    Giezendanner, Stéphanie; Jung, Corinna; Banderet, Hans-Ruedi; Otte, Ina Carola; Gudat, Heike; Haller, Dagmar M; Elger, Bernice S; Zemp, Elisabeth; Bally, Klaus

    2017-01-01

    Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in

  20. A retrospective study of end-of-life care decisions in the critically Ill in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Yi Lin Lee

    2018-01-01

    Full Text Available Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU. The practice of approaching end-of-life (EOL care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU. The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process. Methods: All consecutive patients aged 21 and above admitted to the SICU from July 2011 to March 2012, and who passed away in the ICU or within 7 days of discharge from the ICU (to account for transferred patients out of the ICU after end-of life care decisions were made and subsequently passed away were included in the study. Results: There were 473 SICU admissions during this period, out of which 53 were included with a mean age of 67.2 ± 11.1 years. EOL discussions were held in 81.1% of patients with a median time from admission to first discussion at 1 day (IQR 0–2.75 and a median number of ICU discussion of 1 (IQR 1–2. As most patients lacked decision-making capacity (inability to retain and process information secondary to the underlying disease pathology or sedative use, a surrogate was involved: group decision in 27.9%, child in 25.6% and an unclear family nominated member in 20.9%. 28.3% of patients were managed as for full active with resuscitation, 39.6% nonescalation of care, and 32.1% for withdrawal. The main reasons for conservative management (nonescalation and withdrawal of care were certain death in 52.3%, medical futility with minimal response to maximal care (27.3%, and the presence of underlying malignancy (18.2%. There was no significant difference between race or religion among patients for active or conservative management. Conclusion: 71.7% of patients who passed away in the ICU or

  1. A co-design process developing heuristics for practitioners providing end of life care for people with dementia.

    Science.gov (United States)

    Davies, Nathan; Mathew, Rammya; Wilcock, Jane; Manthorpe, Jill; Sampson, Elizabeth L; Lamahewa, Kethakie; Iliffe, Steve

    2016-08-02

    The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice. Four broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing "routine care" at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering 'comfort feeding' only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer's wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting

  2. Family caregivers' conceptualisation of quality end-of-life care for people with dementia: A qualitative study.

    Science.gov (United States)

    Davies, Nathan; Rait, Greta; Maio, Laura; Iliffe, Steve

    2017-09-01

    People with dementia have been described as the 'disadvantaged dying' with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers' perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia. This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia. Qualitative study using in-depth interviews and analysed using thematic analysis. Purposive sampling from a third sector organisation's caregiver network was used to recruit 47 caregivers in England (2012-2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family caregivers. Three over-arching themes were derived from the interviewees' discourse, including maintaining the person within, fostering respect and dignity and showing compassion and kindness. End-of-life care for people with dementia does not differ from care throughout the dementia trajectory. Throughout the findings, there is an implicit underlying theme of conflict: conflict between family caregivers and an increasingly systematised service of care and conflict between family caregivers and professionals. This study has in particular demonstrated the importance of the psycho-social aspects of care, aligning with the holistic definition of palliative care.

  3. Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life.

    Science.gov (United States)

    Callaghan, Katharine A; Fanning, Joseph B

    2018-02-01

    In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.

  4. Improvement of irradiation facilities performance in JMTR

    International Nuclear Information System (INIS)

    Kanno, Masaru; Sakurai, Susumu; Honma, Kenzo; Sagawa, Hisashi; Nakazaki, Chousaburo

    1999-01-01

    Various kinds of irradiation facilities are installed in the JMTR for the purpose of irradiation tests on fuels and materials and of producing radioisotopes. The irradiation facilities have been improved so far at every opportunity of new irradiation requirements and of renewing them which reached the design lifetime. Of these irradiation facilities, improvements of the power ramping test facility (BOCA/OSF-1 facility) and the hydraulic rabbit No.2 (HR-2 facility) are described here. (author)

  5. Environmental burdens in the management of end-of-life cathode ray tubes

    International Nuclear Information System (INIS)

    Rocchetti, Laura; Beolchini, Francesca

    2014-01-01

    Highlights: • The paper deals with different management options for end-of-life CRTs. • The environmental burdens for disposal and recycling are presented. • Recycling treatments allows to gain benefits for the environment. • Further treatments for fluorescent powders determine CO 2 credits. • More efforts should be directed towards recycling. - Abstract: We compared the environmental burdens in the management of end-of life cathode ray tubes (CRTs) within two frameworks according to the different technologies of the production of televisions/monitors. In the first case, CRT recycling is addressed to the recovery of the panel and funnel glass for the manufacturing of new CRT screens. In the second case, where flat screen technology has replaced that of CRT, the recycling is addressed to the recovery of the glass cullet and lead for other applications. The impacts were evaluated according to the problem-oriented methodology of the Institute of Environmental Sciences, Leiden University, Leiden, The Netherlands. Our data confirm that in both cases, the recycling treatment allows benefits to be gained for the environment through the recovery of the secondary raw materials. These benefits are higher for the “CRT technology” framework (1 kg CO 2 saved per CRT) than for the “flat screen technology” (0.9 kg CO 2 saved, per CRT, as the highest possible), mainly due to the high energy consumption for lead separation from the funnel glass. Furthermore, the recovery of yttrium from the fluorescent powders that are a residue of the recycling treatment would further improve the CO 2 credit for both the frameworks considered, which would provide a further saving of about 0.75 kg CO 2 per CRT, net of the energy and raw materials needed for the recovery. Overall, this study confirms that, even with a change in the destination of the recovered materials, the recycling processes provide a benefit for the environment: indeed the higher loads for the environment are

  6. Environmental burdens in the management of end-of-life cathode ray tubes

    Energy Technology Data Exchange (ETDEWEB)

    Rocchetti, Laura; Beolchini, Francesca, E-mail: f.beolchini@univpm.it

    2014-02-15

    Highlights: • The paper deals with different management options for end-of-life CRTs. • The environmental burdens for disposal and recycling are presented. • Recycling treatments allows to gain benefits for the environment. • Further treatments for fluorescent powders determine CO{sub 2} credits. • More efforts should be directed towards recycling. - Abstract: We compared the environmental burdens in the management of end-of life cathode ray tubes (CRTs) within two frameworks according to the different technologies of the production of televisions/monitors. In the first case, CRT recycling is addressed to the recovery of the panel and funnel glass for the manufacturing of new CRT screens. In the second case, where flat screen technology has replaced that of CRT, the recycling is addressed to the recovery of the glass cullet and lead for other applications. The impacts were evaluated according to the problem-oriented methodology of the Institute of Environmental Sciences, Leiden University, Leiden, The Netherlands. Our data confirm that in both cases, the recycling treatment allows benefits to be gained for the environment through the recovery of the secondary raw materials. These benefits are higher for the “CRT technology” framework (1 kg CO{sub 2} saved per CRT) than for the “flat screen technology” (0.9 kg CO{sub 2} saved, per CRT, as the highest possible), mainly due to the high energy consumption for lead separation from the funnel glass. Furthermore, the recovery of yttrium from the fluorescent powders that are a residue of the recycling treatment would further improve the CO{sub 2} credit for both the frameworks considered, which would provide a further saving of about 0.75 kg CO{sub 2} per CRT, net of the energy and raw materials needed for the recovery. Overall, this study confirms that, even with a change in the destination of the recovered materials, the recycling processes provide a benefit for the environment: indeed the higher loads

  7. A pan-European survey of research in end-of-life cancer care.

    Science.gov (United States)

    Sigurdardottir, Katrin Ruth; Haugen, Dagny Faksvåg; Bausewein, Claudia; Higginson, Irene J; Harding, Richard; Rosland, Jan Henrik; Kaasa, Stein

    2012-01-01

    To date, there is no coordinated strategy for end-of-life (EOL) cancer care research in Europe. The PRISMA (Reflecting the Positive Diversities of European Priorities for Research and Measurement in End-of-life Care) project is aiming to develop a programme integrating research and measurement in EOL care. This survey aimed to map and describe present EOL cancer care research in Europe and to identify priorities and barriers. A questionnaire of 62 questions was developed and 201 researchers in 41 European countries were invited to complete it online in May 2009. An open invitation to participate was posted on the internet. Invited contacts in 36 countries sent 127 replies; eight additional responses came through websites. A total of 127 responses were eligible for analysis. Respondents were 69 male and 58 female, mean age 49 (28-74) years; 85% of the scientific team leaders were physicians. Seventy-one of 127 research groups were located in a teaching hospital or cancer centre. Forty-five percent of the groups had only one to five members and 28% six to ten members. Sixty-three of 92 groups reported specific funding for EOL care research. Seventy-five percent of the groups had published papers in journals with impact factor ≤ 5 in the last 3 years; 8% had published in journals with impact factor >10. Forty-four out of 90 groups reported at least one completed Ph.D. in the last 3 years. The most frequently reported active research areas were pain, assessment and measurement tools, and last days of life and quality of death. Very similar areas--last days of life and quality of death, pain, fatigue and cachexia, and assessment and measurement tools--were ranked as the most important research priorities. The most important research barriers were lack of funding, lack of time, and insufficient knowledge/expertise. Most research groups in EOL care are small. The few large groups (14%) had almost half of the reported publications, and more than half of the current Ph

  8. Environmental impact assessment of different end-of-life LCD management strategies.

    Science.gov (United States)

    Amato, Alessia; Rocchetti, Laura; Beolchini, Francesca

    2017-01-01

    The strong growth of the electrical and electronic equipment production combined with its short lifespan are causing the production of a significant amount of waste to treat. In particular, the present paper focuses on end-of-life liquid crystal displays (LCDs) for their significant content of valuable materials, like plastic, glass and metals that could be recovered after dismantling. In the recent literature, traditional LCD recycling processes are combined with innovative treatments, which allow to recover critical raw materials, such as indium. In this context, we have evaluated the environmental impact of four different strategies of end-of-life LCD management: the disposal in landfilling sites, the incineration, the traditional recycling treatment and an innovative process also addressed to the recovery of indium. The traditional recycling treatment resulted to be the best scenario for the environment. Indeed, a life cycle assessment study gave following environmental burdens (if negative they are credits): 18, 81, -68, -60kg CO 2 -equiv. and 0.08, 0.01, -0.25, -0.18mol H + -equiv., for the four scenarios in the categories of global warming and acidification, respectively. The limit of the variability of LCD composition was overcome including additional literature data in the study. In order to improve the innovative process sustainability, a system of water recirculation was optimized with a consequent impact decrease of 35% in the global warming category. Nevertheless, this action should be combined with an increase of indium concentration in the panel because the low metal content represents the bottleneck of the overall approach. In this regard, a sensitivity analysis showed that an increase of at least five times in indium concentration in the waste is needed to observe an advantage of the innovative vs the traditional recycling process, when the impact category of climate change is considered. As a whole, the life cycle assessment was confirmed as a key

  9. Danish general practitioners’ self-reported competences in end-of-life care

    Science.gov (United States)

    Winthereik, Anna; Neergaard, Mette; Vedsted, Peter; Jensen, Anders

    2016-01-01

    Objective General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics. Design Population-based questionnaire study. Setting Central Denmark Region with approximately 1.3 million inhabitants. Subjects All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail. Main outcome measures Responses to 18 items concerning four aspects: provision of EOL care to patients with different diagnosis, confidence with being a key worker, organisation of EOL care and EOL skills (medical and psychosocial). Results In total, 573 (68%) GPs responded. Of these, 85% often/always offered EOL care to cancer patients, which was twice as often as to patients with non-malignancies (34–40%). Moreover, 76% felt confident about being a key worker, 60% had a proactive approach, and 58% talked to their patients about dying. Only 9% kept a register of patients with EOL needs, and 19% had specific EOL procedures. GP confidence with own EOL skills varied; from 55% feeling confident using terminal medications to 90% feeling confident treating nausea/vomiting. Increasing GP age was associated with increased confidence about being a key worker and provision of EOL care to patients with non-malignancies. In rural areas, GPs were more confident about administering medicine subcutaneously than in urban areas. Conclusion We found considerable diversity in self-reported EOL care competences. Interventions should focus on increasing GPs’ provision of EOL care to patients with non-malignancies, promoting better EOL care concerning organisation and symptom management. KEY POINTSGPs are pivotal in end-of-life (EOL) care, but their involvement has been questioned. Hence, GPs’ perceived competencies were explored.GPs were twice as likely to provide EOL care for patients with cancer than for patients with non-malignancies.EOL care was lacking clear organisation in

  10. End-of-life care of women with gynecologic malignancies: a pilot study.

    Science.gov (United States)

    Nevadunsky, Nicole S; Spoozak, Lori; Gordon, Sharon; Rivera, Enid; Harris, Kimala; Goldberg, Gary L

    2013-03-01

    There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated. One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software. The mean age of patients was 60 years (range, 30-94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0-183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005. End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or

  11. End-of-life vehicle recycling : state of the art of resource recovery from shredder residue.

    Energy Technology Data Exchange (ETDEWEB)

    Jody, B. J.; Daniels, E. J.; Energy Systems

    2007-03-21

    Each year, more than 50 million vehicles reach the end of their service life throughout the world. More than 95% of these vehicles enter a comprehensive recycling infrastructure that includes auto parts recyclers/dismantlers, remanufacturers, and material recyclers (shredders). Today, about 75% of automotive materials are profitably recycled via (1) parts reuse and parts and components remanufacturing and (2) ultimately by the scrap processing (shredding) industry. The process by which the scrap processors recover metal scrap from automobiles involves shredding the obsolete automobiles, along with other obsolete metal-containing products (such as white goods, industrial scrap, and demolition debris), and recovering the metals from the shredded material. The single largest source of recycled ferrous scrap for the iron and steel industry is obsolete automobiles. The non-metallic fraction that remains after the metals are recovered from the shredded materials (about 25% of the weight of the vehicle)--commonly called shredder residue--is disposed of in landfills. Over the past 10 to 15 years, a significant amount of research and development has been undertaken to enhance the recycle rate of end-of-life vehicles (ELVs), including enhancing dismantling techniques and improving remanufacturing operations. However, most of the effort has focused on developing technology to recover materials, such as polymers, from shredder residue. To make future vehicles more energy efficient, more lighter-weight materials--primarily polymers and polymer composites--will be used in manufacturing these vehicles. These materials increase the percentage of shredder residue that must be disposed of, compared with the percentage of metals. Therefore, as the complexity of automotive materials and systems increases, new technologies will be required to sustain and maximize the ultimate recycling of these materials and systems at end-of-life. Argonne National Laboratory (Argonne), in cooperation

  12. Promoting excellence in end-of-life care: a report on innovative models of palliative care.

    Science.gov (United States)

    Byock, Ira; Twohig, Jeanne Sheils; Merriman, Melanie; Collins, Karyn

    2006-02-01

    Promoting Excellence in End-of Life Care, a national program of The Robert Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of health care settings and patient populations to develop innovative models for delivering palliative care that addressed documented deficiencies in the care of patients and families facing the final stage of life. To determine the practicality (feasibility of development and operation as well as acceptance by stakeholders) of new models of care and to determine the impact of the models on access to, quality of and financing for palliative care. The program cannot report scientifically rigorous outcomes, but the grant-funded projects used a variety of methods and measures to assess acceptance of new models and their impact from the perspectives of various stakeholders, including patients and their families, clinicians, administrators and payers. While it is not possible to aggregate data across projects, the data reported to the Promoting Excellence national program office were used to describe program impact with respect to the practicality of palliative care service integration into existing clinical care settings (feasibility and acceptance by stakeholders), the availability and use of palliative care services (access), quality of care (conformance to patient expectations and accepted clinical standards) and costs of care. The 22 projects provided services in urban as well as rural settings, in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal dialysis clinics, inner city public health and safety net systems and prisons. Populations served included prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, and African American patients, inner-city medically underserved patients, pediatric patients, and persons with serious mental illness patients. Hosting or adopting institutions sustained or expanded twenty of the 22 models

  13. Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation.

    Science.gov (United States)

    Benute, Gláucia R G; Nomura, Roseli M Y; Liao, Adolfo W; Brizot, Maria de Lourdes; de Lucia, Mara C S; Zugaib, M

    2012-08-01

    this study investigated the feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. The aim of this study was to present the decision making process of women that chose for pregnancy termination and to present selected speeches of women about their feelings. open psychological interviews conducted by a psychologist immediately after the diagnosis of fetal malformation by ultrasound. Analysis of the results was performed through a content analysis technique. the study was carried out at a public university hospital in Brazil. 249 pregnant women who had received the diagnosis of a severe lethal fetal malformation. fetal anencephaly was the most frequent anomaly detected in 135 cases (54.3%). Termination of pregnancy was decided by 172 (69.1%) patients and legally authorised by the judiciary (66%). The reason for asking for termination was to reduce suffering in all of them. In the 77 women who chose not to terminate pregnancy (30.9%), the reasons were related to feelings of guilt (74%). the results support the importance of psychological counselling for couples when lethal fetal malformation is diagnosed. The act of reviewing moral and cultural values and elements of the unconscious provides assurance in the decision-making process and mitigates the risk of emotional trauma and guilt that can continue long after the pregnancy is terminated. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Communicatively Constructing the Bright and Dark Sides of Hope: Family Caregivers’ Experiences during End of Life Cancer Care

    Directory of Open Access Journals (Sweden)

    Jody Koenig Kellas

    2017-05-01

    Full Text Available (1 Background: The communication of hope is complicated, particularly for family caregivers in the context of cancer who struggle to maintain hope for themselves and their loved ones in the face of terminality. In order to understand these complexities, the current study examines the bright and dark sides of how hope is communicated across the cancer journey from the vantage point of bereaved family caregivers; (2 Methods: We analyzed interviews with bereaved family caregivers using qualitative thematic and case oriented strategies to identify patterns in the positive and negative lived experiences when communicating about hope at the end of life; (3 Results: Two overarching patterns of hope emerged. Those who experienced hope as particularized (focused on cure cited communication about false hope, performing (faking it, and avoidance. Those who transitioned from particularized to generalized hope (hope for a good death reported acceptance, the communication of hope as social support, prioritizing family, and balancing hope and honesty; (4 Conclusion: Family caregivers face myriad complexities in managing the bright and dark sides of hope. Interventions should encourage concurrent oncological and palliative care, increased perspective-taking among family members, and encourage the transition from particularized to generalized hope.

  15. Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role

    Directory of Open Access Journals (Sweden)

    April R. Trees

    2017-06-01

    Full Text Available End-of-life (EOL decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker’s role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

  16. TU-D-201-01: Definition and Purpose of End-Of-Life for Brachytherapy Devices and Software

    International Nuclear Information System (INIS)

    Melhus, C.

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue

  17. Blind post-test analysis of Phenix End-of-Life natural circulation test with the MARS-LMR

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Kwon, Young Min; Chang, Won Pyo; Suk, Su Dong; Lee, Kwi Lim

    2010-01-01

    KAERI is developing a system analysis code, MARS-LMR, for the application to a sodium-cooled fast reactor (SFR). This code will be used as a basic tool in the design and analysis of future SFR systems in Korea. Before wide application of a system analysis code, it is required to verify and validate the code models through analyses for appropriate experimental data or analytical results. The MARS-LMR code has been developed from MARS code which had been well verified and validated for a pressurized water reactor (PWR) system. The MARS-LMR code shares the same form of governing equations and solution schemes with MARS code, which eliminates the need of independent verification procedure. However, it is required to validate the applicability of the code to an SFR system because it adopts some dedicated heat transfer models, pressure drop models, and material properties models for a sodium system. Phenix is a medium-sized pool-type SFR successfully operated for 35 years since 1973. This reactor reached its final shutdown in February 2009. An international program of Phenix end-of-life (EOL) test was followed and some valuable information was obtained from the test, which will be useful for the validation of SFR system analysis code. In the present study, the performance of MARS-LMR code is evaluated through a blind calculation with the boundary conditions measured in the real test. The post-test analysis results are also compared with the test data generated in the test

  18. Communicatively Constructing the Bright and Dark Sides of Hope: Family Caregivers’ Experiences during End of Life Cancer Care

    Science.gov (United States)

    Koenig Kellas, Jody; Castle, Katherine M.; Johnson, Alexis; Cohen, Marlene Z.

    2017-01-01

    (1) Background: The communication of hope is complicated, particularly for family caregivers in the context of cancer who struggle to maintain hope for themselves and their loved ones in the face of terminality. In order to understand these complexities, the current study examines the bright and dark sides of how hope is communicated across the cancer journey from the vantage point of bereaved family caregivers; (2) Methods: We analyzed interviews with bereaved family caregivers using qualitative thematic and case oriented strategies to identify patterns in the positive and negative lived experiences when communicating about hope at the end of life; (3) Results: Two overarching patterns of hope emerged. Those who experienced hope as particularized (focused on cure) cited communication about false hope, performing (faking it), and avoidance. Those who transitioned from particularized to generalized hope (hope for a good death) reported acceptance, the communication of hope as social support, prioritizing family, and balancing hope and honesty; (4) Conclusion: Family caregivers face myriad complexities in managing the bright and dark sides of hope. Interventions should encourage concurrent oncological and palliative care, increased perspective-taking among family members, and encourage the transition from particularized to generalized hope. PMID:28505118

  19. Perceived outcomes of music therapy with Body Tambura in end of life care - a qualitative pilot study.

    Science.gov (United States)

    Teut, Michael; Dietrich, Cordula; Deutz, Bernhard; Mittring, Nadine; Witt, Claudia M

    2014-04-07

    In recent years, music therapy is increasingly used in palliative care. The aim of this pilot study was to record and describe the subjective experiences of patients and their relatives undergoing music therapy with a Body Tambura in a German hospice and to develop hypotheses for future studies. In a qualitative interview pilot study, data collection and analyses were performed according to the methodological framework of grounded theory. We included German-speaking patients, or relatives of patients, receiving end of life care in an inpatient hospice setting. 11 persons consisting of 8 patients (age range 51-82 years, 4 male and 4 female) and 3 relatives were treated and interviewed. All patients suffered from cancer in an advanced stage. The most often described subjective experiences were a relaxing and calming effect, sensations that the body feels lighter, and the generation of relaxing images and visualizations. Family members enjoyed listening to the music and felt more connected with the sick family member. Patient reported beneficial aspects. The small sample size could be seen as a limitation. Assessment instruments measuring relaxation, stress, quality of life and should be included in future quantitative studies.

  20. Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway.

    Science.gov (United States)

    Anshushaug, Malin; Gynnild, Mari Aas; Kaasa, Stein; Kvikstad, Anne; Grønberg, Bjørn H

    2015-03-01

    Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefit is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo- and radiotherapy during EOL, knowledge that might be used to improve practice. Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis. In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3-4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied significantly between the different types of cancer. Multivariate analyses revealed that those at agelife. GPS 2 and synchronous metastases were most significantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo- and radiotherapy during EOL than other patients.

  1. End-of-Life Issues in the United States after Terri Schiavo: Implications for Social Work Practice

    Directory of Open Access Journals (Sweden)

    Darrel Montero

    2011-09-01

    Full Text Available The very public death of Terri Schiavo in 2005 alerted Americans to what is a growing ethical, medical, and social crisis: the status of end-of-life issues and decisions in the United States. Currently, Oregon is the only state to give terminally ill patients the right to end their lives, with physicians’ help, if they so choose. Public opinion data from 1977 to the present show that Americans support greater rights for individuals facing end-of-life decisions--up to and including physician-assisted suicide and euthanasia. This paper considers the status of end-of-life issues in the United States after Terri Schiavo’s death and examines the opportunities for advocacy by social workers who serve clients and families encountering this complex and controversial issue.

  2. Japanese citizens' attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives.

    Science.gov (United States)

    Hirayama, Yoko; Otani, Takashi; Matsushima, Masato

    2017-12-01

    Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.

  3. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

    DEFF Research Database (Denmark)

    Sprung, C.L.; Woodcock, T.; Sjokvist, P.

    2008-01-01

    Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs). Design: A prospective observational study. Setting: Thirty-seven ICUs in 17 European countries. Patients and participants...... for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision......: A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients. Measurements and results: Physicians indicated which of a pre-determined set of reasons...

  4. Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

    Science.gov (United States)

    Seninger, Stephen; Smith, Dean G

    2004-01-01

    Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations.

  5. Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions.

    Science.gov (United States)

    Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

    2015-11-01

    Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps. We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital. Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study. Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes. The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians.

  6. A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication.

    Science.gov (United States)

    Bateman, Lori Brand; White, Marjorie Lee; Tofil, Nancy M; Clair, Jeffrey Michael; Needham, Belinda L

    2017-07-01

    In this study we utilized the framework of patient-centered communication to explore the influence of physician gender and physician parental status on (1) physician-parent communication and (2) care of pediatric patients at the end of life (EOL). The findings presented here emerged from a larger qualitative study that explored physician narratives surrounding pediatric EOL communication. The current study includes 17 pediatric critical care and pediatric emergency medicine physician participants who completed narrative interviews between March and October 2012 to discuss how their backgrounds influenced their approaches to pediatric EOL communication. Between April and June of 2013, participants completed a second round of narrative interviews to discuss topics generated out of the first round of interviews. We used grounded theory to inform the design and analysis of the study. Findings indicated that physician gender is related to pediatric EOL communication and care in two primary ways: (1) the level of physician emotional distress and (2) the way physicians perceive the influence of gender on communication. Additionally, parental status emerged as an important theme as it related to EOL decision-making and communication, emotional distress, and empathy. Although physicians reported experiencing more emotional distress related to interacting with patients at the EOL after they became parents, they also felt that they were better able to show empathy to parents of their patients.

  7. Novice Nurses' Experiences With Palliative and End-of-Life Communication.

    Science.gov (United States)

    Hendricks-Ferguson, Verna L; Sawin, Kathleen J; Montgomery, Kitty; Dupree, Claretta; Phillips-Salimi, Celeste R; Carr, Barb; Haase, Joan E

    2015-01-01

    Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  8. Nurses' Experiences of End-of-life Photography in NICU Bereavement Support.

    Science.gov (United States)

    Martel, Sara; Ives-Baine, Lori

    2018-06-07

    To qualitatively explore neonatal intensive care nurses' experiences with end-of-life photography as part of their bereavement support work with families. An Interpretive Phenomenological Analysis with data collected through a focus group (n = 6) and one semi-structured interview (n = 1) with neonatal nurses from a Level 3/4 NICU in a Canadian pediatric hospital. Participants' comfort with EOL photography developed over time through exposure to bereavement scenarios and positive experiences with families. Participants' experienced a feeling of pressure to balance the photography with clinical responsibilities and find the right time to introduce photography while being sensitive to family experiences. Participants experienced EOL photography as something tangible to give families and were satisfied knowing the images might play an important role in the family's healing after the NICU. All participants had come to value EOL photography as a positive and meaningful part of their work with bereaved families. Identified challenges related to balancing the practice with the unpredictable flow and demands of critical care and to developing an appreciation for and comfort with the photography as part of their healing and the families' healing. Findings contribute insight into care-provider experience that can inform best practices, training, and staff support for palliative and bereavement work in neonatal and pediatric settings. The findings suggest a need to support nurses emotionally and clinically in carrying out this photography as part of their care for families. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Reflections on using biographical approaches in end-of-life care: dignity therapy as example.

    Science.gov (United States)

    Lindqvist, Olav; Threlkeld, Guinever; Street, Annette F; Tishelman, Carol

    2015-01-01

    The therapeutic potential of nonpharmacologic interventions using biographical approaches at the end of life (EoL) is being increasingly recognized, but less attention is paid to processes impeding realization of this potential. In this article, Swedish and Australian researchers reflect on and problematize experiences using one biographical approach, dignity therapy (DT), in EoL care in Sweden. We use this as an example, focusing on critical examination of the process of applying DT in practice, examining frictions experienced in recruiting participants, collecting the data, and creating a biography. We discuss issues regarding agency, which became evident in the recruitment process and choices made about participation, and the power differentials manifested in the interactive process of eliciting stories and crafting them into a final product. We also raise salient questions about how research and practice with biographical approaches in EoL care might better build on and further existing knowledge to better reflect the complexities of everyday life. © The Author(s) 2014.

  10. At-home palliative sedation for end-of-life cancer patients.

    Science.gov (United States)

    Alonso-Babarro, Alberto; Varela-Cerdeira, Maria; Torres-Vigil, Isabel; Rodríguez-Barrientos, Ricardo; Bruera, Eduardo

    2010-07-01

    Using a decision-making and treatment checklist developed to facilitate the at-home palliative sedation process, we assessed the incidence and efficacy of palliative sedation for end-of-life cancer patients with intractable symptoms who died at home. We retrospectively reviewed the medical records of 370 patients who were followed by a palliative home care team. Twenty-nine of 245 patients (12%) who died at home had received palliative sedation. The mean age of the patients who received palliative sedation was 58 +/- 17 years, and the mean age of the patients who did not receive palliative sedation was 69 +/- 15 years (p = 0.002). No other differences were detected between patients who did or did not receive palliative sedation. The most common indications for palliative sedation were delirium (62%) and dyspnea (14%). Twenty-seven patients (93%) received midazolam for palliative sedation (final mean dose of 74 mg), and two (7%) received levomepromazine (final mean dose of 125 mg). The mean time between palliative sedation initiation and time of death was 2.6 days. In 13 of the cases (45%), the palliative sedation decision was made with the patient and his or her family members, and in another 13 patients (45%), the palliative sedation decision was made only with the patient's family members. We concluded that palliative sedation may be used safely and efficaciously to treat dying cancer patients with refractory symptoms at home.

  11. Influence of calcium carbonate on the decomposition of asbestos contained in end-of-life products

    International Nuclear Information System (INIS)

    Belardi, G.; Piga, L.

    2013-01-01

    Highlights: • We characterized end-of-life asbestos-containing materials. • In the range 620–680 °C, calcite and quartz affect decomposition of asbestos. • Hypothesized decomposition reactions match with solid phases revealed by XRD analysis. • TGA of the content of chrysotile gives good results both in air and in nitrogen. - Abstract: Three bearing-asbestos wastes, friction material, vinyl-asbestos (linoleum) and cement-asbestos mainly containing chrysotile were characterized. Powder X-ray diffraction (XRDP), scanning electron microscopy (SEM) with microanalysis observations and thermal analysis (TGA/DTA) were carried out on the materials as received and after heating at 1100 °C in order to observe their structural changes and thermal behaviours. A quantitative determination of chrysotile in the friction material was also carried out. To study the influence of CaCO 3 on the decomposition of asbestos, the three techniques were also applied on the linoleum and cement-asbestos at room temperature and at 1100 °C after leaching of the materials with 1:3 HCl to remove the carbonates present in the wastes. The results show that the presence of CaCO 3 prevents the asbestos to decompose according to the known decomposition reactions and leads to the formation of calcium-silicate compounds. When CaCO 3 is removed by washing with HCl, decomposition of asbestos proceeds according to the expected reactions

  12. Nasogastric feeding at the end of life: a virtue ethics approach.

    Science.gov (United States)

    Krishna, Lalit

    2011-07-01

    The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.

  13. "What the patient wants…": Lay attitudes towards end-of-life decisions in Germany and Israel.

    Science.gov (United States)

    Inthorn, Julia; Schicktanz, Silke; Rimon-Zarfaty, Nitzan; Raz, Aviad

    2015-08-01

    National legislation, as well as arguments of experts, in Germany and Israel represent opposite regulatory approaches and positions in bioethical debates concerning end-of-life care. This study analyzes how these positions are mirrored in the attitudes of laypeople and influenced by the religious views and personal experiences of those affected. We qualitatively analyzed eight focus groups in Germany and Israel in which laypeople (religious, secular, affected, and non-affected) were asked to discuss similar scenarios involving the withholding or withdrawing of treatment, physician-assisted suicide, and euthanasia. In both countries, respect for patient autonomy and patients' wishes to die with dignity found broad consent. Laypeople argued in favor of accepting such wishes when they were put down in an advance directive. Laypeople in non-religious groups in both countries argued on the basis of a respect for autonomy for the possibility of euthanasia in severe cases but, at the same time, cautioned against its possible misuse. National contrast was apparent in the moral reasoning of lay respondents concerning the distinction between withholding and withdrawing treatment. The modern religious laypeople in Israel, especially, argued strongly, on the basis of the halakhic tradition, against allowing the withdrawal of treatment in accord with a patient's wish. We conclude by discussing the emergent notion of shared responsibility and views of professional responsibility, which we connect through relevant cultural themes such as religion and national culture.

  14. From vulnerability to passion in the end-of-life care: The lived experience of nurses.

    Science.gov (United States)

    Liu, Ying-Chun; Chiang, Hsien-Hsien

    2017-12-01

    End-of-life (EOL) care is considered to be inherently difficult and vulnerable for patients and nurses. It also seems hard to develop passion for care during these problematic times. This study elucidates how EOL nurses interpret their care experience and how they transform their experience and mindset. This study was conducted by organizing a reflective group based on the concept of group analysis for oncology and hospice nurses to share their experience. Thirteen registered nurses were enrolled from a medical center in northern Taiwan. Data drawn from the group dialogue was derived from six digitally recorded sessions and then analysed alone with the researcher's diaries and participants' feedback sheets. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. The results showed that nurses who provide EOL care actually experience suffering by witnessing patients' suffering. However, the suffering authentically drives the nurses to encounter their own inner selves, to induce the shift of mindset, and then allow them to continuously provide and maintain the passion in EOL care. This study provides a new viewpoint for understanding of EOL nurses' experiences, indicating that this line of work may be recognized as a privilege. We recommend that the setting of a nurse reflective group is important and it may be considered in providing EOL care training for nurses. Hopefully the study results could shed lights for future policies regarding EOL care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Parental perceptions of forgoing artificial nutrition and hydration during end-of-life care.

    Science.gov (United States)

    Rapoport, Adam; Shaheed, Jenny; Newman, Christine; Rugg, Maria; Steele, Rose

    2013-05-01

    Forgoing artificial nutrition and hydration (FANH) in children at the end of life (EOL) is a medically, legally, and ethically acceptable practice under specific circumstances. However, most of the evidence on FANH involves dying adults. There is a paucity of pediatric evidence to guide health care providers' and parents' decision-making around this practice. Objectives were (1) to explore the experiences of bereaved parents when a decision had been made to FANH during EOL care for their child and (2) to describe the perceived quality of death in these children, as reported by their parents. This was a qualitative study using in-depth interviews with parents whose children died after a decision to FANH. Parental perceptions about the experience and their child's quality of death were explored. Interviews were audiotaped and transcribed, then data were analyzed by using interpretive description methodology. All parents were satisfied with their decision to FANH and believed that their child's death was generally peaceful and comfortable. The child's perceived poor quality of life was central to the decision to FANH, with feeding intolerance often contributing to this perception. Despite overall satisfaction, all parents had doubts and questions about the decision and benefited from ongoing assurances from the clinical team. FANH in children at the EOL is an acceptable form of palliation for some parents and may contribute to a death that is perceived to be peaceful and comfortable. In situations in which FANH may be a reasonable possibility, physicians should be prepared to introduce the option.

  16. Exposing barriers to end-of-life communication in heart failure: an integrative review.

    Science.gov (United States)

    Garland, Ella L; Bruce, Anne; Stajduhar, Kelli

    2013-01-01

    End-of-life (EOL) communication is lacking despite patients with heart failure (HF) and their caregivers desiring it. To review the existing literature to identify barriers that inhibit EOL communication in the HF population. We chose an integrative literature review method and began by searching CINAHL, Medline, PsychInfo, Web of Science, Health Source Nursing Academic, Evidence-Based Medicine Reviews (EBMR), dissertations and theses searches through the University of Victoria and through Proquest from 1995 to 2011. DATA EVALUATION: EOL communication regarding wishes, prognosis and options for care rarely happen. We noted that patients lacked understanding of HF, feared engaging health care professionals (HCP), did not wish to talk about EOL, or waited for HCPs to initiate the conversation. HCPs lacked communication skills, focused on curative therapies and found diagnosing and prognosticating HF difficult. Limited time and space for conversations played a role. The challenge of diagnosing and prognosticating HF, its unpredictable trajectory, HCP inexperience in recognizing nearing EOL and lack of communication skills lead to HCPs avoiding EOL conversations. Four categories of barriers to communication were identified: patient/caregiver, HCP, disease-specific and organizational challenges.

  17. Preparedness for End of Life-a Survey of Jerusalem District Nursing Homes.

    Science.gov (United States)

    Shaulov, Adir; Frankel, Meir; Rubinow, Alan; Maaravi, Yoram; Brezis, Mayer

    2015-10-01

    To evaluate the quality of end-of-life (EOL) care in nursing homes. Survey and semistructured interviews. Jerusalem district nursing homes. Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207). Qualitative analysis of semistructured interviews and statistical analysis of questionnaires. Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents. Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  18. [End-of-life and euthanasia, an intensive care team's experience].

    Science.gov (United States)

    Baruteau, J; Devilliers, A; François, I; Blettery, B

    2002-04-20

    The improvement in the medical techniques used in intensive care units over the last 30 years has led to a different approach towards the end of life and death. Our study has underlined the feelings of all the staff of an intensive care unit towards the various difficulties engendered by death and the question of euthanasia. Conducted in the particular context of an intensive care unit, this work is a survey on the staff's feelings and factual experiences, in order to promote discussions on this painful subject. Sixty-one percent of the persons surveyed declared that euthanasia was ethically acceptable. The patients take the initiative of the request (92%) and the cohesion of the team is unanimously required. Pain and corporeal deterioration are the first motivations. Euthanasia is a difficult question, sometimes impassionate, and the care units have to consider whether they are concerned by the quality of their patients' care. The press regularly issues reports on this. But beyond these quantified questions, the staff who care for these ill patients are often very discreet. The regular confrontation with this situation changes the medical team's view of the profession.

  19. [Volunteering in end-of-life care : Challenges, problems and perspectives].

    Science.gov (United States)

    Schneider, Werner

    2017-01-01

    Volunteering in the hospice movement has had a profound impact on generating awareness of hospice work and palliative care in the context of supporting dying persons and their relatives as well as on integrating respective services in the existing health care system. This paper focuses on two specific questions: First, it asks how society is changing with respect to dealing with dying and death, and more precisely with dying persons, which is recognizable by the integration of hospice work and palliative care in the healthcare system and related to the relevance of volunteering in the sense of a citizens' movement. Second, this paper asks what the specific roles of volunteers are as well as the possibilities and limits of voluntary practice in end-of-life care and accompaniment. To answer these questions, the pivotal objectives of the hospice movement - the transformation of the social awareness regarding dying and death, as well as the reorganization of "institutions of dying" - will first be outlined by reference to the concept of "good dying", a specific hospice attitude together with hospice culture and palliative competence. In a second step, the relevance of volunteering and the specific role of volunteers in the actual practice of hospice work and palliative care will be outlined alongside current indicators and recognizable alteration tendencies, before concluding with a discussion of the perspectives of hospices as a citizens' movement.

  20. Physical activity history and end-of-life hospital and long-term care

    DEFF Research Database (Denmark)

    von Bonsdorff, Mikaela B; Rantanen, Taina; Leinonen, Raija

    2009-01-01

    persons aged 66-98 years at death, who, on average 5.8 years prior to death, had participated in an interview about their current and earlier physical activity. Data on the use of care in the last year of life are register-based data and complete. RESULTS: Men needed on average 96 days (SD 7.0) and women.......06-2.43), than for those who had been consistently active from midlife onward, whereas use of hospital care did not correlate with physical activity history. CONCLUSION: People who had been physically active since midlife needed less end-of-life inpatient care but patterns differed between men and women....... had been consistently physically active, whereas use of long-term care did not correlate with physical activity history. Among women, the risk for long-term care was higher for those who had been sedentary (IRR 2.03, 95% CI 1.28-3.21) or only occasionally physically active (IRR 1.60, 95% CI 1...

  1. Family factors in end-of-life decision-making: family conflict and proxy relationship.

    Science.gov (United States)

    Parks, Susan Mockus; Winter, Laraine; Santana, Abbie J; Parker, Barbara; Diamond, James J; Rose, Molly; Myers, Ronald E

    2011-02-01

    Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

  2. Palliative and end of life care communication as emerging priorities in postgraduate medical education

    Science.gov (United States)

    Roze des Ordons, Amanda; Ajjawi, Rola; Macdonald, John; Sarti, Aimee; Lockyer, Jocelyn; Hartwick, Michael

    2016-01-01

    Background Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees’ educational needs for a palliative and EOL communication curriculum and how these needs could be met. Methods Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted. Results Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Focus groups and interviews identified goals of care conversations as the highest educational priority, with education adapted to learner needs and accompanied by feedback and concurrent clinical and organizational support. Conclusions Our work expands on previous research describing needs for postgraduate education in palliative and EOL communication to include the importance of support, culture change, and faculty development, and provides insight into why such needs exist. PMID:27103952

  3. 'End of life' conversations, appreciation sequences, and the interaction order in cancer clinics.

    Science.gov (United States)

    Maynard, Douglas W; Cortez, Dagoberto; Campbell, Toby C

    2016-01-01

    To address the organization of conversations in oncology visits by taking an "interaction order" perspective and asking how these visits are intrinsically organized. Conversation analysis. Using audio recordings of talk in oncology visits involving patients with non-small cell lung cancer, we identify and analyze an "appreciation sequence" that is designed to elicit patients' understanding and positive assessment of treatments in terms of their prolongation of life. An "appreciation sequence," regularly initiated after the delivery of scan results and/or treatment recommendations, simultaneously reminds patients of their mortality while suggesting that the treatment received has prolonged their lives, and in some cases significantly beyond the median time of survival. We explore the functions of the appreciation sequence for cancer care and set the stage for considering where and when physicians have choices about the order and direction the talk can take and how to allocate time for end of life and quality of life conversations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. The end-of-life phase of high-grade glioma patients: dying with dignity?

    Science.gov (United States)

    Sizoo, Eefje M; Taphoorn, Martin J B; Uitdehaag, Bernard; Heimans, Jan J; Deliens, Luc; Reijneveld, Jaap C; Pasman, H Roeline W

    2013-01-01

    In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as perceived by their relatives and (b) identify disease and care factors correlated with dying with dignity in HGG patients. We approached relatives of a cohort of 155 deceased HGG patients for the study. Participants completed a questionnaire concerning the EOL phase of the patient, covering several subthemes: (a) symptoms and signs, (b) health-related quality of life, (c) decision making, (d) place and quality of EOL care, and (e) dying with dignity. Relatives of 81 patients participated and 75% indicated that the patient died with dignity. These patients had fewer communication deficits, experienced fewer transitions between health care settings in the EOL phase, and more frequently died at their preferred place of death. Relatives were more satisfied with the physician providing EOL care and reported that the physician adequately explained treatment options. Multivariate analysis identified satisfaction with the physician, the ability to communicate, and the absence of transitions between settings as most predictive of a dignified death. Physicians caring for HGG patients in the EOL phase should timely focus on explaining possible treatment options, because patients experience communication deficits toward death. Physicians should strive to allow patients to die at their preferred place and avoid transitions during the last month of life.

  5. Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry.

    Science.gov (United States)

    McKellar, Duncan; Ng, Felicity; Chur-Hansen, Anna

    2016-01-01

    Old age psychiatrists work with end-of-life (EOL) issues and encounter patient deaths, but death and dying have received limited focus in old age psychiatry training and research. This qualitative study explores old age psychiatrists' experience of and approach to working with patients at the EOL. Australian old age psychiatrists were purposively sampled and interviewed in-depth. Data saturation was achieved after nine participant interviews. Verbatim transcripts were analysed for themes, which were independently verified. Two dichotomous overarching themes were identified. Death is not our business reflected participants' experience of working in a mental health framework and incorporated four themes: death should not occur in psychiatry; working in a psychiatric treatment model; keeping a distance from death and unexpected death is a negative experience. Death is our business reflected participants' experience of working in an aged care context and incorporated four themes: death is part of life; encountering the EOL through dementia care; doing EOL work and expected death is a positive experience. Participants reported conflict because of the contradictory domains in which they work. They were comfortable working with patients at the EOL when death was expected, particularly in dementia. By contrast, they struggled with death as an adverse outcome in circumstances influenced by mental health culture, which was characterised by risk management, suicide prevention and a focus on recovery. This study has implications for models of care underpinning old age psychiatry. An integrated person-centred model of care may provide a contextually appropriate approach for practice.

  6. Value estimation of end of life vehicles as a source of competitive advantage for dismantling station

    Directory of Open Access Journals (Sweden)

    Monika Kosacka

    2016-03-01

    Full Text Available   Background: End of Life vehicles become an emerging problem because of the type of waste which they are. Each country is creating own recycling network where ELVs are well secured and recycled. Poland is a country where the system is not working correct because of a high absorption of ELVs by illegal dismantling entities which are more competitive than legal elements of recycling network. The problem is well known but there is still lack of solution. The purpose of this article is to present the concept of tools for the valuation of ELVs in order to improve the competitiveness of disassembly stations. Methods: The research methodology consists of a literature review as well as observations, surveys, BPMN and UML diagrams. On the basis of literature review and observations the problem was identified. The surveys were elaborated in order to identify requirements for the concept of the tool. BPMN and UML diagrams were used to model the processes in dismantling station and the information flow between the user and the tool. Results: There was established a concept of the tool - ELV's Calculator which support decisions of ELV's value estimation. Conclusions: Improving competitiveness of legal dismantling station is extremely important issue in order to provide safe for Environment and People and economically justified ELVs' management. Legal entities have to follow the law what makes their business cost higher. This paper provides a solution of encouraging people to return ELVs to legal dismantlers by offering them price adequate to market demand.    

  7. The impact of culture and religion on truth telling at the end of life.

    Science.gov (United States)

    de Pentheny O'Kelly, Clarissa; Urch, Catherine; Brown, Edwina A

    2011-12-01

    Truth telling, a cardinal rule in Western medicine, is not a globally shared moral stance. Honest disclosure of terminal prognosis and diagnosis are regarded as imperative in preparing for the end of life. Yet in many cultures, truth concealment is common practice. In collectivist Asian and Muslim cultures, illness is a shared family affair. Consequently, decision making is family centred and beneficence and non-malfeasance play a dominant role in their ethical model, in contrast to patient autonomy in Western cultures. The 'four principles' are prevalent throughout Eastern and Western cultures, however, the weight with which they are considered and their understanding differ. The belief that a grave diagnosis or prognosis will extinguish hope in patients leads families to protect ill members from the truth. This denial of the truth, however, is linked with not losing faith in a cure. Thus, aggressive futile treatment can be expected. The challenge is to provide a health care service that is equable for all individuals in a given country. The British National Health Service provides care to all cultures but is bound by the legal principles and framework of the UK and aims for equity of provision by working within the UK ethical framework with legal and ethical norms being explained to all patients and relatives. This requires truth telling about prognosis and efficacy of potential treatments so that unrealistic expectations are not raised.

  8. Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care.

    Science.gov (United States)

    Chappell, Phylliss M; Healy, Jennifer; Lee, Shuko; Medellin, Glen; Sanchez-Reilly, Sandra

    2017-08-01

    The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ 2 or Fisher exact test, and improvement was measured by weighted κ coefficient. On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.

  9. Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology.

    Science.gov (United States)

    Falls, Christopher Edward

    2008-01-01

    American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.

  10. Comparison of end-of-life tire treatment technologies: a Chinese case study.

    Science.gov (United States)

    Li, Xingfu; Xu, He; Gao, Yingnan; Tao, Yijun

    2010-11-01

    The aim of this paper is to compare different end-of-life tire (ELT) treatment technologies in China from an environmental and economic perspective. Four treatment technologies were evaluated: ambient grinding, devulcanization, pyrolysis and illegal tire oil extraction. Life cycle assessment (LCA) was applied to evaluate the potential environmental impact of each treatment based on the Eco-indicator 99 (Hierarchist approach) method provided by GaBi 4 software. The final result shows that pyrolysis represents the environmentally benign option while illegal tire oil extraction caused the worst damages. For the three legal treatments, although high credit was obtained when considering avoided impacts from recycled materials and energy, they have great impact as to respiratory effects (inorganic) dominantly contributed by energy production stage, which implies that the emphasis on environmental policies related to ELT treatment should shift from the control of emissions from treatment process to the reduction of energy consumption. A simplified comparison of net benefits and total impacts shows that the most eco-effective ELT treatment technology is pyrolysis, followed by dynamic devulcanization and ambient grinding. The illegal tire oil extraction, however, must be prohibited immediately because of its highest environmental pollution and lowest net benefit. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. End-of-life parental communication priorities among bereaved fathers due to cancer.

    Science.gov (United States)

    Park, Eliza M; Deal, Allison M; Yopp, Justin M; Edwards, Teresa; Stephenson, Elise M; Hailey, Claire E; Nakamura, Zev M; Rosenstein, Donald L

    2017-05-01

    To elicit widowed fathers' perspectives on which domains of parenting-related communication they consider most important for dying parents to discuss at the end of life (EOL). Two hundred seventy nine fathers widowed by cancer completed a survey about their own depression and bereavement symptoms, their wife's illness, and EOL parental communication priorities. Chi square and Fisher's exact tests and logistic regression were used to evaluate relationships between maternal EOL characteristics and fathers' responses to parenting-related EOL communication priorities. Fathers identified raising children in a manner that reflected maternal wishes, whether/how to talk with children about their mother's death, and how the mother wanted to be remembered as the most important EOL communication domains. Fathers who reported that their dying wives were worried about the children were more likely to prioritize raising children in ways that reflect her wishes (p=0.01). Other EOL characteristics were not associated with communication domains. Communicating with children and maintaining emotional connection with the deceased parent are important priorities for bereaved fathers who lost a spouse to cancer. Health care providers working with seriously ill parents may improve family outcomes by supporting communication at the EOL between co-parents. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Influence of calcium carbonate on the decomposition of asbestos contained in end-of-life products

    Energy Technology Data Exchange (ETDEWEB)

    Belardi, G. [Environmental Geology and GeoEngineering Institute (CNR), Area della ricerca RM1, via Salaria km 29,300, 00016 Monterotondo (Rome) (Italy); Piga, L., E-mail: luigi.piga@uniroma1.it [Department of Chemical Engineering, Materials and Environment, Sapienza University of Rome, via Eudossiana 84, 00184 Rome (Italy)

    2013-12-10

    Highlights: • We characterized end-of-life asbestos-containing materials. • In the range 620–680 °C, calcite and quartz affect decomposition of asbestos. • Hypothesized decomposition reactions match with solid phases revealed by XRD analysis. • TGA of the content of chrysotile gives good results both in air and in nitrogen. - Abstract: Three bearing-asbestos wastes, friction material, vinyl-asbestos (linoleum) and cement-asbestos mainly containing chrysotile were characterized. Powder X-ray diffraction (XRDP), scanning electron microscopy (SEM) with microanalysis observations and thermal analysis (TGA/DTA) were carried out on the materials as received and after heating at 1100 °C in order to observe their structural changes and thermal behaviours. A quantitative determination of chrysotile in the friction material was also carried out. To study the influence of CaCO{sub 3} on the decomposition of asbestos, the three techniques were also applied on the linoleum and cement-asbestos at room temperature and at 1100 °C after leaching of the materials with 1:3 HCl to remove the carbonates present in the wastes. The results show that the presence of CaCO{sub 3} prevents the asbestos to decompose according to the known decomposition reactions and leads to the formation of calcium-silicate compounds. When CaCO{sub 3} is removed by washing with HCl, decomposition of asbestos proceeds according to the expected reactions.

  13. Caregiving Youth Knowledge and Perceptions of Parental End-of-Life Wishes in Huntington's Disease.

    Science.gov (United States)

    Kavanaugh, Melinda S; Noh, Hyunjin; Zhang, Lixia

    2016-01-01

    Knowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles ("young carers" or "caregiving youth"). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10-20, who have a parent with Huntington's disease (HD), provided information about their knowledge of the presence of their ill parent's living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent's LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent's wishes, caregiving youths' opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues.

  14. Let's Talk About It: Supporting Family Communication during End-of-Life Care of Pediatric Patients.

    Science.gov (United States)

    Marsac, Meghan L; Kindler, Christine; Weiss, Danielle; Ragsdale, Lindsay

    2018-05-18

    Communication is key in optimizing medical care when a child is approaching end of life (EOL). Research is yet to establish best practices for how medical teams can guide intrafamily communication (including surviving siblings) when EOL care is underway or anticipated for a pediatric patient. While recommendations regarding how medical teams can facilitate communication between the medical team and the family exist, various barriers may prevent the implementation of these recommendations. This review aims to provide a summary of research-to-date on family and medical provider perceptions of communication during pediatric EOL care. Systematic review. Findings from a review of 65 studies suggest that when a child enters EOL care, many parents try to protect their child and/or themselves by avoiding discussions about death. Despite current recommendations, medical teams often refrain from discussing EOL care with pediatric patients until death is imminent for a variety of reasons (e.g., family factors and discomfort with EOL conversations). Parents consistently report a need for honest complete information, delivered with sensitivity. Pediatric patients often report a preference to be informed of their prognosis, and siblings express a desire to be involved in EOL discussions. Families may benefit from enhanced communication around EOL planning, both within the family and between the family and medical team. Future research should investigate a potential role for medical teams in supporting intrafamily communication about EOL challenges and should examine how communication between medical teams and families can be facilitated as EOL approaches.