Sample records for patients died early

  1. The Angry Dying Patient.

    Houston, Robert E.


    Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way.

  2. Enabling ICU patients to die at home.

    Battle, Emma; Bates, Lucy; Liderth, Emma; Jones, Samantha; Sheen, Sheryl; Ginty, Andrew; Northmore, Melanie


    There is often an overlap between intensive care medicine and palliative medicine. When all curative treatment options have been explored, keeping the patient comfortable and free from pain is the main concern for healthcare practitioners. Patient autonomy in end of life decisions has not been encouraged in the intensive care unit (ICU), until now, because of its specialised and technical nature. Staff at the Royal Bolton Hospital have broken down the barriers to enabling ICU patients to die in their own homes, and have developed a system of collaborative working that can help to fulfil a patient's final wish to go home. This article describes how ICU staff developed a process that enabled two ventilated patients to be transferred home for end of life care.

  3. Health care practitioners and dying patients

    Panagiotis Pentaris


    Full Text Available A full understanding of and a competent approach to dying patients may lead to a more qualitative service delivery, an enhanced quality of life paradigms, and the patients’ wellbeing, all of which remain the ultimate goal of health care practice. The modern world has developed in parallel with secularism and religious diversity. This paper aims to illustrate the secularization process in Britain (with indications of generalized meanings and juxtaposes it with a description of the needs of dying patients regarding the meanings of religion and nonreligion. Although this paper draws on and provides a review of selected theoretical literature, it also addresses a significant challenge: the lack of scientifi c research on the subject. Hence, this paper aims to give an overview of the issues, but not synthesise them. The arguments that are elaborated in the paper are also supported by the author’s current research project in the city of London. The approach here is client oriented, and concerns social and health care. Practitioners ought to become competent, and maintain their competence throughout their professional career. Religious competence seems to have not been at the centre of discussions, regardless of the historical pathway that religious discourse has drawn since the beginnings of humanity. The paper concludes with certain suggestions for future research and inclusive approaches regarding religious matters.

  4. When LVAD Patients Die: The Caregiver's Mourning.

    Rossi Ferrario, Silvia; Omarini, Pierangela; Cerutti, Paola; Balestroni, Giangluigi; Omarini, Giovanna; Pistono, Massimo


    Left ventricular assist devices (LVADs) have progressively evolved, particularly in the last 10 years, to serve patients affected by severe heart failure as a bridge to transplant or destination therapy. The survival rate and quality of life of pre- and postimplant patients, as well as caregivers' perceptions and distress, are under investigation by the scientific community. But what caregivers think and feel after the loss of their loved one has not so far been examined. We contacted 16 principal caregivers of deceased LVAD patients by telephone. They were asked to evaluate their experience with LVADs and were administered a specific questionnaire about their mourning, the Caregiver Mourning Questionnaire (CMQ), to evaluate their perceptions of the physical, emotional, and social support-related problems that they had experienced during the previous 3 months. Positive aspects reported by the caregivers were the patient's overall subjective well-being and increased survival. Negative aspects were the difficulty to manage infections and the driveline, and the incomplete autonomy of the patient. Half of the caregivers reported not being preadvised about many of the problems they would face. The CMQ revealed that numerous caregivers had health problems, difficulty in sleeping, eating disorders, lack of energy, and loneliness. Use of psychotropic drugs and regrets about how they assisted their loved one also emerged. In conclusion, caregivers of LVAD patients may experience complicated mourning. Our data support in particular the need for an early intervention of palliative care which could prevent or reduce complicated mourning. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. Patients who die during palliative radiotherapy. Status survey

    Berger, B.; Ankele, H.; Bamberg, M.; Zips, D. [University of Tuebingen, Department of Radiation Oncology, Tuebingen (Germany)


    Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT. In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified. In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime. The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime. (orig.) [German] Die palliative Radiotherapie (RT) hat einen hohen Stellenwert in der Symptomenkontrolle terminal erkrankter Tumorpatienten. Unnoetig belastende Therapien kurz vor Lebensende sollten jedoch vermieden werden. Bislang gibt es kaum strukturierte Daten ueber Sterbefaelle unter palliativer RT. Im Rahmen der vorgestellten Studie wurden die Sterbefaelle unter stationaer palliativ bestrahlten Patienten der eigenen Abteilung zwischen Januar 2009 und Dezember 2011 analysiert. Ausgewertet wurden epidemiologische Faktoren, Behandlungskonzept und -verlauf. Zeit bis zum RT-Beginn und RT-Dauer wurden ins Verhaeltnis zur tatsaechlichen

  6. Die Starter: A New System to Manage Early Feasibility in Sheet Metal Forming

    Narainen, Rodrigue; Porzner, Harald


    Die Starter, a new system developed by ESI Group, allows the user to drastically reduce the number of iterations during the early tool process feasibility. This innovative system automatically designs the first quick die face, generating binder and addendum surfaces (NURBS surfaces) by taking account the full die process. Die Starter also improves the initial die face based on feasibility criteria (avoiding splits, wrinkles) by automatically generating the geometrical modifications of the binder and addendum and the bead restraining forces with minimal material usage. This paper presents a description of the new system and the methodology of Die Starter. Some industrial examples are presented from the part geometry to final die face including automatic developed flanges, part on binder and inner binder.

  7. Dying with dignity: the good patient versus the good death.

    Proulx, Kathryn; Jacelon, Cynthia


    Death is a unique experience for each human being, yet there is tremendous societal pressure on a dying person to be a "goodpatient " while trying to experience the "good death. " These pressures shape patient, caregiver, and family choices in end-of-life situations. The purpose of this literature review was twofold: first, to develop an understanding of "dying with dignity" to enhance the end-of-life care received by dying patients, and second, to contribute to a concept analysis of dignity to improve the clarity and consistency of future research related to dignity in aging individuals. Articles pertaining to dying with dignity from the disciplines of nursing, medicine, ethics, psychology, and sociology were reviewed using a matrix method. A dichotomy surrounding dying with dignity emerged from this review. The definition of dignity in dying identifies not only an intrinsic, unconditional quality of human worth, but also the external qualities of physical comfort, autonomy, meaningfulness, usefulness, preparedness, and interpersonal connection. For many elderly individuals, death is a process, rather than a moment in time, resting on a need for balance between the technology of science and the transcendence of spirituality.

  8. Barriers to Quality Care for Dying Patients in Rural Communities

    Van Vorst, Rebecca F.; Crane, Lori A.; Barton, Phoebe Lindsey; Kutner, Jean S.; Kallail, K. James; Westfall, John M.


    Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self-administered survey was sent to health care…

  9. Patients who die during palliative radiotherapy. Status survey

    Berger, B.; Ankele, H.; Bamberg, M.; Zips, D.


    Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT. In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified. In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime. The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime. (orig.) [de

  10. The Lived Experiences of Nurses Caring For Dying Pediatric Patients.

    Curcio, Danna L


    Nurses and healthcare professionals may have difficulty adjusting to and comprehending their experiences when a patient’s life ends. This has the potential to interfere with patient care. Reflection on past events and actions enables critical discovery of strategies to benefit both nurses and patients. This qualitative phenomenological study explores the lived experiences of nurses caring for dying pediatric patients. The philosophical underpinning of Merleau-Ponty (2008), in combination with the research method of van Manen (1990), was used for this study. The Roy Adaptation Model (RAM) (Roy, 2009; Roy & Andrews, 1991) was the nursing model that guided the study to help understand that nurses are an adaptive system, using censoring as a compensatory adaptive process to help function for a purposeful cause. Nine female nurse participants with one to four years of experience were interviewed. The context of the experiences told by nurses caring for dying pediatric patents uncovered seven essential themes of empathy, feelings of ambivalence, inevitability, inspiration, relationship, self-preservation, and sorrow, and these themes demonstrated a connection formed between the nurse and the patient.

  11. Experiences of Family Members of Dying Patients Receiving Palliative Sedation.

    Tursunov, Olga; Cherny, Nathan I; Ganz, Freda DeKeyser


    To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. Descriptive comparative study.
. Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. A convenience sample of 34 family members of dying patients receiving palliative sedation. 
. A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time.
. Experiences of family members and time.
. Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time. 
. Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication.
. Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a

  12. Comparing quality of dying and death perceived by family members and nurses for patients dying in US and Dutch ICUs

    Gerritsen, Rik T; Koopmans, Matty; Hofhuis, José G M


    with 8 higher in the US and 2 higher in NL. CONCLUSION: The QODD was rated similarly by family members in the US and the Netherlands but varied when assessed by nurses. These differences may be due to organizational or cultural differences between the two countries or to expectations of respondents.......BACKGROUND: The Quality of Dying and Death (QODD) questionnaire is used as a self-reported measure to allow families and clinicians to assess patients' quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United...... States (US) and the Netherlands (NL) to explore similarities and differences in these experiences and identify opportunities for improving EOL care. METHODS: Questionnaire data were gathered from family members of patients dying in the ICU and nurses caring for these patients. In NL, data were gathered...

  13. The Transformation Process in Nurses Caring for Dying Patients.

    Huang, Ching-Chi; Chen, Jih-Yuan; Chiang, Hsien-Hsien


    Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing

  14. Cause and place of death in patients dying with colorectal cancer.

    Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J


    Few studies on colorectal cancer look at the one-third of patients for whom treatment fails and who need a management strategy for death. This paper has examined the mode and place of death in patients with colorectal cancer. This study was a review of 209 deaths, analysed between January 2001 and September 2004 by retrospective review of a prospectively collected database. A total of 118 patients (group 1) had undergone resection of their primary colorectal cancer, 20 (group 2) had had a defunctioning stoma or bypass surgery and the remaining 71 patients (group 3) had either had no surgery, an open and close laparotomy or had a colonic stent. One hundred and fifty-six (75%) patients died of colorectal cancer with the remainder dying of other causes. The number of admissions to hospital and the number of days spent in hospital from diagnosis to death were greatest in group 1. Overall, only 34 patients (22%) dying from colorectal cancer died at home. Forty (26%) died in hospital and 70 (45%) died in a palliative care unit. Patients dying from colorectal cancer who undergo surgical resection of their primary tumour spend more time between diagnosis and death in hospital. They are also more likely to die in hospital than patients treated by surgical palliation or nonsurgically. Patients who are treated palliatively from the outset (group 3) are most likely to die at home. If hospital is accepted as an appropriate place for death from colorectal cancer, then greater provision for this should be made.

  15. Euthanasia – Help to die : a literature review from patients' perspective

    Nilsson, Kim; Jonas, Andersson


      Background: Euthanasia means help to die. Some terminally ill patients wish for euthanasia. Purpose: Illuminating terminally ill patients' desire for voluntary euthanasia. Method: A general literature study. Seven articles were reviewed and analyzed. Results: Patients do not want to live a painful life or die a painful death, patients want control over their lives and feel involved in decisions affecting their lives and the patients want to feel quality of life despite their illness or trea...

  16. Caring for dying patients: Attitude of nursing students and effects of education

    Mojtaba Jafari


    Full Text Available Background: Education about caring for dying patients could be effective in changing nursing students′ attitude toward caring for dying patients. Aim: The aim of the present study was to examine the nursing students′ attitude toward caring for dying patients and effects of education on their attitude. Materials and Methods: The present study enjoys a quasi-experimental method with using one-group pre-test/post-test design conducted in Bam in southeast of Iran. The attitude of nursing students was measured using Frommelt Attitude Toward Care of the Dying (FATCOD scale before and after an educational intervention. Data were analyzed using non-parametric tests in Statistical Package for the Social Sciences (SPSS 18 software. Results: Of 32 students, 30 participated in this study (response rate of 94%. Only 20% of the students reported previous experience of dying patients in their clinical courses. Students showed moderately negative to neutral attitudes toward caring for dying patients. Education has improved students′ attitude significantly (mean score of FATCOD before study were 3.5 ± 0.43 and after intervention were 4.7 ± 0.33 ( P < 0.001. Conclusion: Educational programs about death and caring for dying patients should be added to undergraduate nursing curricula. Further research recommended examining nursing students′ knowledge about caring for dying patients and the effect of education on their knowledge.

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

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


    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.

  18. Clinical nurses' attitudes towards death and caring for dying patients in China.

    Wang, Liping; Li, Chaxiang; Zhang, Qiongling; Li, YaJie


    To examine Chinese clinical nurses' attitudes towards death and caring for dying patients, and to examine the relationships between clinical nurses' attitudes towards death and caring for dying patients. A convenience sample of 770 clinical nurses from 15 hospitals in China. All participants completed the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), the Chinese version of the Death Attitude Profile-Revised (DAP-R-C), and a demographic questionnaire. The mean score of the FATCOD-B-C items was 95.62 (SD = 7.45). The majority of Chinese clinical nurses were likely to provide care for the dying person's family (mean = 3.77), but did not have a positive attitude towards communication with the dying person(mean = 2.62). The majority of Chinese clinical nurses showed low scores on death avoidance (mean=1.96) and natural acceptance (mean = 1.61), and most of them viewed death as a passageway to a happy afterlife (mean = 4.33). Attitudes towards caring for dying patients were significantly negatively correlated with fear of death (r = -0.120) and positively correlated with approach acceptance (r = 0.127) and natural acceptance (r = 0.117). Factors that predicted clinical nurses' attitudes towards the care of dying patients included education level, fear of death, approach acceptance, religious beliefs, previous education on death and dying, natural acceptance, professional title, and experience with death or dying patients, which accounted for 18.7% of the variance. Nurses' personal attitudes towards death were associated with their attitudes towards the care of dying patients. Training and educational programmes for clinical nurses should take into consideration nurses' personal attitudes towards death as well as their cultural backgrounds and religious beliefs.

  19. On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

    Varelius, Jukka


    Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. © 2015 John Wiley & Sons Ltd.

  20. Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey.

    Wang, Vinchi; Hsieh, Chieh-Chao; Huang, Yen-Ling; Chen, Chia-Ping; Hsieh, Yi-Ting; Chao, Tzu-Hao


    The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.

  1. The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

    Jonnalagada Subbanna


    Full Text Available Abstract Background India has 2.0 million estimated tuberculosis (TB cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i treatment outcomes including the number who died while on treatment, ii the month of death and iii characteristics associated with "early" death, occurring in the initial 8 weeks of treatment. Methods This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results There were 8,240 TB patients (5183 males of whom 492 (6% were known to have died during treatment. Case-fatality was higher in those previously treated (12% and lower in those with extra-pulmonary TB (2%. There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death". Conclusion In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.


    Evgeni I. Paunov


    Full Text Available This paper attempts to trace the distribution of unofficial dies for striking late Republican and early Imperial coins in Moesia and Thrace, discussing eleven dies and one hub (master die. It deals with the key issues concerning these rare numismatic finds , their occurrence in the Balkan provinces of Roman Empire and their interpretation as genuine monetary items or as forgers’ accessories. Such a large concentration of dies is found in a relatively constrained area, but so far understanding does not clearly revealed what their importance is. The problem appears to be essential for the comprehension of Roman political and military activities in the Balkans during the Augustan-Tiberian period, as well as for the general discussion on ancient coin techniques.

  3. Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care.

    Chappell, Phylliss M; Healy, Jennifer; Lee, Shuko; Medellin, Glen; Sanchez-Reilly, Sandra


    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.

  4. Nurses attitudes towards death, dying patients and euthanasia: A descriptive study.

    Ay, Melike Ayça; Öz, Fatma


    Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses' views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. The purpose of this study was to determine nurses' views and attitudes about death, dying patient, euthanasia and the relationships between nurses' characteristics. Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. 'Nurse Information Form' and 'Attitude Scale about Euthanasia, Death and Dying Patients (DAS)' were used as data collection tool. Ethical consideration: Written permissions were received from the 'Noninterventional Clinical Researches Ethics Board' of authors' university and education councils of each hospital. Informed consent was obtained from participants. It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses' attitudes about euthanasia, death and dying patient (p euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.

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

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


    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

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

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


    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

  7. Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study.

    McKeown, Kieran


    More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

  8. Use of sedation to relieve refractory symptoms in dying patients ...

    Indications. Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation.

  9. Factors associated with preference for dying at home among terminally ill patients with cancer

    Schou-Andersen, Marianne; Ullersted, Maria P; Jensen, Anders Bonde


    relatives of deceased patients who died of cancer in Denmark in 2006. Bereaved relatives were asked to state patient's preference concerning place of death at the beginning and end of the palliative period. These data were recently combined with updated, extensive demographic and socio-economic data from...

  10. Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home.

    Yamagishi, Akemi; Morita, Tatsuya; Kawagoe, Shohei; Shimizu, Megumi; Ozawa, Taketoshi; An, Emi; Kobayakawa, Makoto; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori


    This study aims to clarify the length of home hospice care, family-perceived timing of referrals, and their effects on the family-perceived quality of care and quality of death and dying of terminally ill cancer patients who died at home and identify the determinants of perceived late referrals. A multicenter questionnaire survey was conducted involving 1,052 family members of cancer patients who died at home supported by 15 home-based hospice services throughout Japan. A total of 693 responses were analyzed (effective response rate, 66 %). Patients received home-based hospice care for a median of 35.0 days, and 8.0 % received home hospice care for less than 1 week. While 1.5 % of the families reported the timing of referrals as early, 42 % reported the timing as late or too late. The families of patients with a length of care of less than 4 weeks were more likely to regard the timing of referrals as late or too late. The patients of family members who regarded the timing of referrals as late or too late had a significantly lower perceived quality of care (effect size, 0.18; P = 0.039) and lower quality of death and dying (effect size, 0.15, P = 0.063). Independent determinants of higher likelihoods of perceived late referrals included: frequent visits to emergency departments, patient being unprepared for worsening condition, and patient having concerns about relationship with new doctor. Discharge nurse availability was independently associated with lower likelihoods of perceived late referrals. A significant number of bereaved families regarded the timing of referrals to home hospices as late, and the perceived timing was associated with the family-perceived quality of care and quality of death and dying. Systematic strategies to overcome the barriers related to perceived late referrals are necessary.

  11. The absent body: representations of dying early modern women in a selection of seventeenth-century diaries.

    Becker, L


    This article seeks to explore the absence of the body in the depiction of dying women in a selection of seventeenth-century diaries. It considers the cultural forces that made this absence inevitable, and the means by which the physical body was replaced in death by a spiritual presence. The elevation of a dying woman from physical carer to spiritual nurturer in the days before death ensured that gender codes were not broken. The centrality of the body of the dying woman, within a female circle of care and support, was paradoxically juxtaposed with an effacement of the body in descriptions of a good death. In death, a woman might achieve the stillness, silence and compliance so essential to perfect early modern womanhood, and retrospective diary entries can achieve this ideal by replacing the body with images that deflect from the essential physicality of the woman.

  12. Review of Ordering Don't Resuscitate in Iranian Dying Patients.

    Cheraghi, Mohammad Ali; Bahramnezhad, Fatemeh; Mehrdad, Neda


    Making decision on not to resuscitate is a confusing, conflicting and complex issue and depends on each country's culture and customs. Therefore, each country needs to take action in accordance with its cultural, ethical, religious and legal contexts to develop guidelines in this regard. Since the majority of Iran's people are Muslims, and in Islam, the human life is considered sacred, based on the values of the community, an Iranian Islamic agenda needs to be developed not taking measures about resuscitation of dying patients. It is necessary to develop an Iranian Islamic guidelines package in order to don't resuscitate in dying patients.

  13. Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.

    Fridh, Isabell; Forsberg, Anna; Bergbom, Ingegerd


    The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects. Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15]. The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment. This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

  14. Radiotherapy in early stage dupuytren's contracture; Die Radiotherapie des Morbus Dupuytren im Fruehstadium. Langzeitresultate nach einer medianen Nachbeobachtungszeit von 10 Jahren

    Adamietz, B.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Praxis fuer Strahlentherapie, Klinikum Fuerth (Germany); Gruenert, J. [Abt. fuer Plastische und Handchirurgie der Chirurgischen Universitaetsklinik Erlangen-Nuernberg, Erlangen (Germany)


    Purpose: In early stage Dupuytren's contracture radiotherapy was applied to prevent disease progression. Long-term results and late toxicity of this treatment were evaluated in a retrospective analysis. Patients and Methods: Between 1982 and 1994, 99 patients (176 hands) received orthovoltage radiotherapy, which consisted of two courses with 5 x 3 Gy (total dose: 30 Gy, daily fractionated; 120 kV, 4 mm Al), separated by a 6 to 8-week pause. The Dupuytren's contracture was staged according to the classification of Tubiana et al. The long-term outcome was analyzed at last follow-up between July and November 1999. The median follow-up was 10 years (range 7-18 years). Late toxicity was assessed using the LENT-SOMA criteria. Results: In Stage N 84% and Stage N/I 67% of cases remained stable. 65% of the cases in Stage I and 83% in Stage II showed progressive nodules and cords. In case of progression we saw no complications after a second radiotherapy or salvage operation. Conclusion: Radiotherapy effectively prevents disease progression for early stage Dupuytren's contracture (Stage N, N/I). Moreover, in case of disease progression despite radiotherapy salvage surgery is still feasible. (orig.) [German] Hintergrund: Im Fruehstadium des Morbus Dupuytren wird die externe Radiotherapie mit dem Ziel eingesetzt, den progressiven Verlauf der Erkrankung zu verhindern. Eine aktuelle Langzeitverlaufskontrolle soll die Ergebnisse und Nebenwirkungen der Radiotherapie darstellen. Patienten und Methode: Wir untersuchten 99 Patienten (176 Haende), welche sich von 1982-1994 einer Radiotherapie an unserer Klinik unterzogen. Jeder Patient erhielt zwei Serien einer Radiotherapie mit jeweils 5 x 3 Gy (Gesamtdosis 30 Gy, 120 kV, 4 mm Al, Bestrahlungspause von 6-8 Wochen nach 15 Gy). Die Beugekontraktur wurde nach Tubiana et al. eingeteilt. Von Juli bis November 1999 erfolgte nach einer medianen Nachbeobachtungszeit von 10 Jahren (7-18 Jahre) eine Kontrolluntersuchung. Die

  15. Dying cancer patients talk about physician and patient roles in DNR decision making.

    Eliott, Jaklin A; Olver, Ian


    Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.

  16. Oh death, where is thy sting? Reflections on dealing with dying patients.

    Loewy, Erich H


    This paper examines the reactions of physicians and other health professionals when they become involved in decisions about the death of their patients... Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.

  17. The best interests of persistently vegetative patients: to die rather that to live?

    Chan, Tak Kwong; Tipoe, George Lim


    Adults without the capacity to make their own medical decisions have their rights protected under the Mental Capacity Act (2005) in the UK. The underlying principle of the court's decisions is the best interests test, and the evaluation of best interests is a welfare appraisal. Although the House of Lords in the well-known case of Bland held that the decision to withhold treatment for patients in a persistent vegetative state should not be based on their best interests, judges in recent cases have still held that the best interests of persistently vegetative patients demand that the right to die with dignity prevails over society's interest to preserve life. The basis of suggesting that it is in the best interests for one who is alive (although vegetative) in peace to die in peace is weak. Even if it may not be in their best interests to live on, it may not be so to die either. The phrase 'the right to dignity/to die with dignity' has been misused as a trump card to justify the speculation that a vegetative patient would necessarily refuse to live on machines. Without disrespect to the court's decision, we argue that the use of the best interests test to authorise withdrawing/withholding treatment from persistently vegetative patients without an advance directive is problematic. We propose that the court could have reached the same decision by considering only the futility of treatment without working through the controversial best interests of the patient.

  18. Attitudes of elderly Korean patients toward death and dying: an application of Q-methodology.

    Yeun, Eunja


    The aim of this study was to identify the attitudes of elderly Korean patients toward death and dying using Q-methodology to aid in the development of basic strategies for nursing care of elderly Koreans. Thirty participants at a university hospital sorted 40 selected Q-statements on a nine-point scale. Data analysis identified three types of attitudes toward death and dying in elderly patients in Korea: religion-dependent, science-adherent, and sardonic. Religion-dependent elders are highly dependent upon religion as evidenced by their reply that they would like to rely on God and a minister the most. Science-adherent elders have great affection for life and believe in modern medical advancements. The sardonic elders regard death as the dispensation of nature so there is no need to be afraid of death and dying. This study will contribute to the understanding that nurses and other health professionals have of the perceptions of elderly Koreans about death and dying. Also, the findings may provide the basis for the development of more appropriate strategies to improve death and dying education programs of health professionals.

  19. Case study: an ethical dilemma involving a dying patient.

    Pacsi, Alsacia L


    Nursing often deals with ethical dilemmas in the clinical arena. A case study demonstrates an ethical dilemma faced by healthcare providers who care for and treat Jehovah's Witnesses who are placed in a critical situation due to medical life-threatening situations. A 20-year-old, pregnant, Black Hispanic female presented to the Emergency Department (ED) in critical condition following a single-vehicle car accident. She exhibited signs and symptoms of internal bleeding and was advised to have a blood transfusion and emergency surgery in an attempt to save her and the fetus. She refused to accept blood or blood products and rejected the surgery as well. Her refusal was based on a fear of blood transfusion due to her belief in Bible scripture. The ethical dilemma presented is whether to respect the patient's autonomy and compromise standards of care or ignore the patient's wishes in an attempt to save her life. This paper presents the clinical case, identifies the ethical dilemma, and discusses virtue ethical theory and principles that apply to this situation.

  20. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Lemieux-Charles Louise


    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  1. Gestalt Therapy with the Dying Patient: Integrative Work Using Clay, Poetry Therapy, and Creative Media.

    Petzold, Hilarion G.


    Reports the use of death therapy with a cancer patient. Gestalt therapy and creative media were used to facilitate an integration of life and a sense of balance with life. Suggests that counseling the dying means walking along a stretch of the path together. (Author)

  2. From will to live to will to die: oncologists, nurses, and social workers identification of suicidality in cancer patients.

    Granek, Leeat; Nakash, Ora; Ariad, Samuel; Chen, Wendy; Birenstock-Cohen, Shira; Shapira, Shahar; Ben-David, Merav


    The purpose of this research was to examine how oncologists, nurses, and social workers identify suicidality in cancer patients. Sixty-one healthcare professionals (23 oncologists, 18 social workers, and 20 nurses) at two academic cancer centers were interviewed using an in-depth interview guide. This was a qualitative study based on grounded theory methodology. Analysis involved line-by-line coding, with categories and themes emerging from participants' narratives. Suicidality in cancer patients exists on a wide spectrum that ranges from an active will to live to an active will to die. Four phases were identified that included: (A) a strong will to live expressed in themes of active treatments, seeking second opinions, overtreatment, and alternative treatments; (B) a decreasing will to live indicated in themes of mental health distress and physical pain and suffering; (C) a readiness to die expressed in themes of mental health distress, previous mental health diagnoses, physical pain, avoiding more suffering, preserving quality of life in old age, nearing end of life, lack of social support, and maintaining a sense of control; and (D) a will to die indicated in themes of euthanasia and active suicidality. Suicidality in cancer patients exists on a continuum. Cancer patients fluctuate on this spectrum depending on circumstances such as degree of suffering, their personalities and life circumstances, and whether they are nearing the end of life. Results of the study emphasize the need to collect more context specific data on suicidality among cancer patients and the importance of early integration of psychosocial and palliative care in the cancer treatment trajectory.

  3. Early warning score predicts acute mortality in stroke patients

    Liljehult, J; Christensen, Thomas


    OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study wa...... tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation.......OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study...

  4. Do schizophrenia patients age early?

    Shivakumar, Venkataram; Kalmady, Sunil V; Venkatasubramanian, Ganesan; Ravi, Vasanthapuram; Gangadhar, Bangalore N


    The etiopathogenesis of schizophrenia is poorly understood. Within the proposed "neurodegeneration paradigm", observations have been put forth for "accelerated aging" in this disorder. This proposition is largely based on the neuroscience research that demonstrates progressive changes in brain as well as other systemic abnormalities supportive of faster aging process in patients with this disorder. In this review, we have summarized the literature related to the concept of early aging in schizophrenia. These studies include P300 abnormalities & visual motion discrimination, neuroimaging findings, telomere dynamics as well as neuropathology of related brain regions. We also propose a role of vitamin D, neuroimmunological changes and elevated oxidative stress as well as mitochondrial dysfunction in addition to the above factors with 'vitamin-D deficiency' as the central paradox. Put together, the evidence supporting early aging in schizophrenia is compelling and this requires further systematic studies. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. [How Can We Cuddle Up to Dying Patients? Attempts of Cancer Philosophy Clinic and Education].

    Yamada, Keisuke


    What is needed to treat problems about how can we cuddle up to dying patients is not scientific thinking but philosophical thinking. Cancer philosophy clinic is a place where both patients and medical staffs think about death and how to live until death. The author tries to manage cancer philosophy clinic with the idea of logotherapy and terminal art. The author also tries to educate medical students and other medical staffs in cancer philosophy.

  6. Cultural beliefs about a patient's right time to die: an exploratory study.

    Perkins, Henry S; Cortez, Josie D; Hazuda, Helen P


    Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions. Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study. Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses. Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient's right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on "artificial" life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women--but few others--explicitly declared that family have an important say in determining a patient's right time to die. No confounding occurred by religion. Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.

  7. Nursing care of patients during the dying process: a painful professional and human function

    Martha Adiela Lopera Betancur


    Full Text Available Objective. This work sought to describe the care functions of nurses with patients during the dying process. Methodology. This was a qualitative study with ethnographic approach stemming from the analysis of the culture of nurses; it was conducted in the city of Medellín, Colombia. Theoretical saturation was obtained with 23 interviews. Results. Nurses feel the duty to care for patients throughout the vital cycle through functions defined as: serving, helping, accompanying, offering support, advocating, educating, and representing, which they identify as indispensable. They also perceive as their own the social responsibility for some issues related to death and due to this they get involved at the personal level, appropriate care and are affected as persons. Conclusion. Patient care during dying processes transcends the limits of the nurse' professional functions to become a human obligation.

  8. Nursing care of patients during the dying process: a painful professional and human function.

    Lopera Betancur, Martha Adiela


    This work sought to describe the care functions of nurses with patients during the dying process. This was a qualitative study with ethnographic approach stemming from the analysis of the culture of nurses; it was conducted in the city of Medellín, Colombia. Theoretical saturation was obtained with 23 interviews. Nurses feel the duty to care for patients throughout the vital cycle through functions defined as: serving, helping, accompanying, offering support, advocating, educating, and representing, which they identify as indispensable. They also perceive as their own the social responsibility for some issues related to death and due to this they get involved at the personal level, appropriate care and are affected as persons. Patient care during dying processes transcends the limits of the nurse' professional functions to become a human obligation.

  9. Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit.

    Su, Amanda; Lief, Lindsay; Berlin, David; Cooper, Zara; Ouyang, Daniel; Holmes, John; Maciejewski, Renee; Maciejewski, Paul K; Prigerson, Holly G


    Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU. The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care. The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12). Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Death and caring for dying patients: exploring first-year nursing students' descriptive experiences.

    Ek, Kristina; Westin, Lars; Prahl, Charlotte; Osterlind, Jane; Strang, Susann; Bergh, Ingrid; Hammarlund, Kina


    To describe first-year nursing students' experiences of witnessing death and providing end-of-life care. This study is part of a larger longitudinal project. Interviews (n=17) were conducted with nursing students at the end of their first year of education. To analyse the interviews (lived-experience descriptions), a thematic analysis, 'a search for meaning' ( Van Manen, 1997 ) was applied. The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual experience, (2) Daring to approach the dying patient and offering something of oneself, (3) The experience of not sufficing in the face of death and (4) Being confronted with one's own feelings. Nursing students require continuous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical supervisors need to give support using reflective practice to help students to develop confidence in their capacity for caring for dying patients.

  11. die rol van die unieverdedigingsmag in die onderdrukking van die

    agv regeringsoptrede nie.39. Siotsom. In die geskiedenis van die Unieverdedigings- mag word die gebeure random die 1914-staking oorskadu deur die Rebellie en Suid-Afrika se deelname aan die Eerste Wereldoorlog. Tog was dit 'n belangrike mylpaal in die geskiedenis van die organisasie, omdat dit sy eerste optrede ...

  12. Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives.

    Karlsson, Marit; Milberg, Anna; Strang, Peter


    Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.

  13. Music thanatology: prescriptive harp music as palliative care for the dying patient.

    Freeman, Lindsay; Caserta, Michael; Lund, Dale; Rossa, Shirley; Dowdy, Ann; Partenheimer, Andrea


    Music thanatology represents an emerging area in which the raw materials of music, usually harp and/or voice, assist and comfort the dying patient. During prescriptive "music vigils, " the clinician-musician carefully observes physiological changes, cues, and breathing patterns, thereby synchronizing the music to reflect or support the patient's physiology and overall condition. Using data collected from 65 patients, this study was designed to assess the effectiveness of prescriptive harp music on selected palliative care outcomes using a sample of de-identified data forms from past music vigils. Patients were administered a 25- to 95-minute intervention of prescriptive harp music. Data collected included vital signs and observational indicators before (Ti) and after (T2) the vigil. Patients were more likely to experience decreased levels of agitation and wakefulness while also breathing more slowly and deeply with less effort at the conclusion of the music vigil. Results from this study suggest that a prescriptive vigil conducted by a trained music thanatologist could provide an effective form of palliative care for dying patients.

  14. The die is cast - Arsenic exposure in early life and disease susceptibility

    Abstract Early life exposure to arsenic in humans and mice produces similar patterns of disease in later life. Given the long interval between exposure and effect, epigenetic effects of early life exposure to arsenic may account for development and progression of disease in bo...

  15. Transcultural comparison of hospital and hospice as caring environments for dying patients.

    Gates, M F


    Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.

  16. The die is cast: arsenic exposure in early life and disease susceptibility.

    Thomas, David J


    Early life exposure to arsenic in humans and mice produces similar patterns of disease in later life. Given the long interval between exposure and effect, epigenetic effects of early life exposure to arsenic may account for the development and progression of disease in both species. Mode of action and dosimetric studies in the mouse may help assess the role of age at exposure as a factor in susceptibility to the toxic and carcinogenic effects of arsenic in humans.

  17. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

    Lin, Yanxia; Myall, Michelle; Jarrett, Nikki


    To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

  18. Physicians' current practices and opportunities for DNA banking of dying patients with cancer.

    Quillin, John M; Bodurtha, Joann N; Siminoff, Laura A; Smith, Thomas J


    The availability of genetic tests for cancer susceptibility is increasing. Current tests, however, have limited clinical sensitivity. Even when clinically valid tests are available, the genetic counseling and informed consent process might not be feasible for dying patients with cancer. DNA banking preserves the opportunity for future research or clinical testing and may provide critical opportunities for surviving relatives. This study explored the current practices and potential for DNA banking for cancer susceptibility among oncologists specializing in palliative care. Palliative care oncologists actively providing clinical care for dying patients with cancer were recruited for an online survey. Descriptive statistics for DNA banking practices, perceived qualification to recommend banking, and potential predictors were assessed. Data were collected from 49 physicians (37% recruitment rate). Eighty percent reported assessing at least some patients for genetic cancer susceptibility in the past 12 months. No participants reported banking DNA for patients in the past 12 months. Only 5% reported feeling at least somewhat qualified to order DNA banking. A Web-based risk assessment tool and genetic counselor on staff were perceived as the most helpful potential resources. Despite its potential, DNA banking is not being used by palliative care oncologists.


    A. Y. Mikhaylov


    Full Text Available We report a case of acute baclofen poisoning in a 23-year-old female patient, who committed suicide, which led to the development of a deep coma. The electroencephalogram on the first day recorded the phenomenon of “burst suppression”, which was seen as a sign of a dying brain. Subsequent studies have shown positive changes of the electroencephalogram and regression of neurological symptoms. Thus, the phenomenon of “burst suppression” in the depression of consciousness to deep coma and given adequate treatment, can be reversible.

  20. Die binding van die konfessie

    P. J. Coetzee


    Full Text Available Ons moet waak teen twee uiterstes. Aan die een kant het die dogma as onversoenlike vyand die dogmatisme en aan die ander kant die antidogmatisme — dit hou enersyds die gevaar in van verabsolutering (oorskatting, en ander- syds die gevaar van relativisme (onderskatting.

  1. Attitude of Palestinian Nursing Students Toward Caring for Dying Patients: A Call for Change in Health Education Policy.

    Abu-El-Noor, Nasser Ibrahim; Abu-El-Noor, Mysoon Khalikl


    Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses' attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students' attitudes toward caring for dying patients were found between male and female students nor between students who attended death cases and those who did not. The results suggest that theoretical nursing education should place more emphasis on palliative care to improve the quality of care at the end of life. © The Author(s) 2015.

  2. Die Region braucht die Kultur - die Kultur braucht die Region

    Klemm, Ulrich


    Die Region braucht die Kultur - die Kultur braucht die Region. - In: Region in Aktion - oder: Region im Abseits? - Boxberg-Wölchingen : Eigenständige Regionalentwicklung Baden-Württemberg, 1995. - S. 25 f.

  3. "Dies Domini" – Sunday in the early centuries of the Church

    Jan Józef Janicki


    Full Text Available The history of Sunday begins with Christ's resurrection, which gave unique shape and significance to the day. All evangelists agree that Jesus rose from the dead and appeared to his disciples on "the first day of the week", or "the first day after Shabbat". The article discusses the significance and meaning of the Sunday feast in the early centuries of the Church.

  4. Male ICU nurses' experiences of taking care of dying patients and their families: a gender analysis.

    Wu, Tammy W; Oliffe, John L; Bungay, Vicky; Johnson, Joy L


    Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants' practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers. © The Author(s) 2014.

  5. Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study

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


    Background: Primary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and

  6. Dying cancer patients' own opinions on euthanasia: an expression of autonomy? A qualitative study.

    Karlsson, Marit; Milberg, Anna; Strang, Peter


    Deliberations on euthanasia are mostly theoretical, and often lack first-hand perspectives of the affected persons. Sixty-six patients suffering from cancer in a palliative phase were interviewed about their perspectives of euthanasia in relation to autonomy. The interviews were transcribed verbatim and analysed using qualitative content analysis with no predetermined categories. The informants expressed different positions on euthanasia, ranging from support to opposition, but the majority were undecided due to the complexity of the problem. The informants' perspectives on euthanasia in relation to autonomy focused on decision making, being affected by (1) power and (2) trust. Legalization of euthanasia was perceived as either (a) increasing patient autonomy by patient empowerment, or (b) decreasing patient autonomy by increasing the medical power of the health care staff, which could be frightening. The informants experienced dependence on others, and expressed various levels of trust in others' intentions, ranging from full trust to complete mistrust. Dying cancer patients perceive that they cannot feel completely independent, which affects true autonomous decision making. Further, when considering legalization of euthanasia, the perspectives of patients fearing the effects of legalization should also be taken into account, not only those of patients opting for it.

  7. Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study.

    Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert


    Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise. A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent. 266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death. Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.

  8. Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death.

    Krout, Robert E


    Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.

  9. Die nabyheid van die Koninkryk

    W.J. Snyman


    Full Text Available Vanweë die belangrikheid daarvan volg hier ’n breër bespreking van die proefskrif van dr. Tjaart van der Walt oor die nabyheid van die Koninkryk as wat in ’n gewone resensie kan geskied. Die vraagstuk wat onder oë gesien word is so oud as die kerk en die teologie, soms minder en soms meer op die voorgrond. Tans kan gesê word, staan dit in die middelpunt. Daarby is dit nie maar ’n akademiese vraagstuk nie, maar ’n vraagstuk waarvoor elke nadenkende leser van die Skrif te staan kom.

  10. [Can cancer patient in terminal stage of cancer die with dignity at home? And under what conditions?].

    Slovácek, L; Simková, M; Petera, J; Filip, S


    In their brief communication, the authors are discussing the issue of palliative care for cancer patients in terminal stage of cancer. The authors are also contributing their own experience with the provision of such care to patients who wish to die at home.

  11. Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

    Viney, Linda L.; And Others


    Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

  12. A mixed method thematic review: the importance of hope to the dying patient.

    Broadhurst, Kathleen; Harrington, Ann


    To review the literature and investigate the meaning of hope to patients receiving palliative care and to examine the themes that foster hope in those patients. Hope is often linked to the future and is a significant factor for patients dealing with adversity, such as a terminal illness. The concept of hope is underreported in the literature. Mixed method thematic review. CINAHL, Scopus, PsychINFO, Informit, PubMed, Science Direct, ProQuest, Web of Science and Google Scholar online databases were searched using keywords and inclusion and exclusion criteria published between 2003-2013. Twelve qualitative articles were thematically analysed using Braun and Clarke's (2006) steps to ascertain major themes and sub-themes. On analysis, the remaining three mixed method studies were found to reflect the themes generated by the qualitative studies. Seven key themes that increased hope were found: disease status; positive personal relationships; positive character traits; quality of life; setting and achieving goals; spirituality/religion; and hope after death. The importance of hope to dying patients was established. Hope is a very complex and personal phenomena requiring hope-enhancing strategies to be individualized. More research is needed with groups whose culture, youth or type of illness may affect their ability to foster and maintain hope. © 2015 John Wiley & Sons Ltd.

  13. The attitudes of brain cancer patients and their caregivers towards death and dying: a qualitative study

    Kimmelman Jonathan


    Full Text Available Abstract Background Much money and energy has been spent on the study of the molecular biology of malignant brain tumours. However, little attention has been paid to the wishes of patients afflicted with these incurable tumours, and how this might influence treatment considerations. Methods We interviewed 29 individuals – 7 patients dying of a malignant brain tumor and 22 loved ones. One-on-one interviews were conducted according to a pre-designed interview guide. A combination of open-ended questions, as well as clinical scenarios was presented to participants in order to understand what is meaningful and valuable to them when determining treatment options and management approaches. The results were analyzed, coded, and interpreted using qualitative analytic techniques in order to arrive at several common overarching themes. Results Seven major themes were identified. In general, respondents were united in viewing brain cancer as unique amongst malignancies, due in large part to the premium placed on mental competence and cognitive functioning. Importantly, participants found their experiences, however difficult, led to the discovery of inner strength and resilience. Responses were usually framed within an interpersonal context, and participants were generally grateful for the opportunity to speak about their experiences. Attitudes towards religion, spirituality, and euthanasia were also probed. Conclusion Several important themes underlie the experiences of brain cancer patients and their caregivers. It is important to consider these when managing these patients and to respect not only their autonomy but also the complex interpersonal toll that a malignant diagnosis can have.

  14. Die topkwark

    R. Tegen


    Full Text Available ’n Oorsig van die belangrikheid van die onlangs ontdekte topkwark by Fermilab in Chicago word gegee. Daar word aangetnon dat die topkwark belangrik is in fisika van die Oerknal, oftewel "Big Bang", en in die Standaard Model van Elementêredeeltjie-fisika. Toepaslike literatuur vir verdere studie kan van die lys van verwysings in hierdie kort, nietegniese artikel, nagegaan word.

  15. Attitudes and views of physicians and nurses towards cancer patients dying at home.

    Porta, M; Busquet, X; Jariod, M


    The objective was to study attitudes and views of primary care professionals towards terminally ill cancer patients who die at home, using a cross-sectional study based in the health district of Manresa (province of Barcelona, Catalonia, Spain) of the Catalan Health Service, involving 151 primary health care professionals (87 physicians and 64 nurses). By using a self-responded anonymous questionnaire (response rate 89%) it was found that despite excellent motivation, primary care professionals reported widespread frustration and a poor opinion of the quality of care provided to terminally ill cancer patients. Attitudes and views clearly differ by age, sex and geographic setting. In the study area, most professional are reluctant to disclose the diagnosis of cancer, and this attitude is associated with a more favourable assessment of the support provided to the family. The idea that the most appropriate place of death is at home is strongly linked to the belief that patients ought to be informed of their illness, to feelings of frustration and to youth. These findings further substantiate the need and the potential for ample changes in terminal cancer care in Spain.

  16. Abu-Sahl al-Masihi (died circa 1010 AD): The Persian physician in the early medieval era.

    Taghavi-Shirazi, Maryam; Ghods, Roshanak; Hashem-Dabaghian, Fataneh; Zargaran, Arman


    In the early medieval era, in the time which is called the Islamic Golden Age, medicine flourished through the practice of Persian physicians (9th to 12th century AD). Abu-Sahl al-Masihi (died circa 1010 AD) was one of the physicians in that period who had great influence on the progress of medicine by his own writings as well as his influence on great scholars like Biruni and Avicenna as their teacher. He was a polymath and had many writings in various fields of science, in particular medical sciences. Some of his manuscripts in medicine were Al-Mia fil-Tibb (Book of the Hundred), Kitab al-Teb al-Koli (The General Medicine), Ezhar al-Hekmat Allah Ta'ala fi Khalgh al-Ensan (God's Mystery on the Creation of Man), Resalat al-Adwiya (Treatise of Drugs), Osool Elm Nabz (the Principles of Pulse), and Resala f ī Taḥqiq Amral-Waba' (On the determination of the matter of infectious diseases). As a sign of his impact in Persian medicine, many later physicians (until 19th century) referred to and cited his works in their manuscripts several times.

  17. Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives

    Freemantle Alison


    Full Text Available Abstract Background Despite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these patients care was supported by the LCP. Findings Although doctors and nurses reported they preferred to use the Pathway to ensure comfortable death, an important factor influencing their decisions was time of death. Access to timely senior review was regarded as an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients sometimes failed to compete with those receiving curative treatment. Conclusions This study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to ensure regular senior review of all patients at risk of dying and to support front line staff to communicate effectively and make contingency plans focused on patients’ best interests.

  18. Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards

    Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc


    Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662

  19. Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying

    Høiseth AD


    concentration 1.8, CI 1.2–2.6 (P=0.003.Conclusion: By applying a standardized approach when evaluating pulmonary congestion on chest radiographs during AECOPD, a group of patients with increased risk of dying, possibly due to heart failure, is identified.Keywords: heart failure, radiograph, NT-proBNP, mortality, X-ray, cephalization

  20. Work engagement and attitudes toward caring for dying patients and families among home-visiting nurses in Japan.

    Mahiro, Sakai; Takashi, Naruse; Satoko, Nagata


    Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses' work engagement and attitudes. Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses' attitudes toward caring for dying patients and their families. As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staff's engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families.

  1. Indicators for early assessment of palliative care in lung cancer patients: a population study using linked health data.

    Kelly, Maria; O'Brien, Katie M; Lucey, Michael; Clough-Gorr, Kerri; Hannigan, Ailish


    Analysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis. A second aim was to examine the association between receiving any tumour-directed treatment, place of death and survival time. A retrospective observational population based study comparing lung cancer patients who died within 30 days of diagnosis (short term survivors) with those who survived longer using Chi-squared tests and logistic regression. Incident lung cancer (ICD-03:C34) patients diagnosed 2005-2012 inclusive who died before 01-01-2014 (n = 14,228) were identified from the National Cancer Registry of Ireland linked to death certificate data and acute hospital episode data. One in five newly diagnosed lung cancer patients died within 30 days of diagnosis. After adjusting for stage and histology, death within 30 days was higher in patients who were aged 80 years or older (adjusted OR 2.46; 95%CI 2.05-3.96; p < 0.001), patients with emergency admissions at diagnosis (adjusted OR 2.96; 95%CI 2.61-3.37; p < 0.001) and patients with any comorbidities at diagnosis (adjusted OR 1.32 95%CI 1.15-1.52; p < 0.001). Overall, 75% of those who died within 30 days died in hospital compared to 43% of longer term survivors. We have shown a high proportion of lung cancer patients who die within 30 days of diagnosis are older, have comorbidities and are admitted through the emergency department. These characteristics

  2. Die funksie van die belydenis in die struktuur van die kerk en die ...

    Ter wille van die argument wat in hierdie voordrag na vore gebring word, word vier sodanige konstituerende elemente van die kerklike struktuur onderskei, te wete die belydenis, die teologie, die verkondi- ging (meer bepaald die prediking) en die kerkorde (kerkwet volgens ons terminologie). Ons gaan nou elkeen hiervan ...

  3. How to Deal With Relatives of Patients Dying in the Hospital? Qualitative Content Analysis of Relatives' Experiences.

    Witkamp, Erica; Droger, Mirjam; Janssens, Rien; van Zuylen, Lia; van der Heide, Agnes


    Hospital care and communication tend to be focused on the individual patient, and decision making is typically based on the principle of individual autonomy. It can be questioned whether this approach is adequate when a patient is terminally ill. Our aim was to explore the involvement and experiences of relatives in the hospital during the patient's last phase of life. This study was embedded in a retrospective questionnaire study on the quality of dying of a consecutive sample of patients who died in a general university hospital in The Netherlands. We performed a secondary qualitative analysis of relatives' comments and answers to open questions. Relatives of 951 deceased adult patients were asked to complete a questionnaire; 451 questionnaires were returned and analyzed for this study. Relatives expressed a need for 1) comprehensible, timely, and sensitive information and communication, 2) involvement in decision making, 3) acknowledgment of their position, 4) being able to trust health care staff, and 5) rest and privacy. When relatives felt that their role had sufficiently been acknowledged by health care professionals (HCPs), their experiences were more positive. Relatives emphasized their relation with the patient and their involvement in care of the patient dying in the hospital. An approach of HCPs to care based on the concept of individual autonomy seems inadequate. The role of relatives might be better addressed by the concept of relational autonomy, which provides HCPs with opportunities to create a relationship with relatives in care that optimally addresses the needs of patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Why are some patients with Duchenne muscular dystrophy dying young: An analysis of causes of death in North East England.

    Van Ruiten, H J A; Marini Bettolo, C; Cheetham, T; Eagle, M; Lochmuller, H; Straub, V; Bushby, K; Guglieri, M


    Duchenne muscular dystrophy (DMD) is the most common inherited muscle disease in children. Recent years have seen an increase in age of survival into adulthood following the introduction of proactive standards of care. We reviewed mortality in DMD in our population in order to identify potential underlying risk factors for premature death and improve clinical care. A retrospective case note review of all deaths in the DMD population over the last 10 years in North East England. We identified 2 groups of patients: patients who died from underlying cardiac and/or respiratory failure (group 1) and patients who died unexpectedly in the absence of underlying cardio-respiratory failure (group 2). Detailed information was available on 21 patients. Mean age of death in group 1 (17 patients) was 23.9 (14.4-39.5) years, in group 2 (4 patients) 14 (12.7-14.9) years. Causes of death in group 2 were acute pneumonia, cardiac arrest, acute respiratory distress and multi-organ failure. Across both groups we identified concerns regarding respiratory failure, inadequate nutrition, non-attendance at appointments, suboptimal coordination of care and decreased psychological wellbeing. In group 2, fat embolism, cardiac arrhythmia and adrenal insufficiency were also potential contributing factors. The main cause of death in DMD in our population remains cardio-respiratory failure. Four patients (19%) died in their teenage years in the absence of severe cardiorespiratory failure. A more thorough understanding of the impact of DMD and its treatment on all organs systems is required to minimise the risk of an untimely death. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  5. The Contribution of Death-Related Experiences to Health Care Providers' Attitudes toward Dying Patients: II. Medical and Nursing Students with No Professional Experience.

    Brent, Sandor B.; And Others


    Compared attitudes toward care of dying patients of beginning medical and nursing students with no professional death-related experience. On five of six attitude measures, female nursing students expressed more positive attitude than either male or female medical students. Hours of death-and-dying coursework and general life experience exerted…

  6. Die posisie van die Helper in die sending

    I. J. van der Walt


    Full Text Available Gedurende die aanvangsjare van die sending het die helper ’n onmisbare funksie vervul. Hulle het die onherbergsame binnelande geken, waardevolle kontakpunte vir die sendelinge geopen en hulle mense geestelik help voorlig en voorberei.

  7. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying.

    Hendry, Maggie; Pasterfield, Diana; Lewis, Ruth; Carter, Ben; Hodgson, Daniel; Wilkinson, Clare


    Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented. To synthesise the international evidence of people's views and attitudes towards assisted dying in order to inform current debate about this controversial issue. Systematic review and mixed method synthesis of qualitative and survey data. Eleven electronic databases from inception to October 2011; bibliographies of included studies. Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified. Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts. Our review sheds light on ordinary people's perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.

  8. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups.

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D


    Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.

  9. What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

    Kazuko Arai


    Full Text Available Abstract Background How medical residents’ experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents’ emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL care on professional identity formation. Methods Semi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb’s experiential learning cycle. Results Eight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients’ family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age. Conclusions This study revealed Japanese residents’ perceptions, emotions and learning processes in caring for dying patients by applying Kolb’s experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.

  10. Early nutritional support in severe traumatic patients.

    Chuntrasakul, C; Siltharm, S; Chinswangwatanakul, V; Pongprasobchai, T; Chockvivatanavanit, S; Bunnak, A


    Multiple trauma is associated with altered metabolism, wasting of the lean body mass and compromised wound healing. Nutritional support is one way to improve the condition of these critically ill patients. We performed a prospective randomized study on the effect of early nutritional support in severely injured patients admitted to the Division of Traumatic Surgery, Siriraj Hospital between June 1992 and January 1994. Thirty-eight severe traumatic patients with ISS between 20-40 were randomly divided into control and study group. The 17 patients in the control group were treated in the conventional method with administration of hypo caloric intravenous regimen and supplement with oral diet as soon as the bowel function was returned. The 21 patients of the study group were fed either by enteral or parenteral feeding or both with an appropriate caloric and protein requirement as soon as hemodynamic status was stabilized. We found the study group had a lower mortality rate, a lower complication rate, a shorter period of ICU stay, and an earlier weaning from the ventilator than the control group. The study group also lost less weight than the control group. Nitrogen balance in the study group was significantly lower than the control group.


    stel (kortdiensstelsel). Met die uitbreek van die oorlog in 1939 het die. Unieverdedigingsmag uit 40% Staandemag en. 60% aktiewe Burgermag bestaan. Op 22 Sept. 1939 is magtiging aan die Aktiewe Burgermag- eenhede verleen om vrywilligers vir die duur van die oorlog te aanvaar. Agv beswaar dat die Verdedigingswet.

  12. Die Formatestadt

    Günter Trojan


    Zu Zeiten von DV oder VHS (wer kennt das eigentlich noch?) war die Welt noch in Ordnung: Da hatte man eine Kassette in der Hand und wenn das passende Gerät gefunden wurde konnte man das Video auch abspielen. Günter Trojan diskutiert die Geschichte und Gegenwart unterschiedlicher Videoformate ...

  13. Die Formatestadt

    Günter Trojan


    Full Text Available Zu Zeiten von DV oder VHS (wer kennt das eigentlich noch? war die Welt noch in Ordnung: Da hatte man eine Kassette in der Hand und wenn das passende Gerät gefunden wurde konnte man das Video auch abspielen. Günter Trojan diskutiert die Geschichte und Gegenwart unterschiedlicher Videoformate ...

  14. Survival and psychomotor development with early betaine treatment in patients with severe methylenetetrahydrofolate reductase deficiency.

    Diekman, Eugene F; de Koning, Tom J; Verhoeven-Duif, Nanda M; Rovers, Maroeska M; van Hasselt, Peter M


    The impact of betaine treatment on outcome in patients with severe methylenetetrahydrofolate reductase (MTHFR) deficiency is presently unclear. To investigate the effect of betaine treatment on development and survival in patients with severe MTHFR deficiency. MEDLINE, EMBASE, and Cochrane databases between January 1960 and December 2012. Studies that described patients with severe MTHFR deficiency who received betaine treatment. We identified 15 case reports and case series, totaling 36 patients. Data included the following: (1) families with 2 or more patients with severe MTHFR deficiency, of whom at least 1 received betaine, or (2) single patients with severe MTHFR deficiency treated with betaine. To define severe MTHFR deficiency, methionine, homocysteine, MTHFR enzyme activity in fibroblasts, or mutations (in the MTHFR gene) had to be described as well as the effect of treatment (survival and/or psychomotor development). We compared the outcome in treated vs untreated patients and early- vs late-treated patients. Sensitivity analysis was performed to address definition of early treatment. To further assess the impact of treatment on mortality, we performed a subanalysis in families with at least 1 untreated deceased patient. Survival and psychomotor development. Eleven of 36 patients (31%) died. All deaths occurred in patients who did not receive treatment or in patients in whom treatment was delayed. In contrast, all 5 early-treated patients survived. Subgroup analysis of patients with deceased siblings-their genotypically identical controls-revealed that betaine treatment prevented mortality (P = .002). In addition, psychomotor development in surviving patients treated with betaine was normal in all 5 early-treated patients but in none of the 19 surviving patients with delayed treatment (P psychomotor development in patients with severe MTHFR deficiency, highlighting the importance of timely recognition through newborn screening.

  15. Can we make an early 'do not resuscitate' decision in severe burn patients?

    Yüce, Yücel; Acar, Hakan Ahmet; Erkal, Kutlu Hakan; Tuncay, Erhan


    The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort

  16. Would you be surprised if this patient died?: Preliminary exploration of first and second year residents' approach to care decisions in critically ill patients

    Armstrong John D


    Full Text Available Abstract Background How physicians approach decision-making when caring for critically ill patients is poorly understood. This study aims to explore how residents think about prognosis and approach care decisions when caring for seriously ill, hospitalized patients. Methods Qualitative study where we conducted structured discussions with first and second year internal medicine residents (n = 8 caring for critically ill patients during Medical Intensive Care Unit Ethics and Discharge Planning Rounds. Residents were asked to respond to questions beginning with "Would you be surprised if this patient died?" Results An equal number of residents responded that they would (n = 4 or would not (n = 4 be surprised if their patient died. Reasons for being surprised included the rapid onset of an acute illness, reversible disease, improving clinical course and the patient's prior survival under similar circumstances. Residents reported no surprise with worsening clinical course. Based on the realization that their patient might die, residents cited potential changes in management that included clarifying treatment goals, improving communication with families, spending more time with patients and ordering fewer laboratory tests. Perceived or implied barriers to changes in management included limited time, competing clinical priorities, "not knowing" a patient, limited knowledge and experience, presence of diagnostic or prognostic uncertainty and unclear treatment goals. Conclusions These junior-level residents appear to rely on clinical course, among other factors, when assessing prognosis and the possibility for death in severely ill patients. Further investigation is needed to understand how these factors impact decision-making and whether perceived barriers to changes in patient management influence approaches to care.

  17. Early Home Supported Discharge of Stroke Patients:

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan


    : A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... data are excluded. Seven RCTs on EHSD with 1,108 patients followed 3-12 months after discharge are selected for statistical meta-analysis of outcomes. The costs are calculated as a function of the average number of home training sessions. Economic evaluation is organized as a test of dominance (both...... of death is not significant. Length of stay is significantly reduced by 10 days (CI, 2.6-18 days). All outcomes have a nonsignificant positive covariance. The median number of home sessions is eleven, and the average cost per EHSD is 1,340 USD. The "action mechanism" and financial barriers to EHSD...

  18. Long-term results of patients with clinical stage C prostate cancer treated by photontherapy and early orchiectomy

    Wiegel, T. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy]|[Dept. of Radiotherapy, Univ. Hospital Benjamin Franklin, Freie Univ. Berlin (Germany); Tepel, J. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy; Schmidt, R. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy; Klosterhalfen, H. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Urology; Arps, H. [General Hospital Fulda (Germany). Inst. of Pathology; Berger, P. [Univ. Hospital Eppendorf, Hamburg (Germany). Inst. of Medical Statistics; Franke, H.D. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy


    Background: To evaluate the value of radiotherapy and immediate hormonal therapy in the treatment of stage C prostate cancer. Patients and Method: From 1977 to 1986, 169 patients with clinically stage C prostate cancer underwent irradiation with curative intent following early orchiectomy. Sixty-four patients had a transurethral resection, 22 patients a prostatectomy and 83 patients had only a biopsy. In 38 patients a grade Ia/b tumor was found, in 78 patients a grade IIa/b tumor and in 43 patients a grade IIIa/b tumor using the German grade of malignancy. Treatment fields included the prostate, the seminal vesicles and the locoregional lymphatics. Until 1979 the dose was 60 Gy for the tumor encompassing isodose and from then on 65 Gy with a single dose of 2 Gy. Results: With a median follow-up of 98 months, the overall survival rate for 8 and 10 years was 51% and 37% and the cause-specific survival rate was 84% and 77%, respectively. Thirty-two patients (19%) developed distant metastases. Patients with local tumor control (n=148) had a significantly better overall survival rate of 45% for 10 years compared to patients with clinical local progression of disease (n=21) of 22% (p<0.05). Multivariate analysis showed the grade of malignancy and local control as independent factors for overall survival and cause-specific survival (p<0.05). Twenty-three patients (14%) had at least one late side effect for the rectum or the bladder, in almost all cases grade I or II. Five patients (3%) showed severe late side effects RTOG grade III (n=2) or IV (n=3). One patient had a colostomy, in 2 patients a severe haemorrhagic cystitis was seen. Conclusions: Radiotherapy with photons and early orchiectomy for patients with stage C prostate cancer achieves high local control rates and a 30% to 40% 10-year survival rate with a low incidence of late side effects. The value of the radiotherapy of the locoregional lymphatics remains controversial. (orig.) [Deutsch] Zwischen 1977 und 1986

  19. Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis.

    Mårtensson, Johan; Bailey, Michael; Venkatesh, Balasubramanian; Pilcher, David; Deane, Adam; Abdelhamid, Yasmine Ali; Crisman, Marco; Verma, Brij; MacIsaac, Christopher; Wigmore, Geoffrey; Shehabi, Yahya; Suzuki, Takafumi; French, Craig; Orford, Neil; Kakho, Nima; Prins, Johannes; Ekinci, Elif I; Bellomo, Rinaldo


    To determine the impact of the intensity of early correction of hyperglycaemia on outcomes in patients with diabetic ketoacidosis (DKA) admitted to the intensive care unit. We studied adult patients with DKA admitted to 171 ICUs in Australia and New Zealand from 2000 to 2013. We used their blood glucose levels (BGLs) in the first 24 hours after ICU admission to determine whether intensive early correction of hyperglycemia to ≤ 180 mg/dL was independently associated with hypoglycaemia, hypokalaemia, hypo-osmolarity or mortality, compared with partial early correction to > 180 mg/dL as recommended by DKA-specific guidelines. Among 8553 patients, intensive early correction of BGL was applied to 605 patients (7.1%). A greater proportion of these patients experienced hypoglycaemia (20.2% v 9.1%; P < 0.001) and/or hypo-osmolarity (29.4% v 22.0%; P < 0.001), but not hypokalaemia (16.7% v 15.6%; P = 0.47). Overall, 11 patients (1.8%) in the intensive correction group and 112 patients (1.4%) in the partial correction group died (P = 0.42). However, after adjustment for illness severity, partial early correction of BGL was independently associated with a lower risk of hypoglycaemia (odds ratio [OR], 0.38; 95% CI, 0.30-0.48; P < 0.001), lower risk of hypo-osmolarity (OR, 0.80; 95% CI, 0.65-0.98; P < 0.03) and lower risk of death (OR, 0.44; 95% CI, 0.22-0.86; P = 0.02). In a large cohort of patients with DKA, partial early correction of BGL according to DKA-specific guidelines, when compared with intensive early correction of BGL, was independently associated with a lower risk of hypoglycaemia, hypo-osmolarity and death.

  20. Clinical characteristics and course of dying in patients with amyotrophic lateral sclerosis withdrawing from long-term ventilation.

    Kettemann, Dagmar; Funke, Andreas; Maier, André; Rosseau, Simone; Meyer, Robert; Spittel, Susanne; Münch, Christoph; Meyer, Thomas


    Non-invasive ventilation (NIV) or tracheotomy with invasive ventilation (TIV) are treatment options in ALS. However, a proportion of patients receiving long-term ventilation decide to have it withdrawn. The objective of this study was to analyse the clinical characteristics and palliative approaches in ALS patients withdrawing from long-term ventilation (WLTV). In a cohort study, two different palliative concepts in WLTV were studied: (1) augmented symptom control (ASC; sedation not intended) in patients with ventilator-free tolerance; (2) continuous deep sedation (CDS; sedation intended) in patients without ventilator-free tolerance. Results showed that WLTV was realised in 49 ALS patients (NIV = 13; TIV = 36). Mean daily ventilation was 23.4 h. The ALS Functional Rating Scale (ALSFRS-R) was low (5.6 of 48). Forty-one per cent of patients (n = 20) presented with ophthalmoplegia. ASC was performed in 20 patients, CDS in 29 patients. The mean time to death following disconnection was 32 (0.3-164) h during ASC and 0.3 (0.2-0.6) h in CDS. In conclusion, a low ALSFRS-R, high incidence of ophthalmoplegia and extended ventilator dependency were found before WLTV. The presence or absence of ventilator-free tolerance determined the approach to the management of symptoms, the setting for immediate end-of-life care and the course of dying in WLTV.

  1. Die funksie van die skeppingstradisie in die boek Jeremia

    gedeeites voor wat sterk ooreenkomste toon met die beskrywings van die skep pingsgebeure in die boek Jeremia. • Volgpns Von Rad (1957:144-146) het daar wel 'n groep bestaan wat belange ge- had liet by die oorlewering van die skeppingstradisies. Dit was waarskynlik die. Sadokitiese priesters wat om twee redes aan ...

  2. No Negative Impact of Palliative Sedation on Relatives' Experience of the Dying Phase and Their Wellbeing after the Patient's Death: An Observational Study.

    S M Bruinsma

    Full Text Available Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention is beneficial for patients and whether the associated lack of communication in the last phase of life has a negative impact on relatives' wellbeing.An observational questionnaire study was conducted among relatives of a consecutive sample of patients who died a non-sudden death in the Erasmus MC Cancer Institute or in the hospice 'Laurens Cadenza' (both in Rotterdam between 2010 and 2013.Relatives filled in questionnaires regarding 151 patients who had been sedated and 90 patients who had not been sedated. The median time since all patients had passed away was 21 (IQR 14-32 months. No significant differences were found in relatives´ assessments of the quality of end-of-life care, patients´ quality of life in the last week before death and their quality of dying, between patients who did and did not receive sedation, or in relatives' satisfaction with their own life, their general health and their mental wellbeing after the patient's death.The use of sedation in these patients appears to have no negative effect on bereaved relatives' evaluation of the patient's dying phase, or on their own wellbeing after the patient's death.

  3. No Negative Impact of Palliative Sedation on Relatives' Experience of the Dying Phase and Their Wellbeing after the Patient's Death: An Observational Study.

    Bruinsma, S M; van der Heide, A; van der Lee, M L; Vergouwe, Y; Rietjens, J A C


    Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention is beneficial for patients and whether the associated lack of communication in the last phase of life has a negative impact on relatives' wellbeing. An observational questionnaire study was conducted among relatives of a consecutive sample of patients who died a non-sudden death in the Erasmus MC Cancer Institute or in the hospice 'Laurens Cadenza' (both in Rotterdam) between 2010 and 2013. Relatives filled in questionnaires regarding 151 patients who had been sedated and 90 patients who had not been sedated. The median time since all patients had passed away was 21 (IQR 14-32) months. No significant differences were found in relatives´ assessments of the quality of end-of-life care, patients´ quality of life in the last week before death and their quality of dying, between patients who did and did not receive sedation, or in relatives' satisfaction with their own life, their general health and their mental wellbeing after the patient's death. The use of sedation in these patients appears to have no negative effect on bereaved relatives' evaluation of the patient's dying phase, or on their own wellbeing after the patient's death.

  4. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.


    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  5. Die regsposisie van die gemolesteerde kind 1

    P.J. Schabort


    Full Text Available Hoe reik die reg uit na die seksueel gemolesteerde kind? As na die reg in wye verband gekyk word, sou dit alie wetgewing en alle gemeneregsbeginsels en alle regsprosedures insluit waardeur die Staat poog om molestering te voorkom en die gemolesteerde kind in beskerming te neem. Dit le baie wyd en sou byvoorbeeld die maatreels insluit van die Kindenvet 33 van 1960; die Wet op Egskeiding 70 van 1979; die Wet op Kindersorg 74 van 1983; die Wet op die Status van Kinders 82 van 1987 en die Wet op Bemiddeling in Sekere Egskeidingsaangeleenthede 24 van 1987. Eersdaags sal dit moontlik ook ’n Manifes vir die Regte van Kinders insluit wat vermoedelik geskoei sal wees op die W O se Konvensie vir die Regte van die Kind (1989 w a arv an die RSA tan s nog nie ’n ondertekenaar is nie.

  6. Thrombelastography Early Amplitudes in bleeding and coagulopathic trauma patients

    Laursen, Thomas Holst; Meyer, Martin A S; Meyer, Anna Sina P


    BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays Thrombelastography (TEG) and Rotation Thromboelastometry (ROTEM) provide fast results, which is critical in resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG var...

  7. [Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care].

    Mehnert, A; Schröder, A S; Puhlmann, K; Müllerleile, U; Koch, U


    Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

  8. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England [version 2; referees: 2 approved

    Jane Seymour


    Full Text Available Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’ was an integrated care pathway (ICP recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review.  Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1 why and how did the LCP come to prominence as a vehicle of policy and practice? 2 what factors contributed to its demise? 3 what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

  9. Families' experiences with patients who died after assisted suicide: a retrospective interview study in southern Switzerland.

    Gamondi, C; Pott, M; Payne, S


    In Switzerland, if certain conditions are met, assisted suicide is not prosecuted. International debate suggests that requests for hasten death are often altered by the provision of palliative care. Aims of the study were to explore patients' reasons for choice of assisted suicide and family perceptions of the interactions with health care professionals. This is a qualitative study upon 11 relatives of 8 patients cared for by a palliative care team, deceased of assisted suicide. Pain and symptom burden were not regarded by patients as key reasons to seek assisted suicide: existential distress and fear of loss of control were the determinants. Most patients had made pre-illness decisions to use assisted suicide. A general need for perceived control and fear of dependency were reported as a common characteristic of these patients. Patients held misunderstandings about the nature and purpose of palliative care, and the interviewed indicated that patients did not regard provision of palliative care services as influential in preventing their decision. Assisted suicide was preferred despite provision of palliative care. Better understanding of the importance placed on perceived control and anticipated dependency is needed. Further research is needed to develop appropriate support for patients contemplating assisted suicide.

  10. Residents Learning from a Narrative Experience with Dying Patients: A Qualitative Study

    Tait, Glendon R.; Hodges, Brian D.


    For patients at the end of life, it is crucial to address the psychological, existential, and spiritual distress of patients. Medical education research suggests trainees feel unprepared to provide the whole person, humanistic care held as the ideal. This study used an empirically based narrative intervention, the dignity interview, as an…

  11. Hope, Life, and Death: A Qualitative Analysis of Dying Cancer Patients' Talk about Hope

    Eliott, Jaklin A.; Olver, Ian N.


    Although deemed vital to patient well-being, hope in persons who are terminally ill is often thought to be problematic, particularly when centered on cure. As part of a study on end-of-life decision-making, we asked 28 patients with cancer, believed to be within weeks of their death, to talk about hope. Responses were transcribed and discursively…

  12. End-of-Life Care and Circumstances of Death in Patients Dying As a Result of Cancer in Belgium and the Netherlands: A Retrospective Comparative Study

    Meeussen, K.; van den Block, L.; Echteld, M.A.; Boffin, N.; Bilsen, J.; van Casteren, V.; Abarshi-Fatiregun, E.A.B.; Donker, G.; Onwuteaka-Philipsen, B.D.; Deliens, L.


    Purpose: To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and Methods: A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By

  13. End-of-life care and circumstances of death in patients dying as a result of cancer in Belgium and the Netherlands: a retrospective comparative study.

    Meeussen, K.; Block, L. van den; Echteld, M.A.; Boffin, N.; Bilsen, J.; Casteren, V. van; Abarshi, E.; Donker, G.; Onwuteaka-Philipsen, B.; Deliens, L.


    Purpose: To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and methods: A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By

  14. Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia.

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J


    Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mainly related to the patient's suffering.

  15. Influence of Training on First-Year Nursing Department Students' Attitudes on Death and Caring for Dying Patients: A Single-Group Pretest-Posttest Experimental Study.

    Cerit, Birgül


    The study examined the influence of training on first-year nursing department students' attitudes on death and caring for dying patients. Utilizing the experimental model, the study sample consisted of 81 first-year students attending the nursing department of a university. Death Attitude Profile-Revised and Frommelt Attitude toward Care of the Dying Scale were used for data collection. Data analysis included means, standard deviation, and t test for related samples. Student attitudes toward death were measured as 146.43 (16.741) and 152.75 (15.132) for pre- and posttraining, respectively. Student attitudes toward caring for dying patients were established to be 103.02 (7.655) during pretraining period and 111.02 (10.359) at posttraining period. The difference between pre- and posttests for mean attitudes toward death and caring for the dying patient was statistically significant. Study results determined that training was effective in forming positive student attitudes toward death and caring for dying patients.

  16. Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong.

    Ho, Andy Hau Yan; Chan, Cecilia Lai Wan; Leung, Pamela Pui Yu; Chochinov, Harvey Max; Neimeyer, Robert A; Pang, Samantha Mei Che; Tse, Doris Man Wah


    the empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life. to examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong. using qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed. the three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity. these findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.

  17. Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation?

    Akbari, Roghayeh; Rahmani Firouzi, Sedigheh; Akbarzadeh-Pasha, Abazar


    Introduction: Renal transplantation is the treatment of choice in chronic renal failure patients. Objectives: The purpose of this study was to evaluate the impact of urinary catheter removal time on transplanted kidney size and incidence of asymptomatic bacteriuria and urinary tract infections (UTIs). Patients and Methods: This retrospective cohort study evaluated the clinical outcomes of 109 consecutive live donor renal transplant recipients from December 2011 to July 2014. Routine ultrasound examinations were performed on donor's kidney prior to operation and one month later. Kidney volume was calculated. UTI and bacteriuria were evaluated one month later. Patients were divided into two groups based on time of Foley catheter removal (before and after fifth day posttransplantation). Results: In this study 74 males (67.9%) and 35 females (32.1%) were evaluated. Sixty-six patients (57.92%) were in group 1. None of the patients with positive urine culture had UTI but bacteriuria occurred in all of them (21.1%). Bacteriuria time after transplantation and catheter removal was significantly later in group 1 and it was not different in female group but they were later in male group. The mean renal volume increase was positively correlated to renal transplant recipient and donor's age and donor's body mass index (BMI) ( P UTI but increases the probability of bacteria in men whose catheter was removed within 5 days after transplantation. We also found that the renal volume change is not associated with catheter removal time and bacteriuria.

  18. Learning from dying patients during their final days: life reflections gleaned from dignity therapy.

    Hack, Thomas F; McClement, Susan E; Chochinov, Harvey M; Cann, Beverley J; Hassard, Thomas H; Kristjanson, Linda J; Harlos, Mike


    Dignity therapy is a novel therapeutic approach designed to decrease suffering, enhance quality of life and bolster a sense of dignity for patients approaching death. The benefits of dignity therapy were previously documented in a sample of 100 terminally ill patients. One of the products of dignity therapy is a transcript of the edited therapy session(s). In this qualitative study, 50 of the 100 (17 from Winnipeg, Manitoba, Canada, and 33 from Perth, Australia) dignity therapy transcripts were randomly drawn, and independently coded and analysed by three investigators using a grounded theory approach. The transcripts revealed that dignity therapy serves to provide a safe, therapeutic environment for patients to review the most meaningful aspects of their lives in such a manner that their core values become apparent. The most common values expressed by the patients included 'Family', 'Pleasure', 'Caring', 'A Sense of Accomplishment', 'True Friendship', and 'Rich Experience'. Exemplars of each of these values illustrate the pervasive, defining role of values in our lives. The findings are discussed in terms of values theory, the role of dignity therapy, and consideration of values clarification in clinicians' efforts to enhance the dignity of terminally ill patients.

  19. Clinical features analysis of elderly patients with malignant tumor before dying

    Tang Haiying


    Objective: To analyse the clinical features of elderly patients with malignant tumor before death. Method: Fifty-two elderly patients with malignant tumor were retrospectively analyzed respectively from sputum culture and plasma FIB, D-dimer, albumin, hemoglobin aspects. Result: Results of sputum cultures showed the percentage of gram-negative bacteria was 56. 6%, gram-positive bacteria was 24. 5% and fungus was 18. 8%. The level of plasma FIB and D-dimer in the tumor group significantly higher than those in the control (P < 0. 05). The level of plasma albumin and hemoglobin in the tumor group were significantly lower than those in the control (P < 0. 01). Conclusion: Elderly patients with malignant tumor has obvious clinical features before death. Understanding them has important significance for guidelines of clinical treatment and judgement of prognosis. (authors)

  20. Cerebral oxygen metabolism in patients with early Parkinson's disease

    Borghammer, Per; Cumming, Paul; Østergaard, Karen


    ) and cerebral blood flow (CBF) PET scans from PD patients and healthy controls. MATERIALS AND METHODS: Nine early-stage PD patients and 15 healthy age-matched controls underwent PET scans for quantitative mapping of CMRO(2) and CBF. Between-group differences were evaluated for absolute data and intensity...... in spatially contiguous cortical regions in early PD, and support the hypothesis that ETC dysfunction could be a primary pathogenic mechanism in early PD....

  1. Early myeloma-related death in elderly patients: development of a clinical prognostic score and evaluation of response sustainability role.

    Rodríguez-Otero, Paula; Mateos, María Victoria; Martínez-López, Joaquín; Martín-Calvo, Nerea; Hernández, Miguel-Teodoro; Ocio, Enrique M; Rosiñol, Laura; Martínez, Rafael; Teruel, Ana-Isabel; Gutiérrez, Norma C; Bargay, Joan; Bengoechea, Enrique; González, Yolanda; de Oteyza, Jaime Pérez; Gironella, Mercedes; Encinas, Cristina; Martín, Jesús; Cabrera, Carmen; Palomera, Luis; de Arriba, Felipe; Cedena, María Teresa; Paiva, Bruno; Puig, Noemí; Oriol, Albert; Bladé, Joan; Lahuerta, Juan José; San Miguel, Jesús F


    Although survival of elderly myeloma patients has significantly improved there is still a subset of patients who, despite being fit and achieving optimal responses, will die within 2 years of diagnosis due to myeloma progression. The objective of this study was to define a scoring prognostic index to identify this group of patients. We have evaluated the outcome of 490 newly diagnosed elderly myeloma patients included in two Spanish trials (GEM2005-GEM2010). Sixty-eight patients (13.8%) died within 2 years of diagnosis (early deaths) due to myeloma progression. Our study shows that the use of simple scoring model based on 4 widely available markers (elevated LDH, ISS 3, high risk CA or >75 years) can contribute to identify up-front these patients. Moreover, unsustained response (<6 months duration) emerged as one important predictor of early myeloma-related mortality associated with a significant increase in the risk of death related to myeloma progression. The identification of these patients at high risk of early death is relevant for innovative trials aiming to maintain the depth of first response, since many of them will not receive subsequent lines of therapy.

  2. Evaluation of early and late complications in patients with congenital lobar emphysema: A 12 year experience

    Nazem Masood


    Full Text Available Background: Congenital lobar emphysema (CLE is characterised by over distension of one lobe and pressure on the adjacent lobe and mediastinum. In this study, we review the pathological results of our paediatric patients with CLE, highlighting the early and late complications that occurred in these patients. Patients and Methods: In a prospective study from 1996 to 2008, we evaluated 30 patients with CLE diagnosis. Variables collected included sex, age at the time of diagnosis, radiological diagnostic method, type of treatment, pathological analysis, surgical findings and early postoperative complications. Parents were asked to refer to our clinic for follow-up and evaluation of late complications. Results: Thirty patients and males accounted for majority of the study population (n = 20, 67%. The mean age of male and female patients (at admission was 7.2 ± 2.3 and 4.7 ± 1.2 months respectively (P = not significant. The main diagnostic method was chest x-ray (CXR in all patients. Abnormal bronchial cartilage was found in 71% of patients. The most affected lobe was left upper lobe (50%. Associated anomalies were seen in four patients. Early postoperative periodhadtwo cases of pneumothoraces. At six month follow up, five (25% males and four females (40% had delayed weight gain. Permanent oxygen dependency was seen in two patients. Twenty- six patients underwent thoracotomy. Mortality rate was 13%. Base deficit at the time of admission was greater in those patients who eventually died, (-8.6 ± 1.2 versus -3.1 ± 0.4 (P = 0.0003. There were two deaths in the bilobar involvement group and two in the unilobar involvement group (P = 0.07, near significant. Conclusion: This study confirms that the number of affected lobes and base deficit at the time of admission were associated with significantly increased mortality.

  3. Advice and care for patients who die by voluntarily stopping eating and drinking is not assisted suicide.

    McGee, Andrew; Miller, Franklin G


    A competent patient has the right to refuse foods and fluids even if the patient will die. The exercise of this right, known as voluntarily stopping eating and drinking (VSED), is sometimes proposed as an alternative to physician assisted suicide. However, there is ethical and legal uncertainty about physician involvement in VSED. Are physicians advising of this option, or making patients comfortable while they undertake VSED, assisting suicide? This paper attempts to resolve this ethical and legal uncertainty. The standard approach to resolving this conundrum has been to determine whether VSED itself is suicide. Those who claim that VSED is suicide invariably claim that physician involvement in VSED amounts to assisting suicide. Those who claim that VSED is not suicide claim that physician involvement in VSED does not amount to assisting suicide. We reject this standard approach. We instead argue that, even if VSED is classified as a kind of suicide, physician involvement in VSED is not a form of assisted suicide. Physician involvement in VSED does not therefore fall within legal provisions that prohibit VSED.

  4. Ricinosomes provide an early indicator of suspensor and endosperm cells destined to die during late seed development in quinoa (Chenopodium quinoa).

    López-Fernández, M P; Maldonado, S


    In mature quinoa (Chenopodium quinoa) seeds, the lasting endosperm forms a micropylar cone covering the radicle. The suspensor cells lie within the centre of the cone. During the final stage of seed development, the cells of the lasting endosperm accumulate protein and lipids while the rest are crushed and disintegrated. Both the suspensor and endosperm die progressively from the innermost layers surrounding the embryo and extending towards the nucellar tissue. Ricinosomes are endoplasmic reticulum-derived organelles that accumulate both the pro-form and the mature form of cysteine endopeptidase (Cys-EP), first identified in castor bean (Ricinus communis) endosperm during germination. This study sought to identify associations between the presence of ricinosomes and programmed cell death (PCD) hallmarks in suspensor and endosperm cells predestined to die during quinoa seed development. A structural study using light microscopy and transmission electron microscopy was performed. To detect the presence of Cys-EP, both western blot and in situ immunolocalization assays were carried out using anti-R. communis Cys-EP antibody. A TUNEL assay was used to determine DNA fragmentation. Except for the one or two cell layers that constitute the lasting endosperm in the mature seed, ricinosomes were found in suspensor and endosperm cells. These cells were also the site of morphological abnormalities, including misshapen and fragmented nuclei, vesiculation of the cytosol, vacuole collapse and cell wall disorganization. It is proposed that, in suspensor and endosperm cells, the early detection of Cys-EP in ricinosomes predicts the occurrence of PCD during late seed development.

  5. Die rol van die blanke werker in die motivering van die swart werker

    G. J. Oosthuizen


    Opsomming Die motivering van die Swart werker kan nie in die huidige situasie in isolasie bestudeer word nie, omdat die Blanke werker steeds in die bestuursposisie is en daarom die motivering van die Swart werker kan beïnvloed. Hierdie ondersoek was daarop gerig om die rol van die Blanke werker in die motivering van die Swart werker nader te ondersoek. Die houding en die leierskapsbenadering van die Blanke werker teenoor die Swart werker is gemeet, asook die behoeftes wat volgens die Blanke werker by die Swart werker bestaan, bevredig is, of nie bestaan nie. Die behoeftes van Swart werkers, soos deur hulleself gesien, is ook ondersoek. Ten opsigte van sekere aspekte is beduidende verskille gevind.

  6. Tropical anurans mature early and die young: Evidence from eight Afromontane Hyperolius species and a meta-analysis.

    Ulrich Sinsch

    Full Text Available Age- and size-related life-history traits of anuran amphibians are thought to vary systematically with latitude and altitude. Because the available data base is strongly biased towards temperate-zone species, we provide new estimates on eight afrotropical Reed Frog species. A meta-analysis of the demographic traits in 44 tropical anuran species aims to test for the predicted clinal variation and to contrast results with variation detected in temperate-zone species. The small-sized reed frogs reach sexual maturity during the first or second year of life, but longevity does not exceed three to four years. Latitudinal effects on demographic life-history traits are not detectable in tropical anurans, and altitudinal effects are limited to a slight size reduction at higher elevations. Common features of anuran life-history in the tropics are early sexual maturation at small size and low longevity resulting in low lifetime fecundity. This pattern contrasts with that found in temperate-zone anurans which mature later at larger size and grow considerably older yielding greater lifetime fecundity than in the tropics. Latitudinal and altitudinal contraction of the yearly activity period shape the evolution of life-history traits in the temperate region, while trait variation in the tropics seems to be driven by distinct, not yet identified selective forces.

  7. Lactate clearance cut off for early mortality prediction in adult sepsis and septic shock patients

    Sinto, R.; Widodo, D.; Pohan, H. T.


    Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patient was determined by consensus from small sample size-study. We investigated the best lactate clearance cut off and its ability to predict early mortality in sepsis and septic shock patients. This cohort study was conducted in Intensive Care Unit of CiptoMangunkusumo Hospital in 2013. Patients’ lactate clearance and eight other resuscitationendpoints were recorded, and theoutcome was observed during the first 120 hours. The clearance cut off was determined using receiver operating characteristic (ROC) analysis, and its ability was investigated with Cox’s proportional hazard regression analysis using other resuscitation endpoints as confounders. Total of 268 subjects was included, of whom 70 (26.11%) subjects died within the first 120 hours. The area under ROC of lactate clearance to predict early mortality was 0.78 (95% % confidence interval [CI] 0.71-0.84) with best cut off was <7.5% (sensitivity and specificity 88.99% and 81.4% respectively). Compared with group achieving lactate clearance target, group not achieving lactate clearance target had to increase early mortality risk (adjusted hazard ratio 13.42; 95%CI 7.19-25.07). In conclusion, the best lactate clearance cut off as anearly mortality predictor in sepsis and septic shock patients is 7.5%.

  8. How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient?

    Gambles, M; McGlinchey, T; Latten, R; Dickman, A; Lowe, D; Ellershaw, J E


    Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

  9. Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions.

    Khandelwal, Nita; Benkeser, David; Coe, Norma B; Engelberg, Ruth A; Teno, Joan M; Curtis, J Randall


    Terminal intensive care unit (ICU) stays represent an important target to increase value of care. To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Secondary analysis of an intervention study to improve quality of care for critically ill patients. 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models.

  10. Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore.

    Lee, Yee Song; Akhileswaran, Ramaswamy; Ong, Eng Hock Marcus; Wah, Win; Hui, David; Ng, Sheryl Hui-Xian; Koh, Gerald


    Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home. To examine the independent factors associated with home hospice patient dying at home. Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death. A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home. Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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

    Sharma, B R


    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.

  12. Die hervertolking van die paradigma in verband met die ...

    Kerkorde van De Mist en die Algemene Reglement van 1816, wat onderskeidelik vir die Kaapse Kerk en die .... Een van die eerstes was Sam Freiherr von Pufendorf (1632-1694) wat in sy werk De habitu religionis ..... Koning was weer aan bewind (vgl Diepenhorst sj:74w; De Visser 1926/1927 lll:202w). 43.1 JD Janssen ...

  13. die heidelbergse kategismus en die kategesemateriaal van die ned

    subjek, objek, leerstof en die metodiek van die senior kategese. Bloemfontein: Algemene Jeugkommissie Sondagskoolboekhandel. de rAAd oer ned ger kerken in Zuid AfrikA. 1921. De zevende vergadering: handelinge. 1925. De negende vergadering: handelinge. de villierS, d. W. 1957. Die Kategese in die Ned. Geref.

  14. die sinodale verband van die nederduitse gereformeerde kerk in die


    Strauss. Die sinodale verband van die Nederduitse Gereformeerde Kerk. 122 die Vrystaatse Sinode anti-veranderingsgesind of eerder gesond-behoudend of gereformeerd-gematig? Veral as dit .... howe) in moeilike omstandighede gebring is (NG Kerk in die OVS 1865-1912:5). In 'n brief op 8 Augustus 1864 ontken Ds.

  15. Die kerkregtelike posisie van die ouderling en diaken in die ...

    ... drie dekades die Kerkreg gevestig as 'n selfstandige vak in die teologiese curriculum, maar ook 'n baie groot rol gespeel daarin dat die beginsels van die kerk like reg beter begryp word. Naas sy wetenskaplike bydrae word met eweveel genoegdoening gedink aan sy bcsondere persoonlikheid, sy werkvermoe, sy humor-.

  16. A Retrospective Medical Records Review of Risk Factors for the Development of Respiratory Tract Secretions (Death Rattle) in the Dying Patient.

    Kolb, Hildegard; Snowden, Austyn; Stevens, Elaine; Atherton, Iain


    Identification of risk factors predicting the development of death rattle. Respiratory tract secretions, often called death rattle, are among the most common symptoms in dying patients around the world. It is unknown whether death rattle causes distress in patients, but it has been globally reported that distress levels can be high in family members. Although there is a poor evidence base, treatment with antimuscarinic medication is standard practice worldwide and prompt intervention is recognised as crucial for effectiveness. The identification of risk factors for the development of death rattle would allow for targeted interventions. A case ̶ control study was designed to retrospectively review two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009 - 2011. Fifteen potential risk factors including the original factors weight, smoking, final opioid dose and final Midazolam dose were investigated. Binary logistic regression to identify risk factors for death rattle development. Univariate analysis showed death rattle was significantly associated with final Midazolam doses and final opioid doses, length of dying phase and anticholinergic drug load in the pre-terminal phase. In the final logistic regression model only Midazolam was statistically significant and only at final doses of 20 mg/24hrs or over (OR 3.81 CI 1.41-10.34). Dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  17. Hospice assist at home : does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study

    de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm

    BACKGROUND: A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM: The aims of

  18. No negative impact of Palliative sedation on relatives' experience of the dying phase and their wellbeing after the patient's death: An observational study

    S.M. Bruinsma (Sophie); A. van der Heide (Agnes); M. Van Der Lee; Y. Vergouwe (Yvonne); J.A.C. Rietjens (Judith)


    textabstractBackground: Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention

  19. Factors associated with dying at the place of wish: a cross-country comparison of cancer patients with the EURO SENTI-MELC Study 2009-2010.

    Ko, W.; Miccinesi, G.; Beccaro, M.; Vanthomme, K.; Donker, G.A.; Onwuteaka-Philipsen, B.; Alonso, T.V.A.V; Deliens, L.; Block, L. van den


    Aims: 1) To study demographic and clinical factors associated with dying at a preferred place for cancer patients 2) To study cross-country differences in the intensity of factors Methods: A mortality follow-back study was undertaken in 2009-2010 via representative nationwide networks of general

  20. Radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET; Die Strahlenexposition des Patienten durch die Einzelphotonen-Transmissionsmessung bei der PET

    Schaefer, A.; Donsch, P.; Kirsch, C.M. [Universitaet des Saarlandes, Homburg/Saar (Germany). Abt. fuer Nuklearmedizin; Seifert, H. [Universitaet des Saarlandes, Homburg/Saar (Germany). Abt. Strahlentherapie der Radiologischen Klinik


    Aim: The aim of the study was the determination of the radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET. Material and method: Single-photon-transmission measurement is performed using two Cs-137 pointsources (E{gamma}=662 keV, A=2*614 MBq) on a 3D PET scanner (ECAT ART). During a simulation of a whole body transmission scan (axial length: 75 cm, 6 contigous bed positions) dose measurements with thermoluminescent dosimeters were carried out using a thorax and an abdomen phantom. Following the guidelines of the ICRU report No. 60 an estimation of the effective dose caused by a single-photon transmission measurement was calculated. Results: For a total acquisition time of 360 min (6 beds with an acquisition time of 60 min per bed) the absorbed doses amounted to: Surface (xyphoid) 189 {mu}Gy, heart 196 {mu}Gy, lungs 234 {mu}Gy, vertebra 240 {mu}Gy, liver 204 {mu}Gy, gonads 205 {mu}Gy, thyroid 249 {mu}Gy and bladder 185 {mu}Gy resulting in a conversion factor of 1.7*10{sup -4} mSv/(h*MBq). The estimation of the effective dose for a patient's transmission (acquisition time of 3.2 min per bed) yields a value of 11 {mu}Sv. An estimation of the ratio of the conversion factors for transmission measurements in single-photon- and in coincidence mode (two Ge-68/Ga-68 rod sources of 40 MBq each), respectively, resulted in a value of 0.18. The comparison of the effective doses caused by single-photon transmission and by emission measurement (injection of 250 MBq of FDG) yields a ratio of 2.3*10{sup -3}. Conclusion: The radiation exposure of the patient caused by the transmission measurement for 3D whole-body-PET can be neglected. In comparison with the coincidence-transmission using uncollimated line sources of low activity the radiation exposure is still reduced using single photon transmission with collimated point sources of high activity. (orig.) [German] Ziel: Ziel war die Bestimmung der Strahlenexposition des

  1. Early Home Supported Discharge of Stroke Patients:

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan


    OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS......: A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... are discussed. CONCLUSIONS: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD...

  2. Early rehabilitation in Resurfacing, standard and large head THA patients

    Penny, Jeannette Østergaard; Varmarken, Jens-Erik; Ovesen, Ole


    in the resurfacing patient may impair the early rehabilitation. We aimed to investigate early differences in rehabilitation parameters amongst the different groups. Materials and methods We randomized to resurfacing (n=20), standard 28 mm THA (n=19) and large head MoM THA (n=12). We recorded operation time, blood...

  3. Trends in the aggressiveness of end-of-life care for Korean pediatric cancer patients who died in 2007-2010.

    June Dong Park

    Full Text Available In light of the Korean Supreme Court's 2009 ruling favoring a patient's right to die with dignity, we evaluated trends in aggressive care in a cohort of pediatric cancer patients. Methods We conducted a population-based retrospective study that used administrative data for patients who died in 2007-2010 among the 5,203 pediatric cancer patients registered at the Korean Cancer Central Registry (KCCR during 2007-2009.In the time period covered, 696 patients died. The proportion who had received chemotherapy in the last 30 days of life decreased from 58.1% to 28.9% (P<0.001, those who received new chemotherapy in the same time period decreased from 55.2% to 15.1% (P<0.001, and those who received treatment in the last 2 weeks of life decreased from 51.4% to 21.7% (P<0.001. In the last 30 days of life, the proportion of patients whose hospital admission period was over 14 days increased from 70.5% to 82.5% (P = 0.03, the proportion who received cardiopulmonary resuscitation decreased from 28.6% to 9.6% (P<0.001, and we found no statistically significant trends in the proportion of emergency department visits, intensive care unit admissions, or mechanical ventilation.In this study, in contrast with earlier ones, the aggressiveness of end-of-life care of Korean pediatric cancer patients decreased dramatically.

  4. Riglyne vir die onderwys.

    J. L. du Plooy


    Full Text Available In die afgelope vyftig jaar sedert die Unie tot stand gekom het, is veel op die gebied van onderwys tot stand gebring. Dit is heel natuurlik dat ’n mens sou vra: Wat van die toekoms?

  5. Patients with neuromyelitis optica have a more severe disease than patients with relapsingremitting multiple sclerosis, including higher risk of dying of a demyelinating disease

    Denis Bernardi Bichuetti


    Full Text Available Although neuromyelitis optica (NMO is known to be a more severe disease than relapsing-remitting multiple sclerosis (RRMS, few studies comparing both conditions in a single center have been done. Methods: Comparison of our previously published cohort of 41 NMO patients with 177 RRMS patients followed in the same center, from 1994 to 2007. Results: Mean age of onset was 32.6 for NMO and 30.2 for RRMS (p=0.2062 with mean disease duration of 7.4 years for NMO and 10.3 years for RRMS. Patients with NMO had a higher annualized relapse rate (1.0 versus 0.8, p=0.0013 and progression index (0.9 versus 0.6, p≪0.0001, with more patients reaching expanded disability status scale (EDSS 6.0 (39 versus 17%, p=0.0036. The odds ratio for reaching EDSS 6.0 and being deceased due to NMO in comparison to RRMS were, respectively, 3.14 and 12.15. Conclusion: Patients with NMO have a more severe disease than patients with RRMS, including higher risk of dying of a demyelinating disease.

  6. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England [version 1; referees: 2 approved

    Jane Seymour


    Full Text Available Background: The Liverpool Care Pathway for the Dying Patient (‘the LCP’ was an integrated care pathway (ICP recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review.  The ensuing debate among clinicians polarised between ‘blaming’ of the LCP and regret at its removal. Employing the concept of ‘boundary objects’, we aimed to address three questions: 1 why and how did the LCP come to prominence as a vehicle of policy and practice 2 what factors contributed to its demise? 3 what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP ‘scandal’ demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care.  Conclusions:  In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

  7. Die partypolitiek en die toekoms van die Afrikaanse volkskultuur

    A.P. Treurnicht


    Full Text Available Reeds in 1853 het die Zuid Afrikaan hom soos volg uitgelaat: „Dis ’n dwaling wat ons reeds meermale bestry het dat ons as Britse onderdane verplig sou wees, om die Britse nasionaliteit ons s’n te maak. Die Kolonis van Hollandse oorsprong kan geen Engelsman word nie, en moet ook geen Nederlander wil wees nie. Wanneer hy weet om sy standpunt te waardeer, dan sal hy as verligte kolonis die grondtrekke van die Engelse volkskarakter met dié van die Nederlandse harmonies leer verenig en daardeur word wat hy as Kapenaar moet word.”

  8. Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

    Verreault, René; Arcand, Marcel; Misson, Lucie; Durand, Pierre J; Kroger, Edeltraut; Aubin, Michèle; Savoie, Maryse; Hadjistavropoulos, Thomas; Kaasalainen, Sharon; Bédard, Annick; Grégoire, Annie; Carmichael, Pierre-Hughes


    Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care. To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities. Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying. A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group). The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group. Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.

  9. Parenteral and Early Enteral Feeding in Patients with Colonic Tumor

    O. A. Malkov


    Full Text Available Objective: to provide evidence whether it is expedient to use an early enteral feeding protocol in patients with colonic malignancies in the postoperative period to prevent and to correct hemodynamic disorders, oxygen imbalance, and malnutrition. Subjects and methods. A hundred patients (61 males and 39 females aged 66.2±5.0 years, who had Stages 2—3 colonic malignancies, were examined. Two algorithms of postoperative management were analyzed using the traditional diet and early enteral feeding. Results. The early enteral feeding protocol improves central hemodynamics and oxygen and nutritional status, prevents moderate protein-energy deficiency in the early postoperative period and reduces the number of complications and fatal outcomes in patients with colonic malignancies. Key words: malignancies, malnutrition, hemo-dynamics, oxygen status, enteral feeding.

  10. Concepts of mental capacity for patients requesting assisted suicide: a qualitative analysis of expert evidence presented to the Commission on Assisted Dying.

    Price, Annabel; McCormack, Ruaidhri; Wiseman, Theresa; Hotopf, Matthew


    In May 2013 a new Assisted Dying Bill was tabled in the House of Lords and is currently scheduled for a second reading in May 2014. The Bill was informed by the report of the Commission on Assisted Dying which itself was informed by evidence presented by invited experts.This study aims to explore how the experts presenting evidence to the Commission on Assisted Dying conceptualised mental capacity for patients requesting assisted suicide and examine these concepts particularly in relation to the principles of the Mental Capacity Act 2005. This study was a secondary qualitative analysis of 36 transcripts of oral evidence and 12 pieces of written evidence submitted by invited experts to the Commission on Assisted Dying using a framework approach. There was agreement on the importance of mental capacity as a central safeguard in proposed assisted dying legislation. Concepts of mental capacity, however, were inconsistent. There was a tendency towards a conceptual and clinical shift toward a presumption of incapacity. This appeared to be based on the belief that assisted suicide should only be open to those with a high degree of mental capacity to make the decision.The 'boundaries' around the definition of mental capacity appeared to be on a continuum between a circumscribed legal 'cognitive' definition of capacity (in which most applicants would be found to have capacity unless significantly cognitively impaired) and a more inclusive definition which would take into account wider concepts such as autonomy, rationality, voluntariness and decision specific factors such as motivation for decision making. Ideas presented to the Commission on Assisted Dying about mental capacity as it relates to assisted suicide were inconsistent and in a number of cases at variance with the principles of the Mental Capacity Act 2005. Further work needs to be done to establish a consensus as to what constitutes capacity for this decision and whether current legal frameworks are able to

  11. Die Voortrekker-Monument

    Gerard Moerdyk


    Full Text Available Die Eeufeesjaar is vir die Afrikaner ’n tydperk van besieling. Nog nooit sedert die ontstaan van ons volk het een enkele gebeurtenis soveel nasietrots gewek as die honderdjarige herdenking van die Groot Trek. Vir die eerste keer in ons geskiedenis voel ons ons nie meer Kapenaars, Vrystaters, Natalers, en Transvalers nie, maar Afrikaners, saamgesnoer deur die tradisies van ’n selfstandige kultuurvolk. Wanneer die klimaks van die Ossewatrek met die hocksteenlegging van die Voortrekker-Monument bereik word, sal die besieling nie uitsterf nie, die krag wat geskep is sal bly voortgroei tot ’n onweerstaanbare mag. Die Afrikaner sal homself vind, en as die Monument na sowat vyf jaar onthul word, sal die saad wat in hierdie jaar gesaai is, tot voile rypheid gekom het. Dan sal die Monument self tot die volk spreek; intussen egter, is dit wenslik, nee noodsaaklik selfs, om die Monument aan die Afrikaners te verklaar, om ‘n uiteensetting te gee van die noodsaaklikheid van so ’n Monument, sowel as om die motief te verduidelik wat as inspirasie gedien het vir die ontwerpdaar van.

  12. Dying for security

    Buchan, Bruce


    Full Text Available If political statements and media coverage are any guide, it seems Australians today are dying for security. At no other moment in our history has the spectre of war and terrorism so haunted popular, political and scholarly perceptions of Australia’s colonial past and of its geopolitical future. And yet, debates over colonial war or genocide and contemporary terrorism have been conducted in more or less complete isolation. In this article I argue that our contemporary obsession with ‘security’ is premised on the perennial threat of ‘insecurity’. This is the problem of in/security, and it has played a central role in the development of Western political thought. More importantly, its formulation in Western political thought provided a powerful justification for the violence of the early decades of Australia’s colonisation during which Indigenous Australians could also be said to have been dying for security.

  13. Dying for Security

    Bruce Buchan


    Full Text Available If political statements and media coverage are any guide, it seems Australians today are dying for security. At no other moment in our history has the spectre of war and terrorism so haunted popular, political and scholarly perceptions of Australia’s colonial past and of its geopolitical future. And yet, debates over colonial war or genocide and contemporary terrorism have been conducted in more or less complete isolation. In this article I argue that our contemporary obsession with ‘security’ is premised on the perennial threat of ‘insecurity’. This is the problem of in/security, and it has played a central role in the development of Western political thought. More importantly, its formulation in Western political thought provided a powerful justification for the violence of the early decades of Australia’s colonisation during which Indigenous Australians could also be said to have been dying for security.

  14. [Neuroplasticity as a basis for early rehabilitation of stroke patients].

    Putilina, M V


    The review is devoted to the current state of the problem of early rehabilitation of stroke patients. The rate of primary disability in patients after stroke is 3.2 per 10000 population but only 20% of previously working patients return to work. Early rehabilitation is treatment actions during a period following stroke. Adequate treatment during this period may decrease the extent of brain damage and improve disease outcome. The complexity of rehabilitation consists in using several complementary pharmacological and non-pharmacological rehabilitation measures. Appearance of new techniques of rehabilitation treatment aimed at neuroplasticity stimulation increases treatment potential of rehabilitative technologies.

  15. Let him not be alone: perspectives of older British South Asian minority ethnic patients on dying in acute hospitals.

    Venkatasalu, Munikumar Ramasamy


    To investigate older British South Asians' views on dying at acute hospitals. Older people, including those from ethnic minorities prefer 'home as a haven' for their last days of life; however, they are more likely to die in hospital. Constructive grounded theory was used as a methodological approach that informed data collection to data analysis. Open meetings with 11 local South Asian community organisations enabled the researchers to recruit a total of 55 older South Asians in this study. Data were collected using gender-based focus groups (n=5) and in-depth, semi-structured interviews (n=29). Transcripts were analysed using Nvivo 9. Three key themes were identified: 'mistrust', 'let him not be alone' and 'family as a protective shield'. The theme 'mistrust' is explored through examination of beliefs, attitudes and expectations about 'hospital' as a place in the care of the dying. The theme of 'let him not be alone' draws the family's preferences and concerns in relation to leaving their older dying relative alone in the hospital. The final theme of 'family as a protective shield' describes the element of family care as a protective shield for their older one to have peaceful end-of-life care moments in the hospital. Allowing older relatives to die in hospital seems to evoke feelings of missed filial responsibilities and guilt among family carers among older ethnic minorities. The presence of cultural paranoia and mistrust often led minorities to experience sub-standard end-of-life care in acute hospitals.

  16. Die Britse owerheid en die onderwys op Heidelberg gedurende die ...

    The establishment of Christian National Education (CNE) Schools stimulated the concept of mother tongue education. Oor die klaskamerpraktyk en die werklike gehalte van onderrig tydens die kampskooltydperk is daar min bekend. Heidelberg wat na 1902 in 'n belangrike onderwyssentrum in Transvaal ontwikkel het, het ...

  17. Die belangrikste kenmerk van die diereproduksie- bedrywe oor die ...

    digdhede teen 1980 uit 'n kudde van 30 rnilj.skape ge- produseer moet word. Tweedens sal die faktore ... die Republiek van Suid-Mrika teen 1980 in totaal 28 milj. sal wees. Indien die produsente dit as 'n ..... Appendix Table 4 in Digestive Physiology and nutrition of ruminants Vol. 3 Ed. and Publ. D.C. Church, Oregon State ...


    aanslag op die sogenaamde "Intentional Fallacy", heelwat verder. n. Mens sou hier eintlik ook op die invloed van Lacan se toepassing van. De Sacs sure op Freud moet wys, en op Macherey se Theory of Literary. Production. Barthes is naamlik besig om repressie teen te werk, en die teks as produksieproses in stede van ...

  19. Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context.

    Allard, Julie; Fortin, Marie-Chantal


    In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

    Tan, Amy; Manca, Donna


    Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing

  1. Markus 16:1-8 in die konteks van 'n konstniksie van die Markaanse ...

    Gager notes that a sociological approach to early Christianity takes what redaction ...... die Markaanse ervaring die ander kant van die saak nie so 'getrou' weerspieel nie. Markaansc .... insider's knowledge of the apocalyptic code is bound to conclude that Mark and his ..... The ethics of Mark's gospel: In the middle of time.

  2. Wêreldmededingendheid en die tegnologie

    C. W. I. Pistorius


    Full Text Available Afgesien van die interne uitdagings wat die Heropbou- en Ontwikkelingsprogram (HOP aan Suid-Afrika bied, moet die land ook tred hou met die veranderende globale omgewing, spesifiek die toenemende belangrikheid van ekonomiese sekuriteit as komponent van nasionale sekuriteit. Die konsep van mededingendheid vergestalt die doelwit wat nagestreef moet word ten einde die ontluikende globale ekonomiese stryd aan te durf. As ’n belangrike drywer van ekonomiese welvaart is tegnologie een van die belangrikste sleutels tot internasionale mededingendheid. Tegnologiese innovasie is die proses wat as hefboom hiervoor gebruik moet word. Dit is egter nodig dat tegnologie, en spesifiek die proses van tegnologiese innovasie, formeel en gestruktureerd bestuur moet word, sowel op nasionale as firmavlak. Op nasionale vlak is die voorsiene Nasionale Innovasiestelsel beslis ’n stap in die regte rigting.

  3. die ontstaan en die ontwikkeling van die skoolkadette-stelsel in die rsa

    toe algemene diensplig ingestel is. Die diens- plig het intussen sy volle beslag gekry en in. Weermagkringe het die gedagte posgevat dat skoolkadette. 'n deeglike ondersoek vereis ten einde die skoolgaande seun vir sy komende nasionale diensplig te orienteer. Tydens kadetopleldlng leer die seuns al die fynere kunsles ...

  4. Van die Gasredakteur

    cherish and teach.'1. Die Fakulteit Geneeskunde van die Universiteit van die Oranje-Vrystaat het pragtig gegroei ge- durende die eerste 21 jaar van sy bestaan. Die entoesiasme, doelgerigtheid, harde werk en inisia- tiewe van 'n groot aantal persone was hiervoor verantwoordelik. 'If we see a bit more clearly than they, it is ...

  5. Halfkrone vir die Nagmaal


    die omgewing van Velddrif en Laaiplek, ook noordwaarts verby Lambertsbaai tot by. Doringbaai en Strandfontein. “Haar seeverhale is Sussie (Kotze) se belangrikste bydrae tot die Afrikaanse letterkunde”, sê Kotzé-Myburgh in die voorwoord van die versamelbundel. Die leser word herinner aan Kotze se debuutroman, ...

  6. Die teologie in gesprek met die ekonomie

    (1723-1790) sy vertrekpunt neem, ontwikkel, as oorwinnaars uit die Franse Revolu .... Die onmiddellike sukses van Adam Smith se 'Wealth of Nations' was .... alle vorme van sosialisme niks anders as 'kommunisme' (Wassenaar 1977:12) nie.

  7. Genotyping of Toxoplasma gondii: DNA extraction from formalin-fixed paraffin-embedded autopsy tissues from AIDS patients who died by severe disseminated toxoplasmosis.

    Bastos da Silva, Inara; Batista, Tatiana Pimental de Andrade; Martines, Roosecelis Brasil; Kanamura, Cristina Takami; Ferreira, Isabelle Martins Ribeiro; Vidal, Jose Ernesto; Pereira-Chioccola, Vera Lucia


    This study investigated the genetic features of Toxoplasma gondii isolated directly in autopsies of HIV-infected patients who died with severe disseminated toxoplasmosis. This retrospective analysis was conducted in a cohort of 15 HIV-infected patients with clinical and laboratory data. They had previous cerebral toxoplasmosis at least 6 months before the disseminated toxoplasmosis episode. The hypothesis was that they were infected with highly virulent parasites due to the condition in which they died. T. gondii genotyping was done directly in DNA extracted from 30 autopsy brain and lung samples (2 per patient) and mutilocus PCR-RFLP genotyping was done using 12 molecular markers. The 30 clinical samples were genotyped successfully in 8 or more loci and six suggestive genotypes were identified. One of them was Toxo DB #11, previously identified in different domestic animals and virulent in experimental animals. The other five suggestive genotypes identified in 14 patients were not described. TgHuDis1 was the most frequent and was determined in 8 patients. TgHuDis3 and TgHuDis5 were identified in two patients each. TgHuDis2 and TgHuDis4 have been identified in one patient each. These suggestive genotypes could be considered as virulent, since they caused severe tissue damage and had similar characteristics as Toxo # DB 11. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Cardiac Function in Patients with Early Cirrhosis during Maximal Beta-Adrenergic Drive

    Krag, Aleksander; Bendtsen, Flemming; Dahl, Emilie Kristine


    BACKGROUND AND AIM: Cardiac dysfunction in patients with early cirrhosis is debated. We investigated potential cardiac dysfunction by assessing left ventricular systolic performance during a dobutamine stress test in patients with early cirrhosis. PATIENTS AND METHODS: Nineteen patients with Chil...

  9. Die dogmatiese binding van die prediking

    genoemde probleemstelling wat ons homileties na riglyne wil soek, sonder die pretensie dat finale oplossings gevind sal word. Om hierdie probleem te ontleed is dit nodig om eers kortliks 'n begripsbepaling van die begrippe dogma, binding en prediking te maak. Vanuit die begripsbepaling kan ons dan probeer vasstel wat ...


    aan dat 'n lewe onder die gesag van God tot volle vrede lei: “In coming under the rule of Yahweh, moreover, life was made whole and safe.” Dit is spesifiek in die tempel waar die volheid van God se vrede ondervind word (1997:662):. The temple is indeed the place where Israel entered into Yahweh's full zone of shalom.

  11. Early Maladaptive Schemas in the Patients with Somatoform Disorders

    Ýsmet Kýrpýnar


    Method: We investigated a total of 28 patients aged 18-65 years, were diagnosed as Hypochondriasis or Somatization Disorder according to DSM-IV and 30 healthy controls. All participitans were assessed with The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1. Data were obtained by using a Sociodemographic Questionnaire and Young Schema Questionnaire-Short Form 3. Results: The main age of patients was 36,71 ± 10.39. Most of the patients were female, married and housewives. All early maladaptive schema scores of patients with somatoform disorders were higher than healthy controls. Conclusion: All early maladaptive schemas have been found to be related to somatoform disorders in this study. The role of not a specific one but a total of maladaptive schemas in etiology may reflect the unspecific general sources of the tendency to somatoform disorders. [JCBPR 2014; 3(2.000: 84-93

  12. Early fluid loading for septic patients: Any safety limit needed?

    Gong, Yi-Chun; Liu, Jing-Tao; Ma, Peng-Lin


    Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed. It was concluded that early aggressive fluid loading improved hemodynamics transitorily, but was probably traded off with a follow-up organ function impairment, such as worsening oxygenation by reduction of lung aeration, in a part of septic patients at least. Thus, a safeguard is needed against unnecessary excessive fluids in early aggressive fluid loading for septic patients. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  13. n Oorsig van die huidige stand van navorsing oor die


    7 Jun 2011 ... Die eerste maal wat dit as deel van die teks van 1 Johannes aangehaal word, is in die. 4de eeu in 'n Latynse teks, Liber Apologeticus (hf 4). Eers aan die einde van die 16de eeu is dit in 'n amptelike Katolieke uitgawe van die Vulgaat ingesluit. Die doel van die Johannesbriewe. Waarom is die Briewe ...

  14. Die Ware Buch und die Philologie

    Bernhard Hurch


    Full Text Available Die im 19. Jahrhundert sich verändernden Produktionsbedingungen für Druckwerke (Buchdruck, Satz, Papier, Bindung wirkten katalysierend auf die Fachkonstitution und Institutionalisierung der Philologien. Hier steht der tatsächliche Buchmarkt im Vordergrund der Darstellung, das Käuferpublikum und die Voraussetzungen des Vertriebs. Dazu gehören auch die Rezension als entstehende Textsorte und die rasch arbeitenden Rezensionsorgane. F.-R. Hausmann wurde in den letzten Jahren unentbehrlicher Mitarbeiter dieses im Rahmen des Grazer Schuchardt-Projekts "Netzwerk des Wissens" angesiedelten Ansatzes.

  15. Serological analysis and therapy in patients with early syphilis

    Wu Zhifen


    Sixty one patients with early syphilis were treated with benzathine penicillin under guide of serological analysis, the results showed that benzathine penicilline was able to cure indurated chancre and skin rashes in a month, flat condyloma in one and a half month, and PRP were all negative in 18 month

  16. Anatomical correlates of cognitive functions in early Parkinson's disease patients.

    Roberta Biundo

    Full Text Available Cognitive deficits may occur early in Parkinson's disease (PD but the extent of cortical involvement associated with cognitive dysfunction needs additional investigations. The aim of our study is to identify the anatomical pattern of cortical thickness alterations in patients with early stage PD and its relationship with cognitive disability.We recruited 29 PD patients and 21 healthy controls. All PD patients performed an extensive neuropsychological examination and 14 were diagnosed with mild cognitive impairment (PD-MCI. Surface-based cortical thickness analysis was applied to investigate the topographical distribution of cortical and subcortical alterations in early PD compared with controls and to assess the relationship between cognition and regional cortical changes in PD-MCI.Overall PD patients showed focal cortical (occipital-parietal areas, orbito-frontal and olfactory areas and subcortical thinning when compared with controls. PD-MCI showed a wide spectrum of cognitive deficits and related significant regional thickening in the right parietal-frontal as well as in the left temporal-occipital areas.Our results confirm the presence of changes in grey matter thickness at relatively early PD stage and support previous studies showing thinning and atrophy in the neocortex and subcortical regions. Relative cortical thickening in PD-MCI may instead express compensatory neuroplasticity. Brain reserve mechanisms might first modulate cognitive decline during the initial stages of PD.

  17. Legal physician‐assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit


    Background Debates over legalisation of physician‐assisted suicide (PAS) or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician‐assisted dying is legal and data have been collected over a substantial period. Methods The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government‐commissioned nationwide studies of end‐of‐life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Results Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Conclusions Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician‐assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. PMID

  18. Early versus late tracheostomy in cardiovascular intensive care patients.

    Puentes, Wilfredo; Jerath, Angela; Djaiani, George; Cabrerizo Sanchez, Rosa; Wąsowicz, Marcin


    Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population. After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as "early" if tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P=0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups. There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.

  19. Various opportunistic infections and neoplasms in patients dying of AIDS in the last 12 years--report based on pathomorphological investigations.

    Kamiński, Z


    The aim of the study was microscopic diagnostics of infections and neoplasms in patients who died of AIDS. Post-mortem analyses were performed in the Hospital for Infectious Diseases in Warsaw. In total, 200 patients with AIDS who were treated and subsequently died were included in the analysis. The study group consisted of 175 men and 25 women. Patients' age ranged between 11 months and 64 years (mean age 43 years). The most frequent infection diagnosed in these subjects was cytomegalovirus, followed by bacterial, mycotic, tuberculotic infections and toxoplasmosis. As far as neoplasms are concerned, patients with AIDS suffered most frequently from malignant lymphoma, Kaposi's sarcoma and finally, from Hodgkin's disease. In most cases, many types of infections coexisted with one another or there was a co-occurrence of the infection and neoplasm. The author suggests that the material presented in this paper is representative for Polish population. Pulmonary changes is the most often cause of the death of the patients with AIDS.

  20. Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

    Agulnik, Asya; Forbes, Peter W; Stenquist, Nicole; Rodriguez-Galindo, Carlos; Kleinman, Monica


    To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients. We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient. A large tertiary/quaternary free-standing academic children's hospital. One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls. None. Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004). We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and

  1. Early versus delayed hormonal treatment in locally advanced or asymptomatic metastatic prostatic cancer patient dilemma.

    Prezioso, Domenico; Iacono, Fabrizio; Romeo, Giuseppe; Ruffo, Antonio; Russo, Nicola; Illiano, Ester


    The objective of this work is to compare the effectiveness of hormonal treatment (luteinizing hormone-releasing hormone agonists and/or antiandrogens) as an early or as a deferred intervention for patients with locally advanced prostate cancer (LAPC) and/or asymptomatic metastasis. Systematic review of trials published in 1950-2007. Sources included MEDLINE and bibliographies of retrieved articles. Eligible trials included adults with a history of LAPC who are not suitable for curative local treatment of prostate cancer. We retrieved 22 articles for detailed review, of which 8 met inclusion criteria. The Veterans Administration Cooperative Urological Research Group suggested that delaying hormonal therapy did not compromise overall survival and that many of the patients died of causes other than prostate cancer. In European Organisation for Research and Treatment of Cancer (EORTC) 30846 trial, the median survival for delayed endocrine treatment was 6.1 year, and for immediate treatment 7.6 year, the HR for survival on delayed versus immediate treatment was 1.23 (95 % CI 0.88-1.71), indicating a 23 % nonsignificant trend in favour of early treatment. In EORTC 30891, the immediate androgen deprivation resulted in a modest but statistically significant increase in overall survival. The protocol SAKK 08/88 showed the lack of any major advantage of immediate compared with deferred hormonal treatment regarding quality of life or overall survival. The early intervention with hormonal treatment for patients with LAPC provides important reductions in all-cause mortality, prostate cancer-specific mortality, overall progression, and distant progression compared with deferring their use until standard care has failed to halt the disease.


    Aleš Demšar


    Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

  3. Cytokine profile in patients with early latent syphilis

    Zakharov S.V.


    Full Text Available The purpose of this study was to study the change in the content of the most active cytokines (interleukins 6 and 10 during the formation of the immune response in patients with latent early syphilis, as well as to study the possible relationship between the concentrations of these cytokines and the duration of the disease. In 50 patients with early latent syphilis, the concentration of interleukins 6 and 10 in serum was studied. The serum level of interleukins was studied by the enzyme immunoassay. A statistically significant increase in the concentration of interleukin 6 in the blood of patients with latent syphilis and decrease in the interleukin 10 concentration in comparison with healthy people was established. At the same time, in patients with latent syphilis with term of infection for more than 1 year, interleukin 10 has been expressed, as compared with healthy people and, especially, with patients with syphilis with a duration of infection of up to 1 year. Along with this, a lower degree of increase in the concentration of interleukin 6 in patients with latent syphilis with a duration of infection over 1 year has been established, as compared with patients with latent syphilis with a term of infection up to 1 year, against the background of its increased concentration as compared with a group of healthy individuals.

  4. Die vrede van Münster / Westfale en die betekenis daarvan vir die ...

    In die Suid-Afrikaanse kerkgeskiedenis egter is die Vrede van Münster as epogmakende gebeure tot dusver nie net in die algemeen verwaarloos nie, maar boonop is die direkte verband tussen hierdie sentrale historiese baken aan die een kant en aan die ander kant die vestiging van die VOC se verversingspos aan die ...

  5. Tegnologie en die mens

    omgewingsbesoedeling, volgend op industrialisasie en verstedeliking, gee uit- ing tot krete van wanhoop en frustrasie. Die maatskaplike ontwrigting agv outomatisasie het die begrippe van vervreemding en naam- loosheid op die voorgrond van sosiale be- wustheid geplaas. • Die Neutrale Siening. Tegnologie was nag. 34.


    15 Mei 2010 ... Biezeveld, de Boer, Brümmer, Muis. 2001; Brown 2006; Durand 2007). ... Wanneer sal hy weer in God se teenwoordigheid verskyn (vers 3)? Dié vraag is vol onsekerheid. (Schuman 2004:8). Sy onsekerheid ... God se volk en die enkeling in die geskiedenis het al die trou van God ervaar waarop die digter ...

  7. Die ontwikkeling van die bestuursmotiveringsvraelys (BMV

    A. S. Engelbrecht


    Full Text Available The development of the Managerial Motivation Questionnaire (MMQ: Several criticisms of the psychometric suitability of existing measures of managerial motivation are reported in the literature. This study aimed at developing a new psychometrically sound instrument, the Managerial Motivation Questionnaire (MMQ. This was done on the basis of a comprehensive study of the literature on managerial motivation and the role-motivation theory. The preliminary MMQ was systematically shortened and refined until the final MMQ of 98 items was composed. This was based on social desirability and semantic appraisal, item analysis and factor analysis of the questionnaire. The results indicate that it was possible to develop a final MMQ that was relatively free of social desirability. It further demonstrated satsifactory internal consistencies on two samples (a = 0/90, N = 360; a = 0/91, N = 535, where all subscale items were found to be relatively pure measures of the isolated factors. Although some evidence was found providing support for the reliability of the MMQ, a need for further research on the construct validity of managerial motivation still exists. Opsomming In die literatuur word verskeie punte van kritiek teen die psigometriese geskiktheid van bestaande meetinstrumente van bestuursmotivering gerapporteer. Die doelstelling van hierdie studie was dus om aan die hand van die konseptuele omiyning van bestuursmotivering, en die rolmotiveringsteorie as algemene verwysingsraamwerk, 'n nuwe psigometries aanvaarbare meetinstrument, die Bestuursmotiveringsvraelys (BMV, te ontwikkel. Op grond van sosiale wenslikheids- en semantiese beoordeling, itemontleding en faktorontleding van die voorlopige BMV is die vraelys stelselmatig verkort en verfyn totdat die finale BMV van 98 items saamgestel is. Die resultate dui daarop dat hierdie studie wel daarin geslaag het om 'n finale BMV te ontwikkel wat relatief vry van sosiale wenslikheid is, bevredigende interne

  8. Varswateralge en die ekonomie

    W. E. Scott


    Full Text Available Die artikel bespreek die ekonomiese belong wat varswateralge alreeds het en hul moontlike verdere ontginning in die toekoms. Sowel gewenste as ongewenste aspekte word oorweeg en hoofsaaklik met voorbeelde uit Suid-Afrika geïllustreer. Die oormatige ontwikkeling van ongewenste alge in varswater verlaag die watergehalte dear verskeie chemiese veranderinge, wat kan wissel van smake en geure tot die produksie van verbindings wat gesondheidsgevare vir mens of dier inhou. Verwydering van ongewenste alge dra aansienlik by tot die koste van waterbehandeling. Oormatige alggroei belemmer ontspanningsgebruike en kan eiendomswaardes langs rivier- en damoewers beïnvloed.

  9. Prediking aan die hand van die metafoor van fiksieskryf


    HTS 64(3) 2008 siening van die self en waarheid. In die pre-moderne paradigma kan die dominante metafoor verstaan word aan die hand van 'n spieël wat die lig uit 'n transendente oorsprong weerkaats, terwyl die moderne paradigma uitgedruk word met die metafoor van 'n lamp wat 'n eie, oorspronklike lig binne die self.



    ENGELBRECHT ver antwoordelik vir die Ou-Testamentiese vakke en Hebreeus. Die aan stelling van 'n derde professor het noodsaaklik geword, want dit sou. 85 .... De .Spreuken ran 5a/o?no omvat die nuwe vertaling en die ekse gese van die eerste 24 hoofstukke van die Spreukeboek. Die geskoold- heid in die Semitiese ...

  11. Die dialogiese prinsipe

    J. J. de Klerk


    Full Text Available Met die dialogiese prinsipe word daardie beginsel bedoel, waarin die tweerigtingverkeer of kommunikasie onder, of met, of deur die mense op 'n heel besondere gesprekmatige wyse gere�l word. Tot die wese van die dialogiese prinsipe behoort "als Grundvoraussetzung das Ernstnehmen des Gesprachspartners und das darin enthaltene zuhoren-konnen. Dialog ist also etwas anderes als Disput oder Diskussion. Er setzt gegenseitiges Vertrauen und Hochachtung voraus."

  12. Die sestienpersoonlikheidsfaktorvraelys as hulpmiddel by die takseersentrum

    J. C. D. Augustyn


    Full Text Available The 16PF Personality Test as an aid to the assessment centre Assessment centres still remains costly and thime consuming. This study investigates the reduction of time and costs by the use of the 16 PF Personality Test as a method for measuring management dimensions. Promising results were obtained with a relatively small sample for the prediction of initiative and perseverance. Significant multiple correlations were also found for three criteria of management success. Further research may establish the use of the 16 PF as an aid to management assessment and thereby reduce the costs and time involved in assessment centres. Opsomming Takseersentrums se grootste probleem is gelee in die koste en tyd wat dit behels. Hierdie studie ondersoek die moontlikheid om beide te verminder deur die aanwending van die 16 PF Persoonlikheidsvraelys vir die meting van bestuursdimensies. Belowende resultate is met 'n relatiewe klein steekproef bevind ten opsigte van die voorspelling van inisiatiefen deursettingsvermoe. Beduidende meervoudige korrelasies is ook ten opsigte van drie kriteria van bestuursukses bevind. Verdere navorsing kan die gebruik van die 16 PF as hulpmiddel by bestuursevaluering vestig en sodoende die tydsduur en koste van takseersentrums verminder.

  13. Dying with dignity.

    Madan, T N


    Death is a theme of central importance in all cultures, but the manner in which it is interpreted varies from society to society. Even so, traditional cultures, including Christian, Hindu and Jain religious traditions, exhibited a positive attitude to death and did not look upon it in a dualistic framework of good vs bad, or desirable vs undesirable. Nor was pessimism the dominant mood in their thinking about death itself. A fundamental paradigm shift occurred in the West in the eighteenth century when death was desacralized and transformed into a secular event amenable to human manipulation. From those early beginnings, dying and death have been thoroughly medicalized and brought under the purview of high technology in the twentieth century. Once death is seen as a problem for professional management, the hospital displaces the home, and specialists with different kinds and degrees of expertise take over from the family. Everyday speech and the religious idiom yield place to medical jargon. The subject (an ageing, sick or dying person) becomes the object of this make-believe yet real world. As the object of others' professional control, he or she loses the freedom of self-assessment, expression and choice. Or, he or she may be expected to choose when no longer able to do so. Thus, not only freedom but dignity also is lost, and lawyers join doctors in crisis manipulation and perpetuation. Although the modern medical culture has originated in the West, it has gradually spread to all parts of the world, subjugating other kinds of medical knowledge and other attitudes to dying and death.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. The management of patients with early Parkinson's disease.

    Rascol, O; Payoux, P; Ferreira, J; Brefel-Courbon, C


    A major problem in the management of early Parkinson's disease is to choose the first medication to prescribe. This decision should rely on the level of available clinical evidence, largely based, at least for efficacy, on the results of randomised clinical trials. Safety and costs are also crucial to consider. Other factors like for example pathophysiological concepts, individual experience, marketing pressure, socio-economical environment, patients needs and expectations have, however, also their own influence. Levodopa is efficacious and cheap, but induces long-term motor complications. The early use of dopamine agonists is more and more frequently promoted, because large prospective L-dopa-controlled trials demonstrated that this strategy reduces the risk of such long-term complications. Integrating individual clinical expertise to the best available external clinical evidence (evidence-based medicine) is the best strategy in making decisions about the care of individual patients. Copyright 2002 Elsevier Science Ltd.

  15. The early detection of antral malignancy in the postmaxillectomy patient

    Som, P.M.; Shugar, J.M.; Biller, H.F.


    A protocol was developed for the radiographic evaluation of the postmaxillectomy patient that called for a six- to eight-week postoperative, baseline computed tomography (CT) scan, followed by CT scans at four- to six-month intervals for at least three years. This protocol allowed for an early, more complete assessment of clinically discovered recurrences and the detection of clinically occult recurrences in three out of 18 patients who followed the protocol. The CT appearance of the normal partial and total maxillectomy is discussed, as well as the focal nodular soft-tissue findings suggestive of recurrent disease

  16. The early detection of antral malignancy in the postmaxillectomy patient

    Som, P.M. (Mount Sinai Hospital, New York); Shugar, J.M.; Biller, H.F.


    A protocol was developed for the radiographic evaluation of the postmaxillectomy patient that called for a six- to eight-week postoperative, baseline computed tomography (CT) scan, followed by CT scans at four- to six-month intervals for at least three years. This protocol allowed for an early, more complete assessment of clinically discovered recurrences and the detection of clinically occult recurrences in three out of 18 patients who followed the protocol. The CT appearance of the normal partial and total maxillectomy is discussed, as well as the focal nodular soft-tissue findings suggestive of recurrent disease.


    1 Aug 1978 ... dan ook aangebied, Agv die probleem wat ont- staan het met die gebrek aan goedgekeurde poste vir die Afdeling en as gevolg van die ver- wagte vertraging met die ondersoek van die. DOS-span, het die Afdeling Logistiek en Afde- ling Personeel oorleg gepleeg en laasgenoemde het ingestem dat die ...

  18. Die relevansie van die boek Prediker

    ook in die dogmatiek te bespeur is nie. 'n Vinnige oorsig oor die teksverwysings van. 'n paar wydgelese dogmatiekhandboeke kan dit bevestig. In Karl Barth se omvang- ryke Kirchliche Dogmatik word Prediker slegs vyf en dertig maal aangehaal en slegs sewe maal word teksgedeeltes bespreek. Emil Brunner haal Prediker ...

  19. Finding privacy from a public death: a qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families.

    Slatyer, Susan; Pienaar, Catherine; Williams, Anne M; Proctor, Karen; Hewitt, Laura


    To explore the experiences and perceptions of hospital staff caring for dying patients in a dedicated patient/family room (named Lotus Room). Dying in hospital is a common outcome for people across the world. However, noise and activity in acute environments present barriers to quality end-of-life care. This is of concern because care provided to dying patients has been shown to affect both the patients and the bereaved families. A qualitative descriptive approach was used. Semi-structured interviews were conducted with 17 multidisciplinary staff and seven families provided information through an investigator-developed instrument. Qualitative data analysis generated three categories describing: Dying in an hospital; The Lotus Room; and the Outcomes for patients and families. The Lotus Room was seen as a large, private and, ultimately, safe space for patients and families within the public hospital environment. Family feedback supported staff perspectives that the Lotus Room facilitated family presence and communication. The privacy afforded by the Lotus Room within this acute hospital provided benefits for the dying patients and grieving families. Improved outcomes included a peaceful death for patients, which may have assisted the family with their bereavement. This study provides evidence of how the physical environment can address well-established barriers to quality end-of-life care in acute hospitals. © 2015 John Wiley & Sons Ltd.

  20. Student Nurses' Perception of Death and Dying

    Niederriter, Joan E.


    Student nurses are involved in caring for patients who are actively dying or who have been told they have a terminal illness and are faced with the process of dying. Students encounter these patients in hospitals, nursing homes, at home or in hospice care settings. According to Robinson (2004), "nurses are the healthcare providers that are most…

  1. Existential Needs among the Dying

    Moestrup, Lene

    meaning making. Methods: The key research question is: 1. What kind of existential needs are central to dying cancer patients and their relatives during the terminal phase in Danish hospices? Exploring this highly sensitive and complex research area entails substantial ethical responsibility during data...... based and practice relevant knowledge about the complexity of existential considerations and needs among dying cancer patients and their relatives in a secularized society as Denmark. Existential needs are seen as a multidimensional concept that encompasses religious, spiritual and secular existential...

  2. Minor cognitive disturbances in old age - an early stage of dementia?; Die leichte kognitive Stoerung Vergesslichkeit im Alter - eine Vorstufe der Demenz?

    Hoedl, A.K.; Bonelli, R.M.; Kapfhammer, H.P. [Universitaetsklinik fuer Psychiatrie, Karl-Franzens-Univ. Graz (Austria)


    In clinical practice, minor cognitive disturbances should not be neglected as they may be the first signs of a process that may in the end lead to a loss of cognitive skills and even to dementia. (orig.) [German] Alter und zunehmende Vergesslichkeit werden oft mit grosser Selbstverstaendlichkeit assoziiert. (''Bei Opa rieselt eben schon der Kalk.'') Dass sich hier ein schleichender Verlust der kognitiven Faehigkeiten bis hin zur Demenz ankuendigen kann, wird dabei verkannt. Fuer die Praxis ist es daher von grosser Bedeutung, bereits leichte kognitive Stoerungen richtig einzuschaetzen und bei Bedarf zu therapieren. (orig.)

  3. Time trends in axilla management among early breast cancer patients

    Gondos, Adam; Jansen, Lina; Heil, Joerg


    Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data...... for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were...... younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79...

  4. P. J. N. Smal, Die Universalisme in die Psalms. Academisch ...


    dat die historiese element in Israel se Godsopenbaring en daarmee die insig in sy betekenis te kort gedoen word. Die betekenis van die studie vir die historia revelationis is daardeur gering; as duidelike „tydlose” sistematisering van Outestamentiese gegewens oor die betrokke onder- werpe, soos die laaste hoofstuk, bl.



    DIE ONTVC'ERP VAN 'N SENDINGBELEID IN DIE. HUIDIGE SITUASIE. Sending is 'n deel van die vervulling van die apostoliese opdrag van die kerk. Dit geskied op grond van en in gehoorsaamheid aan Gods. \\C'oord. Teologiese besinning is daarom die eerste en grondliggende vereiste by die ontwerp van 'n ...

  6. Effect of Cytoflavin on Early Postanesthetic Recovery of Cancer Patients

    K. F. Fatullayeva


    Full Text Available Objective: to evaluate the effect of the metabolic antihypoxant cytoflavin on the course of early postanesthetic recovery in patients operated on for various cancers. Subjects and methods: Fifty-seven patients aged 30 to 65 years, operated on for gynecological cancer, were examined. The patients were divided into 2 groups: 1 28 patients who took cytoflavin and 2 29 who did not. At the end of an operation, the agent was intravenously injected in a dose of 10 ml in a mixture with an equal volume of 0.9% sodium chloride solution. Thiopental sodium was used for initial anesthesia; arduan was employed to maintain muscle relaxation. Neuroleptic analgesia with fentanyl and droperidol or ataralgesia (fentanyl + relanium was applied in both groups. The levels of hemoglobin, glucose, sodium, potassium, calcium, malonic dialdehyde (MDA (Andreyev’s test, antioxidative activity (AOA (Semenov’s test were measured to evaluate the functional state of patients. The rating system for determining the recovery of consciousness, respiration, and motor activity, proposed by Aldret and Kroulik [8], and Bidway’s psychological testing, blood oxygen saturation and cardiac performance monitoring (TRITON, Russia and some others were used to evaluate the efficacy of the drug in the early postanesthetic period. The results were statistically processed using Microsoft Excel and a package of Biostatistics 6.0. Results. The use of cytoflavin at the end of surgery has been established to have a beneficial effect on the early recovery period. This is manifested as shorter recovery of consciousness and respiration mainly in the ataralgesia group; fair oxygen saturation, lower MDA concentrations and higher AOA are revealed. Conclusion. Cytoflavin significantly reduces the recovery of consciousness and adequate respiration and the incidence of the fever, muscle tremor syndrome and fails to favor the occurrence of hypoglycemia. Inclusion of cytoflavin into a complex of

  7. End-of-life care: nurses' experiences in caring for dying patients with profound learning disabilities--a descriptive case study.

    Li, S; Ng, J


    This qualitative study identifies areas of expertise and deficits in the specific knowledge and practical skills of nurses in the care of dying patients with profound learning disabilities in one NHS Primary Care Trust in the UK. In response to these findings, we have developed a simple observational checklist applicable to profound learning disability nursing to identify disease-related personality and physiological changes. The method consists of a descriptive case study of five nurses qualified in learning disabilities nursing, using semi-structured interviews. The disease trajectory was used as a framework of reference to guide the data analysis. Themes showed were 'certainty of knowing' about disease-related changes in patients' habits and behaviour and 'uncertainty and ambiguity' in the patho-physiology of advanced diseases and disease progression. This study interprets a lack of patho-physiological knowledge in both malignant and non-malignant diseases leading to delayed diagnosis and timely intervention. Timeliness of observation and intervention are emphasised.



    Sy moet hierdie opdrag uitvoer deur mid del van die Prediking d.w.s. deur middel van die Woord-vorm, maar ook deur die bediening van die sakramente, dws. deur middel van die vorm van die Daad. Maar nou wil God nie hê dat die Kerk slegs één maal die Evangelie sal predik en die mense sal doop om hulle daarna.

  9. Efficiency of teaching patients with early-stage rheumatoid arthritis

    Evgenia Vladislavovna Orlova


    Full Text Available Education programs are an important part of the management of patients with rheumatoid arthritis (RA.Objective: to develop a unified model of an education program for RA patients and to evaluate its efficiency at the early stage of the disease.Material and methods. A group education program was worked out with the support of the All-Russian public organization of the disabled “The Russian rheumatology organization “Nadezhda” (Hope” and encompassed 4 daily classes lasting 90 min. All information was presented by a multidisciplinary team of specialists (rheumatologists, a cardiologist, a psychologist, a physiotherapist, and a physical trainer. The study included 55 patients with early RA (89.1% of women aged 18 to 62 years; the duration of the disease was 2 to 22 months; of them 25 were taught using the education program (a study group; 30 received drug therapy only (a control group. Following 3 and 6 months, the number of tender and swollen joints, erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, and pain were determined applying a 100-ml VAS, DAS28, HAQ, and RAPID3. Adherence to non-drug treatments was assessed employing a special patient questionnaire.Results. Three and six months after being taught, two patient groups showed increases in adherence to joint protection methods by 13 and 10 times (p<0.01, regular physical training by 4 and 3.25 times (p<0.01, uses of orthoses for the wrist joint by 2 times and 75% (p<0.01 and knee orthoses by 33.3 and 50.0% (p<0.01, and orthopedic insoles by 71.4 and 57.1% (p<0.01, respectively. Following 6 months, there were statistically significant differences between the two groups in most parameters (p<0.05, except for ESR, CRP, and DAS28 (p>0.05. Further more, a good response to treatment was significantly more common in these periods, as shown by the EULAR response criteria (DAS28: 56.3% versus 40% in the control group (p<0.05.Conclusion. The education program decreases the intensity

  10. Bone mineral density in patients with early axial spondyloarthritis

    E. E. Gubar


    Full Text Available Objective: to study bone mineral density (BMD of the lumbar spine (LS and femoral neck (FN in patients with early axial spondyloarthritis (SpA and to reveal its association with inflammatory disease activity.Subjects and methods. Seventy-three patients aged 18–45 years with inflammatory back pain lasting at least 3 months and not more than 5 years were examined. Axial SpA was diagnosed according to the 2009 ASAS criteria. BASDAI and ASDAS C-reactive protein (CRP values were used to estimate disease activity; BASFI was employed to evaluate functional status. The examination encompassed determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI of sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their injuries, densitometry of LS (LI-IV and FN. By taking into account the young age of patients, the Z-score was applied to measure BMD. The latter is considered lower if the Z-score is 1–2 standard deviations (SD in at least one of the segments under study.Results. The median Z-score was -0.7 (-1.3; -0.3 SD for FN and 0.9 (-1.6; -0.5 SD for LS. Reduced BMD in at least one of the segments under study was detected in 13 (17.8% patients: that in LS and FN in 11 (15.1% and 5 (6.8% patients, respectively. Lower BMD was observed in two segments in 3 (4.1% patients. No association was found between lower BMD and age, gender, disease activity (BASDAI, ASDAS, and laboratory inflammatory markers (erythrocyte sedimentation rate (ESR and CRP. A relationship was established between inflammatory changes according to the data of MRI of LS (MRI spondylitis and reduced BMD in the same segment. MRI spondylitis was detected in 8 patients. Five and 3 patients with spondylitis of LS were found to have lower and normal BMD in this segment, respectively. Six out of 65 patients without MRI spondylitis in LS had its reduced BMD and the remaining (n=59 patients had its normal BMD (p=0.0014.Conclusion. There was an

  11. Early antibiotic administration but not antibody therapy directed against IL-6 improves survival in septic mice predicted to die on basis of high IL-6 levels.

    Vyas, Dinesh; Javadi, Pardis; Dipasco, Peter J; Buchman, Timothy G; Hotchkiss, Richard S; Coopersmith, Craig M


    Elevated interleukin (IL)-6 levels correlate with increased mortality following sepsis. IL-6 levels >14,000 pg/ml drawn 6 h after cecal ligation and puncture (CLP) are associated with 100% mortality in ND4 mice, even if antibiotic therapy is initiated 12 h after septic insult. Our first aim was to see whether earlier institution of antibiotic therapy could improve overall survival in septic mice and rescue the subset of animals predicted to die on the basis of high IL-6 levels. Mice (n = 184) were subjected to CLP, had IL-6 levels drawn 6 h later, and then were randomized to receive imipenem, a broad spectrum antimicrobial agent, beginning 6 or 12 h postoperatively. Overall 1-wk survival improved from 25.5 to 35.9% with earlier administration of antibiotics (P 14,000 pg/ml, 25% survived if imipenem was started at 6 h, whereas none survived if antibiotics were started later (P 14,000 pg/ml. These results demonstrate that earlier systemic therapy can improve outcome in a subset of mice predicted to die in sepsis, but we are unable to demonstrate any benefit in similar animals using targeted therapy directed at IL-6.

  12. Early antibiotic administration but not antibody therapy directed against IL-6 improves survival in septic mice predicted to die based upon high IL-6 levels

    Vyas, Dinesh; Javadi, Pardis; DiPasco, Peter J; Buchman, Timothy G; Hotchkiss, Richard S; Coopersmith, Craig M


    Elevated interleukin (IL)-6 levels correlate with increased mortality following sepsis. IL-6 levels >14,000 pg/ml drawn 6 hours following cecal ligation and puncture (CLP) are associated with 100% mortality in ND4 mice, even if antibiotic therapy is initiated 12 hours after the septic insult. The first aim of this study was to see if earlier institution of antibiotic therapy could improve overall survival in septic mice and rescue the subset of animals predicted to die based upon high IL-6 levels. Mice (n=184) were subjected to CLP, had IL-6 levels drawn six hours later and then were randomized to receive imipenem, a broad spectrum antimicrobial agent, beginning six or twelve hours post-operatively. Overall one-week survival improved from 25.5% to 35.9% with earlier administration of antibiotics (p14,000 pg/ml, 25% survived if imipenem was started at 6 hours, while none survived if antibiotics were started later (p14,000 pg/ml. These results demonstrate that earlier systemic therapy can improve outcome in a subset of mice predicted to die in sepsis, but we are unable to demonstrate any benefit in similar animals using targeted therapy directed at IL-6. PMID:15947070

  13. Packaged die heater

    Spielberger, Richard; Ohme, Bruce Walker; Jensen, Ronald J.


    A heater for heating packaged die for burn-in and heat testing is described. The heater may be a ceramic-type heater with a metal filament. The heater may be incorporated into the integrated circuit package as an additional ceramic layer of the package, or may be an external heater placed in contact with the package to heat the die. Many different types of integrated circuit packages may be accommodated. The method provides increased energy efficiency for heating the die while reducing temperature stresses on testing equipment. The method allows the use of multiple heaters to heat die to different temperatures. Faulty die may be heated to weaken die attach material to facilitate removal of the die. The heater filament or a separate temperature thermistor located in the package may be used to accurately measure die temperature.

  14. Die radio in Afrika

    S. de Villiers


    Full Text Available Omvang van radio-uitsendings in en na Afrika. — Redes vir die versnelde tempo van uitbreiding. — Radio as die geskikste massa-kommunikasiemiddel vir Afrika. — Faktore wat die verspreiding bemoeilik. — Skouspelagtige toename in luistertalle.Toe Plinius, wat in die jaar 79 oorlede is, in sy „Historia Naturalis” verklaar het dat daar altyd iets nuuts uit Afrika afkomstig is, kon hy nouliks voorsien het dat die „iets" negentien eeue later in die lug sou setel wat hierdie reuse-vasteland oorspan — ’n Babelse spraakverwarring en ’n ongekende, verbete woorde-oorlog in die etergolwe, onder meer daarop bereken om die harte en hoofde van derduisendes te verower.

  15. Early detection of abnormal patient arrivals at hospital emergency department

    Harrou, Fouzi; Sun, Ying; Kadri, Farid; Chaabane, Sondes; Tahon, Christian


    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  16. Efficiency of photodynamic treatment in patients with early gastric cancer

    Е. V. Filonenko


    Full Text Available The experience of photodynamic therapy for early gastric cancer is described in the article. The treatment results in 68 patients who were excluded for convenient surgical treatment because of advanced age or severe co-morbidity are represented. 63 patients had single tumor, 5 patients – 2 tumors. Four Russian agents: photogem, photosens, radaсhlorin and alasens, were used for photodynamic therapy. The treatment session was performed under local anesthesia during routine endoscopy with diode laser with wavelength consistent with photosensitizer (photogem – 630 nm, photosens – 670 nm, alasens-induced protoporphyrin IX – 635 nm, radaсhlorin – 662 nm. The short-term results were analyzed 1 month after treatment according to endoscopy, morphological study, CT, ultrasound or endosonography. For 73 lesions complete regression was observed in 53 (72.6% and partial regression in 20 tumors (27.4%. The efficacy of photodynamic therapy was shown to be directly associated with tumor size. Thus, for tumors up to 1 cm regression occurred in 100% of cases, up to 1.5 cm – in 70.8%, up to 3 cm – in 65.2%, up to 5 cm – in 58.3%. The median survival rates accounted for 7.31 years, 3-year survival – 83±5%, 5-year - 69±8%. The experience showed that the developed method of photodynamic therapy was promising in treatment for early gastric cancer as an alternative to surgery. 

  17. Early detection of abnormal patient arrivals at hospital emergency department

    Harrou, Fouzi


    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  18. Die Erfindung des Manuskripts

    Benne, Christian

    Die Entstehung der literarischen Moderne ging seit dem 18. Jahrhundert damit einher, dass die Anzahl literarischer Manuskripte ebenso wuchs wie deren Bedeutung. Der Buchdruck hatte die Handschrift keineswegs überflüssig gemacht, sondern provozierte im Gegenteil einen neuen, am Autographen...

  19. Early graft function and carboxyhemoglobin level in liver transplanted patients.

    Ali, Yasser; Negmi, H; Elmasry, N; Sadek, M; Riaz, A; Al Ouffi, H; Khalaf, H


    Heme-Oxygenase-1 catalyzes hemoglobin into bilirubin, iron, and carbon monoxide, a well known vasodilator. Heme-Oxygenase-1 expression and carbon monoxide production as measured by blood carboxyhemoglobin levels, increase in end stage liver disease patients. We hypothesized that there may be a correlation between carboxyhemoglobin level and early graft function in patients undergoing liver transplant surgeries. In a descriptive retrospective study, 39 patients who underwent liver transplantation between the year 2005 and 2006 at KFSH&RC, are included in the study. All patients received general anesthesia with isoflurane in 50% oxygen and air. Levels of oxyhemoglobin, carboxyhemoglobin and methemoglobin concentration in percentage were recorded at preoperative time, anhepatic phase, end of surgery, ICU admission and 24 hr after surgery. The level of lactic acid, prothrombin time (PT), partial thrombin time (PTT), serum total bilirubin and ammonia were also recorded at ICU admission and 24 hr after surgery. The numbers of blood units transfused were recorded. 39 patients were included in the study with 13/39 for living donor liver transplant (LDLT) compared to 26/39 patients scheduled for deceased donor liver transplant (DDLT). The mean age was 35.9 +/- 16.9 years while the mean body weight was 60.3 +/- 20.9 Kg. Female to male ratio was 21/18. The median packed red blood cell (PRBC) units was 4 (Rang 0-40). There was a significant increase in carboxyhemoglobin level during the anhepatic phase, end of surgery and on ICU admission compared with preoperative value (pcarboxyhemoglobin level on ICU admission and 24 hrs postoperatively were positively correlated with the changes in serum total bilirubin and prothrombin time (R = 0.35, 0.382, 0.325 and 0.31) respectively pcarboxyhemoglobin concentration and PT and total bilirubin while still the correlation with lactic acid was weak. There was no correlation between average perioperative carboxyhemoglobin concentration

  20. Die begrafnisdíens

    Num 20: 1; Jos 24: 30; Hand 5: 5 - 11). Selfs van die ... Gebruike rondom die begrafnis het van geslag tot geslag gewissel. De Vaux ... der geskied deur die hoorders 'te onderrig, te vermaan, te vertroos en te bestraf, soos dit in elke geval ..... gehandhaaf hoef te word, veral in die lig van die feit dat die predikant die kerklike.

  1. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis

    DARA, Naghi; SAYYARI, Ali-Akbar; IMANZADEH, Farid


    How to Cite This Article: Dara N, Sayyari AA, Imanzadeh F. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis. Iran J Child Neurol. 2014 Winter; 8(1):1-11.ObjectiveAs acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy.Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complic...

  2. Die gebruik van parallelplaatreologie vir die bepaling van die intrinsieke viskositeit van poli-etileentereftalaat

    O. C. Vorster


    Full Text Available Die bepaling van die intrinsieke viskositeit van poli-etileentereftalaat word bemoeilik deur die feit dat daar tans slegs twee metodes in gebruik is. In die eerste metode word die bepaling deur middel van oplossingsviskometrie gedoen, maar die toksisiteit van die oplosmiddel, asook die tydperk wat dit neem om die bepaling te doen, is ’n probleem. Die tweede metode word beperk deur die kompleksiteit en beskikbaarheid van die apparatuur in Suid-Afrika. In hierdie studie word ’n alternatiewe metode, gebaseer op parallelplaatreologie, voorgestel wat albei hierdie probleme oorkom en die resultate sodoende verkry, word vergelyk met dié wat met bestaande metodes verkry is.

  3. Photodynamic therapy in patients with early central lung cancer

    V. V. Sokolov


    Full Text Available The results of photodynamic therapy (PDT for early central lung cancer are represented in the article. The study included 37 patients (52 tumor lesions. For 52 lesions pre-invasive cancer (carcinoma in situ was determined in 6 cases, squamous cell cancer with invasion within mucosal and submucosal layers of bronchial wall – in 46 cases. 51 tumors were primary lesion, 1 – residual after radiotherapy. 17 of 37 patients underwent previous surgical or combined modality treatment for cancer in other anatomical sites. For PDT we used photosensitizers photogem, photosens and radachlorine. The treatment response was assessed 1 months later by data of endoscopy and morphological study, CT, US and endosonography. Complete regression was achieved in 86,5% of cases, partial regression – in 13,5%. The efficacy of PDT was depended on tumor size. For lesion up to 1 cm in size complete regression was in 100% of cases, from 1.5 cm to 2.0 cm – in 28.6%, for tumors more than 2 cm the complete regression was not achieved. The recurrence of tumor was diagnosed in 2 patients in the period from 1 to 5 years with following successful repeated courses of PDT. Adverse effects included inflammation changes in mucosa at the PDT region with transient (up to 6-7 days local fibrinous endobronchitis with obturation of segmental bronchial lumen by fibrin membranes (7 patients, scar stenosis of segmental bronchus (2 patients. All patients had increased sensitivity to sun exposure, mild skin burns at exposed areas of body were in 2 patients. The results showed that method was highly efficient and applicable for pre-invasive central lung cancer and in patients with multiple primary bronchial lesions and high risk of surgical complications. 

  4. Die invloed van die neo-marxistiese kultuuranalise op die Wêreldraad van Kerke en die Gereformeerde Kerke van Nederland

    J. M. Vorster


    Full Text Available Toe die studente dwarsoor die VSA en Europa in die laat sestigerjare ’n plotselinge en radikale verset openbaar het teen die bestaande orde, het hulle die deur geopen vir ’n nuwe mededinger om die hart van die Westerse kultuur. Dit is die nou reeds bekende neo-Marxisme. Sedertdien het hierdie jongeling sy voetspore op vele vlakke van die Westerse kultuur gelaat.

  5. Importance of early nutritional screening in patients with gastric cancer.

    Gavazzi, Cecilia; Colatruglio, Silvia; Sironi, Alessandro; Mazzaferro, Vincenzo; Miceli, Rosalba


    In the present study, we evaluated the relationship between nutritional status, disease stage and quality of life (QoL) in 100 patients recently diagnosed with gastric carcinoma. The patients' nutritional status was investigated with anthropometric, biochemical, inflammatory and functional variables; and we also evaluated the nutritional risk with the Nutritional Risk Screening 2002. Oncological staging was standard. QoL was evaluated using the Functional Assessment of Anorexia/Cachexia Therapy questionnaire. The statistical correlation between nutritional risk score (NRS) and oncological characteristics or QoL was evaluated using both univariable and multivariable analyses. Weight loss and reduction of food intake were the most frequent pathological nutritional indicators, while biochemical, inflammatory and functional variables were in the normal range. According to NRS, thirty-six patients were malnourished or at risk for malnutrition. Patients with NRS ≥ 3 presented a significantly greater percentage of stage IV gastric cancer and pathological values of C-reactive protein, while no correlation was found with the site of tumour. NRS was negatively associated with QoL (P gastric cancer malnutrition is frequent at diagnosis and this is likely due to reduction in food intake. Moreover, NRS is directly correlated with tumour stage and inversely correlated with QoL, which makes it a useful tool to identify patients in need of an early nutritional intervention during oncological treatments.

  6. Surgical nurses' work-related stress when caring for severely ill and dying patients in cancer after participating in an educational intervention on existential issues.

    Udo, Camilla; Danielson, Ella; Henoch, Ingela; Melin-Johansson, Christina


    The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues. This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions. Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work. Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. "What happens behind the curtains?" An exploration of ICU nurses' experiences of post mortem care on patients who have died in intensive care.

    de Swardt, Carien; Fouché, Nicola


    The aim of this study was to explore the experiences of intensive care nurses performing post mortem care on patients who had died in an intensive care unit at a private hospital in Cape Town. The study further sets out to identify educational needs and to offer recommendations that may address these needs for this sample of nurses. A qualitative research design using a descriptive method was used to explore the experiences of a purposive heterogeneous sample of six nurses who were working in an intensive care unit in a private hospital in Cape Town. A semi-structured interview which was audio-taped and transcribed verbatim was employed to collect data. Colaizzi's (1978) seven step inductive method was used to formulate naïve themes. Following participant feedback, three main themes emerged: care of the dead body, detachment and thanatophobia. Safeguarding the integrity and physical appearance of the dead body was the major finding and of the utmost priority for the participants in this study. Regardless of how the nurses felt about death, providing professional and quality care to the dead body and the family was seen as significantly important. The nurses, whilst performing post mortem care, experienced detachment from various relationships. This comprised of the nurse detaching him/herself professionally and emotionally from the dead patient, the family and him/herself from the death experience. This 'unspoken' experience of thanatophobia became apparent when the nurses were confronted by the reality of their own deaths. In a technological society, where answers to many questions can be pursued through science, understanding the experience of death, as opposed to dying, may be logically incomprehensible. Death remains one of the most traumatic events experienced by the patient and their family, and in some instances nurses themselves. The study has drawn attention to the nurses' experiences and in doing so; the emotional and educational needs have been

  8. Patent foramen ovale does not have a negative impact on early outcomes in patients undergoing liver transplantation.

    Alba, Ana Carolina; Verocai Flaman, F; Granton, J; Delgado, D H


    To identify the impact of the presence of patent foramen ovale (PFO) in patients undergoing liver transplantation. Twenty-seven pre-liver transplant patients who had a PFO (PFO group) were identified and compared with 61 patients without PFO (NoPFO group). Patients were matched according to age, gender and cause of liver disease. The diagnosis of PFO was made by transthoracic echocardiography prior to liver transplantation. Patient baseline characteristics and complications during the early post-transplant period were analyzed. The mean age in the PFO group was 47 ± 14 (range 18-68) yr and 50 ± 11 (range 12-65) yr in the NoPFO group. The PFO group had a mean model for end-stage liver disease (MELD) score of 15 ± 10 whereas in the NoPFO group the MELD score was 19 ± 10 (p = 0.08). There were non-significant differences in echocardiographic parameters between groups. Duration of mechanical ventilation and the incidence of neurological complications were similar. Thirty-day mortality rate was similar in both groups; only one patient in the NoPFO group died within the first 30 days post-transplantation. The presence of PFO in patients with end-stage liver disease undergoing liver transplantation does not appear to affect patient outcomes during the peri-operative period. © 2010 John Wiley & Sons A/S.

  9. A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient.

    Cooke, Mary; Hurley, Ciarán


    We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end-of-life illness are referred to acute care services. Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision-making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient. We used a 'lens' approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients' decisions. End-of-life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy-based systems currently used to deliver care across the primary care - hospital care border are far from seamless and can lead to foreseeable problems. Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients. Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional-patient relationship to one of partnership.

  10. die pers as bron oor die geskiedenis van die eerste vrydeidsoorlog

    dood agv wonde wat hy tydens die slag opgedoen het. Dit was vir die Britse volk onaanvaarbaar dat slegs twee Boere gedood is nadat daar tussen. 20 000 en 30 000 rondtes op die Boere afgevuur is. Die pers kon net nie die ware syfers publiseer nie, want dit sou na 'n onwaarheid Iyk. Het die. Britse volk egter die Boere ...

  11. die impak van metodologie op die verstaan van die nuwe testament

    voorbeeld eers een maal deur die bril van die vorm- en redaksiekritiek na die Evangelies gekyk het, dink jy vir altyd anders oor hulle tot- standkoming. Inderdaad, nuwe metodes lei tot nuwe perspektiewe! Dit is dan ook waar die fokus van hierdie artikel val: die impak van metodologie op die verstaan van die Nuwe ...

  12. Verskuiwing in die moraal?

    S.P. van der Walt


    Full Text Available Modewoorde het ons deesdae oorgenoeg in die Christelike sedeleer en hulle kan nogal verwarring stig. U moet my vergun om met u te spreek oor een so ’n modewoord nl „verskuiwing’’ in die moraal. Dis nogal ’n mooi woord, wat so dikwels gebruik word op baie terreine en tog meer wil aandui as maar net ’n veranderde sienswyse, ’n wysiging in opvattinge of nuwe riglyne wat al gangbaar geword het in die praktyk. Die begrip wil eintlik die ewolusionêre gang beklemtoon, want dit is dan eintlik net die ou norme wat effens anders bekyk word of nie meer so nou geneem of dik onderstreep word nie. Die verskuiwing beteken dan dat alles nog dieselfde bly, net die posisie of plek het verander. Verskuiwing beteken tog plekverandering of plekwisseling en dan sekerlik nie in die sin dat die plekke ver uitmekaar lê nie. Verskuiwing beteken net maar vlak langs die vorige te staan kom. As dit dan ’n beter plek is, is dit ewolusie, ontwikkeling, verbetering.

  13. Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: a prospective, multicenter, comparative study.

    Coselli, Joseph S; Volguina, Irina V; LeMaire, Scott A; Sundt, Thoralf M; Connolly, Heidi M; Stephens, Elizabeth H; Schaff, Hartzell V; Milewicz, Dianna M; Vricella, Luca A; Dietz, Harry C; Minard, Charles G; Miller, D Craig


    To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Two patients (0.6%)--1 in each group--died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P = .6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group (P = .02). One AVS patient required late AVR. AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  14. [Early digitalisation of patients with arterial hypertension (author's transl)].

    Nechwatal, W; König, E; Eversmann, A; Lehnert, J


    Haemodynamic tests were performed at rest and during exercise in 41 patients with arterial hypertension and early impairment of left-ventricular function, before and after administration of a single dose of 0.6 mg beta-methyl-digoxin. After clinical, ECG and coronary-angiographic studies, the patients were assigned to two groups. Group I: 17 patients with transmural infarcts in the chronic stage or with angina. Cardiac output was within normal limits at rest and on exercise and was not significantly altered by administration of beta-methyl-digoxin. There was no significant fall during exercise of the abnormally elevated pulmonary "wedge" pressure or of other pressures in the lesser circulation after digitalis. Group II: 24 patients without signs of coronary heart disease. They, too, had a normal cardiac output at rest and on exercise, not significantly changed by digitalisation with beta-methyl-digoxin. But pulmonary "wedge" pressure and right-atrial mean pressure were significantly reduced during exercise. Before beta-methyl-digoxin the mean "wedge" pressure rose on exercise to an average of 27.3 +/- 5.4 mm Hg, but after beta-methyl-digoxin to only 21.7 +/- 5.1 mm Hg (P less than 0.001). The mean right atrial pressure changed similar. These results indicate that acute digitalisation at the stated dosage in general has an effect on abnormal myocardial function only if there is no additional coronary heart disease.

  15. Early detection of consciousness in patients with acute severe traumatic brain injury.

    Edlow, Brian L; Chatelle, Camille; Spencer, Camille A; Chu, Catherine J; Bodien, Yelena G; O'Connor, Kathryn L; Hirschberg, Ronald E; Hochberg, Leigh R; Giacino, Joseph T; Rosenthal, Eric S; Wu, Ona


    of language function, responses to language and music were more frequently observed than responses to motor imagery (62.5-80% versus 33.3-42.9%). Similarly, in 16 matched healthy subjects, responses to language and music were more frequently observed than responses to motor imagery (87.5-100% versus 68.8-75.0%). Except for one patient who died in the intensive care unit, all patients with cognitive motor dissociation and higher-order cortex motor dissociation recovered beyond a confusional state by 6 months. However, 6-month outcomes were not associated with early functional magnetic resonance imaging and electroencephalography responses for the entire cohort. These observations suggest that functional magnetic resonance imaging and electroencephalography can detect command-following and higher-order cortical function in patients with acute severe traumatic brain injury. Early detection of covert consciousness and cortical responses in the intensive care unit could alter time-sensitive decisions about withholding life-sustaining therapies. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email:

  16. Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

    Langhorne, Peter; Taylor, Gillian; Murray, Gordon; Dennis, Martin; Anderson, Craig; Bautz-Holter, Erik; Dey, Paola; Indredavik, Bent; Mayo, Nancy; Power, Michael; Rodgers, Helen; Ronning, Ole Morten; Rudd, Anthony; Suwanwela, Nijasri; Widen-Holmqvist, Lotta; Wolfe, Charles

    Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (pstroke patients with mild to moderate disability. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

  17. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    J.A. Mendonça


    Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

  18. oor die inhoud en boodskap van die heidelbergse kategismus

    Smit. Oor die Inhoud en Boodskap van die Heidelbergse Kategismus. 52. Uiteraard sal dié tema saamhang met die bedoelinge agter die opstel van die Kategismus. Ook die vraag na moontlike bedoelinge of motiewe is egter 'n ingewikkelder vraag as wat miskien gedink mag word. Uiteraard was daar agter elke kategismus ...

  19. Thomas Erastus oor die struktuur van die gemeenskap'^

    óók aansprake en regte het, is die opvatting dat sowel die burgerlike gemeenskap as die kerk 'n perfecta societas sibi sufficiens is, nié werklik aanvaar nie. Die Middeleeuse gemeenskap was die corpus christianum,. 'n gemeenskap wat nie deur fisiese of politieke grense beperk was nie. Sy grense het gelê waar die grense ...

  20. die doel en wese van opvoedende onderwys en die implikasies

    Oaar moet onderskei word tussen die doelstellings van opvoedende onderwys en die einddoel wat bereik word deur die nastrewing van hierdie doelstellings. Gunter praat van die naderliggende doelstellings (1981, b1.105). \\/at die enddoel van opvoedende onderwys bet ref, gaan die meeste opvoedkundi ges akkoord dat ...

  1. Treating palliative care patients with pain with the body tambura: A prospective case study at St. Joseph′s hospice for dying destitute in Dindigul South India

    Cordula Dietrich


    Full Text Available Background: The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain. Materials and Methods: A prospective case study was carried out with patients of St. Joseph′s Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0-10, 10 maximum intensity of pain felt at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain. Results: Ten patients (five women and five men participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2. Conclusion: A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment.

  2. Die tug oor ampsdraers tydens die doleansie van 1886

    J. Visser


    Full Text Available In art 29 van die Nederlandse Geloofsbelydenis word bely: “Die merktekens om die ware Kerk te ken is die volgende: As die Kerk die suiwere prediking van die evangelie uitoefen, as dit die suiwer bediening van die sakramente gebruik soos Christus dit ingestel het, as die kerklike tug gebruik word om die sondes te straf.” Dit spreek vanself dat wanneer ampsdraers, aan wie Christus sy kudde toevertrou het (Hand 20 : 28, met leer en /of lewenswandel in sonde volhard en nie daarin met tug gestuit word nie, word die ware kerk nie gebou nie maar afgebreek. 0ns sal later in hierdie artikel aantoon hoedanig die suiwer tug oor ampsdraers, veral leertug, tydens die Doleansie tot skade van die kerk van Christus agterweë gebly het.

  3. Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction

    Smilde, Tom; Hillege, Hans; Voors, Adriaan; Dunselman, P.H.J.; Van Veldhuisen, D.J.


    We evaluated the prognostic value of renal function in an initially “untreated” population with mild heart failure and compared the prognosis of this population with a matched controlled population. During a follow-up of 13 years (mean 11.7), 90 patients (56%) died. Mortality was higher compared

  4. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

    M.R. Bacci


    Full Text Available Community-acquired pneumonia (CAP is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II. The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1 and interleukin-6 (IL-6, tumor necrosis factor alpha (TNF-α, C-reactive protein (CRP, and homocystein were collected at the time of admission (day 1 as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1 to 8 pg/mL (day 7 (P=0.016. The median levels of TNF-α were higher in patients: i with acute kidney injury (AKI (P=0.045, ii requiring mechanical ventilation (P=0.040, iii with short hospital stays (P=0.009, iv admitted to the intensive care unit (ICU (P=0.040, v who died early (P=0.003, and vi with worse CRB scores (P=0.013. In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

  5. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients.

    Bacci, M R; Leme, R C P; Zing, N P C; Murad, N; Adami, F; Hinnig, P F; Feder, D; Chagas, A C P; Fonseca, F L A


    Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

  6. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

    Bacci, M.R.; Leme, R.C.P.; Zing, N.P.C.; Murad, N.; Adami, F.; Hinnig, P.F.; Feder, D.; Chagas, A.C.P.; Fonseca, F.L.A.


    Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI

  7. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

    Bacci, M.R.; Leme, R.C.P.; Zing, N.P.C. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Murad, N. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Adami, F.; Hinnig, P.F. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Feder, D. [Departamento de Farmacologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Chagas, A.C.P. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Fonseca, F.L.A. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil)


    Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

  8. Early prognostication markers in cardiac arrest patients treated with hypothermia.

    Karapetkova, M; Koenig, M A; Jia, X


    Established prognostication markers, such as clinical findings, electroencephalography (EEG) and biochemical markers, used by clinicians to predict neurological outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain. MEDLINE and Embase were searched for evidence on the current standards for neurological outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers and multimodal approaches for prognostication are included and reviewed. Whilst the prognostic accuracy of various tests after TH has been questioned, pupillary light reflexes and somatosensory evoked potentials are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 h after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as magnetic resonance imaging and computed tomography, can identify functional and structural brain injury but are not readily available at the patient's bedside because of limited availability and high costs. A multimodal algorithm composed of neurological examination, EEG-based quantitative testing and somatosensory evoked potentials, in conjunction with newer magnetic resonance imaging sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed more than 72 h after CA. © 2015 EAN.

  9. Die metafoor by Breyten Breytenbach


    23 Jun 2009 ... metafories, of spesifiek verwysend, te werk gegaan is. Tyd sou mens die hoofmotief van die bundel noem, tyd en geheue wat verbygaan: 1 en 2; en die einde van die storie wat gekom het: “fluit-fluit my storie is uit”. (Die tema van verbygaan word weer opgeneem in 8 en 9: die stories wat nooit meer gehoor ...


    In die verband kan genoem word dat die Russe nog grotendeels gebruik maak van 'n metode waarvolgens water in die oliestratum gepomp word om 'n opwaartse druk van ru-olie te verseker; een nadeel hiervan is dat die water mettertyd deur die oliehoudende laag ontsnap en agv die drukverlies isvoortgesette ontginning.

  11. Die singulation method

    Swiler, Thomas P.; Garcia, Ernest J.; Francis, Kathryn M.


    A method is disclosed for singulating die from a semiconductor substrate (e.g. a semiconductor-on-insulator substrate or a bulk silicon substrate) containing an oxide layer (e.g. silicon dioxide or a silicate glass) and one or more semiconductor layers (e.g. monocrystalline or polycrystalline silicon) located above the oxide layer. The method etches trenches through the substrate and through each semiconductor layer about the die being singulated, with the trenches being offset from each other around at least a part of the die so that the oxide layer between the trenches holds the substrate and die together. The trenches can be anisotropically etched using a Deep Reactive Ion Etching (DRIE) process. After the trenches are etched, the oxide layer between the trenches can be etched away with an HF etchant to singulate the die. A release fixture can be located near one side of the substrate to receive the singulated die.

  12. The situation of radiation oncology patients' relatives. A stocktaking; Die Situation der Angehoerigen von Strahlentherapiepatienten. Eine Bestandsaufnahme

    Momm, Felix; Lingg, Sabine; Adebahr, Sonja; Grosu, Anca-Ligia [Klinik fuer Strahlenheilkunde, Univ. Freiburg (Germany); Xander, Carola; Becker, Gerhild [Palliativeinheit, Univ. Freiburg (Germany)


    Background and Purpose: Recent studies have shown a very high importance of relatives in decisions about medical interventions. Therefore, the situation of this group was investigated in the sense of a stocktaking by interviewing the closest relatives of radiotherapy patients. Interviewed Persons and Methods: In a defined span of time (6 weeks), a total of 470 relatives (evaluable: n = 287, 61%) of radiotherapy patients were interviewed by a newly developed questionnaire about their contentment with their inclusion in the therapy course. Further, they gave information about specific needs of relatives as well as proposals for direct improvements in the context of a radiation therapy. Results: In total, the relatives were satisfied with their inclusion in the radiotherapy course and with the patient care. As an example, more than 95% of the relatives agreed with the statement ''Here in the hospital my ill relative is cared for well.'' Nevertheless, direct possibilities for improvements were found in the interdisciplinary information about oncologic topics and in the organization of the therapy course. Conclusion: In the stocktaking the situation of radiotherapy patients' relatives was generally satisfactory. Further improvements for the future can be expected mainly from interdisciplinary cancer centers having the best suppositions to care for the relatives, if necessary. Structures known from palliative care can be used as a model. (orig.)

  13. Ontsporing van die regstaatsbegrip en sy konsekwensies vir die afrikanervolk

    N. G.S. Van der Walt


    Full Text Available Die opvatting van die suiwere regstaat bring sy vraagstukke mee wanneer dit in verband gebring word met die leer van die soewereiniteit in eie kring. Laasgenoemde leer wortel in die geloof dat God die mens roep tot diens aan Hom, en dat die mens vry moet wees om ten opsigte van alle lewensaspekte God na die hoogste mate te kan dien. Hierdie verskeidenheid van aspekte is deur dr. A. Kuyper en sy volgelinge gesistemati- seer tot menslike verbande en lewenskringe, elk met ’n be- paalde sfeer waarin ander kringe nie mag inmeng nie. Elkeen is dan soewerein binne sy eie kring. Met verwysing na die staat is dan gespreek van die staatstaak as synde die hand- hawing van die reg, en omdat die staat in toenemende mate hom veral in die latere tyd ook besig gehou het met bedrywig- hede wat nouliks as van juridiese aard beskou kan word, is daar die onderskeid gemaak tussen die primêre en sekundêre taak van die staat. Die sistematiek van die wetsidee, deur prof. Dooyeweerd ontwikkel, waar die staat sy bestemmingsfunksie in die regsaspek vind, het vanselfsprekend geen plek vir so 'n dualistiese staatstaak nie, en die oplossing is deur sommige daarin gesoek om sulke staatsoptrede te vertolk as hebbende wel betrekking op die regsgemeenskap of die regsverkeer. Staatsondernemings soos paaie, spoorweë, spellingreëling, ens. word dan beskou as noodsaaklik vir die instandhouding van die regsgemeenskap en regsverkeer. Tereg wys A. M. Donner1 daarop dat so ’n vertolking eintlik neerkom op ’n oorspanning van die regsbegrip. Hy self sien dan die staatstaak in vrede- of orde-handhawing, wat in die eerste plaas wel regshandha- wing veronderstel. Onder orde word dan alles verstaan wat noodsaaklik is vir die gladde verkeer in die ontwikkelingsgang van die regsgemeenskap. Die wese van die staat het dan vol- gens hom te doen met reg, maar sy taak is meer as suiwere regshandhawing. Wat onrus verwek en die orde versteur, moet uit die openbare lewe verwyder word, en die

  14. [Clinical characteristics and renal uric acid excretion in early-onset gout patients].

    Li, Q H; Liang, J J; Chen, L X; Mo, Y Q; Wei, X N; Zheng, D H; Dai, L


    Objective: To investigate clinical characteristics and renal uric acid excretion in early-onset gout patients. Methods: Consecutive inpatients with primary gout were recruited between 2013 and 2017. The patients with gout onset younger than 30 were defined as early-onset group while the others were enrolled as control group. Clinical characteristics and uric acid (UA) indicators were compared between two groups. Results: Among 202 recruited patients, the early-onset group included 36 patients (17.8%). Compared with control group, the early-onset group presented more patients with obesity [13 patients (36.1%) vs. 22 patients (13.3%), Pgout early onset. Conclusion: The gout patients with early-onset younger than 30 present high serum and glomerular load of uric acid which might be due to obesity and relative under-excretion of renal uric acid.

  15. Die sterwende kindjie

    J.T. De Jongh van Arkel


    Full Text Available The thought of a child dying appears as an antithesis and thus the feelings evoked by the dying child are stronger than when older persons are dying. Around the child’s death bed there is no place for detached spectators and all become involved in caring for and supporting him. Caregivers also have a supporting responsibility towards the members of the child’s family.

  16. Au XXIème siècle, qui sont les patients dialysés souffrant d'une hyperparathyroïdie secondaire sévère ? Cohorte prospective, multicentrique de patients dialysés, incidents pour l'hyperparathyroïdie secondaire. EPHEYL (Etude PHarmacoEpidémiologique de l'hYperparathyroïdie secondaire en Lorraine)

    Thomas-Laurain , Emmanuelle


    Non disponible / Not available; L'hyperparathyroïdie secondaire (HPTS) est une complication fréquente de l'insuffisance rénale chronique. Mais son diagnostic et sa prise en charge sont encore complexes et mal codifiés. Dans notre étude, nous faisons l'hypothèse que la population de patients atteints d'HPTS est hétérogène. L'objectif de notre étude était d'identifier des sous-groupes de patients présentant un profil d'HPTS commun à partir des données cliniques, biologiques et thérapeutiques di...

  17. Analise van die Tswanaraaisel

    S. A. Swanepoel


    Full Text Available ’n Strukturele, stilistiese en funksionele bcskrywing van die Twanaraaisel bring mee dat daar aan die volgende aspekte aandag gegee moet word: •\tWat is ’n raaisel en lioe word dit in Tswana genoem. •\tTot watter studiegebied en literere genre hoort die raaisel en watter subvorme kan vir Tswana onderskei word. •\tHoe sien die struktuur van Tswanaraaisels daar uit. •\tDeur wie, waar, wanneer en hoe word Tswanaraaisels voorgedra. •\tWatter stilistiese kenmcrke kan in Tswanaraaisels onderskei word. •\tWatter funksies vervul raaisels in ’n Tswanagcmeenskap.

  18. Die brein soos beskou deur die Grieke en Romeine

    Francois P. Retief


    Full Text Available In Ou Egipte is mummifikasie met uitgebreide reseksie of uitsnyding van organe geassosieer, maar geen kennis is geneem van die morfologie van die brein nie. Griekse skrywers van die sesde en vyfde eeue v.C. het die brein aanvanklik gesien as die setel van intelligensie, die orgaan van sensoriese waarneming en gedeeltelik die oorsprong van sperma. Pneuma het ’n belangrike rol in breinfunksie gespeel. Hippokrates was die eerste om die brein te beskryf as ’n dubbele orgaan, wat met harsingvlies (meninges bedek, funksioneel van pneuma afhanklik en vertolker van begrip is. Tydgenote soos Plato, Aristoteles en Diokles het tot die beskrywing bygedra, maar laasgenoemde twee het beweer dat die hart die middelpunt van intelligensie is en nie die brein nie. Gedurende die laaste helfte van die vierde eeu v.C. is disseksie van die menslike liggaam tydelik aan die mediese skool van Alexandrië toegelaat en het dit tot merkwaardige vooruitgang in die begrip van die menslike anatomie en fisiologie gelei. Herofilus en Erasistratus het uitstekende beskrywings van die struktuur en funksie van die brein gegee wat eers in die tweede eeu n.C. deur Galenus geëwenaar is.

  19. An Early Glenn Operation May be Associated with the Later Occurrence of Protein-Losing Enteropathy in Fontan Patients : Association of Early Glenn and Failing Fontan.

    Unseld, Bettina; Stiller, Brigitte; Borth-Bruhns, Thomas; du Bois, Florian; Kroll, Johannes; Grohmann, Jochen; Fleck, Thilo


    Protein-losing enteropathy (PLE) and plastic bronchitis (PB) are major causes of long-term mortality after Fontan operation. The objective of this study was to determine early clinical risk factors before the onset of PLE and PB. In a cohort study, 106 Fontan patients between 2005 and 2013 were examined. A median of 5.3 (1.5-8.5) years later, follow-up questionnaires were used to group the patients in a PLE or PB group (n = 14) and a non-PLE/PB group (n = 92). Prevalence of PLE was 9.4% (n = 10) and of PB 3.8% (n = 4). At follow-up, five patients (4.7%) died of PLE or PB. Median age at death was 6.2 years (IQR 10.5, 95% CI 5.3-23.4). We observed no significant group differences in gender distribution (p = 0.73), ventricular morphology (p = 0.87), surgical technique (p = 0.64), conduit fenestration (p = 0.34), age at Fontan operation (p = 0.54), and need for diuretics (p = 0.56). Hypoplastic left heart syndrome was more frequent in the PLE/PB group 50 vs. 22.8% (p = 0.03) OR 3.4 (95% CI 1.1-10.8). The modified Glenn procedure was performed at a median age of 4 months (IQR 4.0) in the PLE/PB group versus 8 months (IQR 8.0) in the non-PLE/PB group (p = 0.01). The early Glenn procedure and hypoplastic left heart syndrome may be associated with the development of PLE and PB.


    dien. Die planke en velie moes keer dat die assegaaie die mense tref. Voor die geveg het die vrouens en groter dogters koeels gegiet. Tydens die geveg het die seuns gehelp skiet terwyl die vrouens en dogters die gewere vir die mans gelaai het. Van die dogters soos Nellie. Botha (11 jaar oud) en haar sussie Fya (15 jaar.

  1. Die uitbouing van die Bybelse kanon in antieke Judaïsme en die ...

    31 Jul 2015 ... die oer-Christelike boodskap tot by sy Ou Testamentiese wortels, die geskrifte van Israel wat cum grano salis die 'Bybel' van die oer-Christendom geword het en die blywende verwysingspunt van die Christelike boodskap is. Erkenning. Hierdie artikel is vertaal na Afrikaans deur Prof. Jan G. van der Watt.

  2. Die opleiding van bedryfsielkundiges aan die universiteit van Fort Hare

    W. Botha


    Full Text Available Die Departement Bedryfsielkunde aan die Universiteit van Fort Hare is 'n relatiewe jong departement en het eers in 1965 tot stand gekom. Voor hierdie datum is Bedryfsielkunde as 'n kort kursus deur die departement van suiwer Sielkunde aangebied en een van die destydse dosente, Dr. W. Backer, het die inisiatief geneem om 'n selfstandige departement van Bedryfsielkunde in die Fakulteit van Ekonomiese Wetenskappe op die been te bring.

  3. Are religiousness and death attitudes associated with the wish to die in older people?

    Bonnewyn, Anke; Shah, Ajit; Bruffaerts, Ronny; Demyttenaere, Koen


    A wish to die is common in older persons and is associated with increased mortality. Several risk factors have been identified, but the association between religiousness and a wish to die in older adults has been underexplored, and the association between death attitudes and the presence of a wish to die has not been investigated yet. The aim of this study is to explore the relationship between religiousness and death attitudes on the one hand and wish to die on the other hand, adjusting for clinical factors such as the presence of depression or somatic disorder. The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the Structured Clinical Interview for DSM-IV Disorders, and logistic regression analyses estimated the unique contribution of religiousness and death attitudes to the wish to die, controlling for socio-demographic variables, depressive disorder, and somatic symptoms. Both religiousness and death attitudes were associated with a wish to die in univariate models. Adding these variables in a multivariate logistic hierarchical model, death attitudes remained significant predictors but religiousness did not; 55% of the pseudovariance of the wish to die was explained by these variables, with an effective size of 0.89. Major depressive episode, somatic symptoms, Fear of Death, and Escape Acceptance were the most important predictors of the wish to die. This study suggests that how older adults perceive death partly determines whether they have a wish to die. There may be a clinical, patient-oriented benefit in discussing with older patients about how they perceive death, as this can play a role in the early detection (and prevention) of death or suicide ideation and associated behaviors in older adults.

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

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


    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.

  5. A special radiation shielding for the radiotherapy of a pregnant patient; Eine Spezialabschirmung fuer die Strahlentherapie von Schwangeren

    Buchgeister, M.; Mondry, A. [Bereich Medizinische Physik, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany); Spillner, P.; Paulsen, F.; Belka, C.; Bamberg, M. [Strahlentherapie, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany)


    Purpose: measurement of the radiation dose of different radiotherapy techniques with a phantom at the position of the uterus of a pregnant patient with and without a special radiation shielding. Material and methods: a special radiation shielding for the radiation therapy of a pregnant patient was constructed in the shape of a tunnel over the abdomen from 1 cm thick lead to reduce scatter radiation to the uterus and the fetus therein. The reduction of the scatter radiation to the lower abdomen was measured for three typical cases (cerebrum with lateral opposed fields, 6-MV photons; tangential fields for mamma irradiation, 6 MV; and anteroposterior-posteroanterior [AP-PA] opposed fields of 15 MV for treatment of the mediastinum) at an anthropomorphic Alderson phantom with thermoluminescence dosimeters in different depths and with an ionization chamber positioned in an RW3 solid water phantom. In the case of lateral opposed fields, a movable lead wall was additionally positioned next to the accelerator's head to reduce the scatter radiation from this source. Results: depending on the geometry of the radiation fields and on the photon energy, a reduction of the dose to the lower abdomen averaged over the depths of 6, 9, and 12 cm from 16% (15 MV, mediastinum case) to 51% (6 MV, cerebrum with additional lead wall) was achieved. The absolute scattered dose with shielding in place for a 2-Gy fraction dose results to 3.85 mGy and 0.27 mGy, respectively. Conclusion: national and international recommendations on the radiation dose to a fetus of a pregnant patient state limits of 200 mSv (DGMP report no. 7) and 100 mGy (ICRP 84), below which an abortion should not be considered and above which an indication for termination of the pregnancy could be given, respectively. The dose to the fetus can be kept below these limits with the shielding described in this work. Therefore, a radiation therapy of a pregnant patient is possible when these special precautions to reduce

  6. Oor die Bybel in die Afrikaanse digkuns

    another. As a matter of fact, the development of Afri kaans, the instrument of the poet, has been significantly influenced the Afrikaans translation of the Bible. Belie ... ook gesê het: Saam met ons literatuur, so oud as hy is. Die eerste Afrikaanse digter by wie ons omvattende Bybelse invloed kry, is. Totius, een van ons vroegste ...

  7. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Brković E


    Full Text Available Eliana Brković,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

  8. Statues Also Die

    Pierre-Philippe Fraiture


    Full Text Available “African thinking,” “African thought,” and “African philosophy.” These phrases are often used indiscriminately to refer to intellectual activities in and/or about Africa. This large field, which sits at the crossroads between analytic philosophy, continental thought, political philosophy and even linguistics is apparently limitless in its ability to submit the object “Africa” to a multiplicity of disciplinary approaches. This absence of limits has far-reaching historical origins. Indeed it needs to be understood as a legacy of the period leading to African independence and to the context in which African philosophy emerged not so much as a discipline as a point of departure to think colonial strictures and the constraints of colonial modes of thinking. That the first (self-appointed exponents of African philosophy were Westerners speaks volumes. Placide Tempels but also some of his predecessors such as Paul Radin (Primitive Man as Philosopher, 1927 and Vernon Brelsford (Primitive Philosophy, 1935 were the first scholars to envisage this extension of philosophy into the realm of the African “primitive.” The material explored in this article – Statues Also Die (Marker, Resnais, and Cloquet, Bantu Philosophy (Tempels, The Cultural Unity of Negro Africa (Cheikh Anta Diop, and It For Others (Duncan Campbell - resonates with this initial gesture but also with the ambition on part of African philosophers such as VY Mudimbe to challenge the limits of a discipline shaped by late colonialism and then subsequently recaptured by ethnophilosophers. Statues Also Die is thus used here as a text to appraise the limitations of African philosophy at an early stage.  The term “stage,” however, is purely arbitrary and the work of African philosophers has since the 1950s often been absorbed by an effort to retrieve African philosophizing practices before, or away from, the colonial matrix. This activity has gained momentum and has been

  9. calvyn oor die leiding van die heilige gees in die verklaring van die

    Mittel alters, bis er zur Ruhe kommt bei den kanonischen Schriften der. Urzeit der christlichen Ära (Barth ... (ego tamen dimoveri non possum ab amore compendii, CO 10, 403). Deur die boodskap van die .... Idem ergo spiritus qui per os prophetarum loquutus est, in corda nostra penetret necesse est, ut persuadeat fideliter ...


    Acta Theologica is an accredited South. African journal publishing ... SciELO South Africa. REDAKSIE/ ... 'n persoon belydenis van geloof af wat instemming met die betrokke kerk se ...... Ek was na my ongeluk buite aksie en op Clarens. 'n Mede-lid ...... Die “formation of new confessions, change to current confessions, and.

  11. Dying with dignity

    S P Kalantri


    The concept of dignity has beeen one of the ambiguous concepts in biomedical ethics. Thus the ambiguous nature of this concept has been extended to what it means to die with dignity. This research work is an investigation into the complexity in the understanding of "dying with dignity" in Applied Ethics.

  12. The day Madiba died

    8 Apr 2016 ... shibien en ma is nie happy nie. Susan Gaigher se allegoriese fanta- sie- oftewel wetenskapsfiksieverhale. “Martine se teepot” (46–55) en “Maslow”. (56–67) is verfrissend. Gaigher is een van die min skrywers in die bundel wat 'n kenmerkende en oorspronklike stem laat klink. 'n Mens sal 'n Gaigher-verhaal.

  13. Die entwicklung, die metamorphose, die entstehung: Die konzepte des organismus von Aristoteles bis Darwin

    Kamerer Eva


    Full Text Available (nemački In diesem Aufsatz versuche ich, die Elemente verschiedener Konzepte des Organismus in der Philosophie und in der Wissenschaft zu analysieren. Die Deutungen des Organismus und der Einheit der Natur bei Aristoteles, Kant und Goethe werden als ein Beispiel der Bewegung von einem finalistischen zum antifinalistischen Bild der Natur verstanden.

  14. Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis.

    Creutzig, Ursula; Rössig, Claudia; Dworzak, Michael; Stary, Jan; von Stackelberg, Arend; Wössmann, Wilhelm; Zimmermann, Martin; Reinhardt, Dirk


    The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed. Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis. ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC. © 2015 Wiley Periodicals, Inc.

  15. Paradigmas en progressie in die teologie: *n Perspektief op die ...

    Die metodologie as besinningsterrein word egter al belangriker. Gedurende die tweede week van April 1988 het teoloë van dwarsoor Suid-. Afrika by die nuwe gebou van die Raad vir Geesteswetenskaplike Navorsing in. Pretoria byeen gekom vir 'n kongres van amper drie dae met die tema Paradigma.'> 476. ISSN 0259 ...

  16. die korrelasie tussen die gemiddelde daaglikse toename van ...

    'n Regressielyn is uit die gegewens bereken deur 'n beswaarde regressieanaliese en die 80 persent-voorspellings- bande is bepaal. Die punte wat ver buite die normale ver- spreidingsband geval hetkon almal met goeie rede as abnor- maal beskou word (sien tabel 1) en is nie ingesluit by die statistiese berekenings nie.

  17. amp' van die ouderling in die Nuwe Testament

    Jesus self het geen kerk gestig nie en daarom, veral omdat die Jesus-beweging inter mums ten opsigte van die Joodse godsdiens van sy tyd tot stand gekom het, het ...... Die klem val dus nie op die npoTCTT0fievo<; se rang of outoriteit nie, maar op sy pastorale funksie in die huishouding of huisgemeente (kyk Reicke.

  18. Die beroepsoriëntasie van professioneel-rekeningkundiges tydens die vroeë beroepsjare

    L. J. Van Vuuren


    Full Text Available The career orientation of professional accountants during the early career stage. The purpose with this study was to conduct research into the career orientations of aspiring and qualified persons in the accounting profession. Schein's Career Orientation Inventory was administered to 221 respondents in the early career stage and in different phases of Involvement in the profession. Managerial skill featured as the most prominent career orientation. It was also evident that respondents who had had occupational experience measured highest on the same orientation, i.e. managerial skill, irrespective of their phase within the early career stage. Furthermore, there were indications that career orientation differentiation increased in accordance with occupational experience. Opsomming Die doel met hierdie studie was om die beroepsoriëntasies van aspirant en gekwalifiseerde persone in die rekenmeesterprofessie na te vors. Schein se Beroepsorientasievraelys is afgeneem op 221 proefpersone in hul vroee beroepsjare en in verskillende fases van betrokkenheid in die professie. Bestuursbedrewenheid is as die mees kenmerkende beroepsorientasie geidentifiseer. Dit het ook aan die lig gekom dat proefpersone wat oor beroepsondervinding beskik, ongeag hul fase van betrokkenheid in die vroee beroepsjare, dieselfde orientasie naamlik bestuursbedrewenheid, realiseer. Aanduidings is verder verkry dat beroepsorientasie-differensiasie na gelang van beroepsblootstelling toeneem.

  19. Die toekoms en ons roeping

    S. du Toit


    Full Text Available Om te weet wat ons roeping in die toekoms sal wees, moet ons eers besef wat in ons eie tyd aan die gang is en langs watter lyne die dinge beweeg. Dit is ons plig om te let op die tekens van die tye in die lig van die profetiese Woord. En dan wil ons dadelik beklemtoon dat ons in Suid-Afrika nie in die waan moet lewe dat ons hier onbekommerd en onaangetas deur die wêreldgebeure ons roeping en bestemming kan uitwerk nie.

  20. Die Hervormde Teologiese Studies na vyftig jaar

    INLEIDEND. In die tweede helfte van die jaar 1943 het die Hervormde Teologiese Studies die eerste maal verskyn. Dit was die produk van lang besinning en beplanning. Die dryfkrag agter die totstandkoming was prof dr S P Engeibrecht, 'n man wie se idealisme en toewyding aan die kerk groot dinge vir die kerk en ook die ...

  1. Die owerheidsinmenging met betrekking tot kerklike tughandelinge.

    L. Roeleveld


    Full Text Available Volgens art 29 NGB is die merktekens van die ware kerk die suiwere prediking van die Evangelie, die suiwere bediening van die Sakramente en die gebruik van die kerklike tug. Art. 32 NGB spreek uit dat die Kerkorde nie mag afwyk van wat Christus ingestel het nie. Menslike vindinge en wette om die gewetens te bind en te dwing, moet daarom verwerp word. Die ekskommunikasie of die ban moet toegepas word volgens die Woord van God.

  2. Pentateugtradisies in die boek Hosea

    om te bepaal of die verwysing na 'n gebeure te doen het met die verre verlede of met die .... Hosea 2:1-2 JHWH se trou aan sy beloftes. ... dat huile na Egipte sal terugkeer. Die presiese bedoeiing van die woorde 'huile sal terugkeer na Egipte' is omstre- de. Kommentatore soos Rudolph meen dat dit verstaan moet word as ...

  3. Die begrafnisdíens

    (De Vaux 1961:108). Was die begrafnis 'n familie of 'n kerklike aangeleentheid? Hierdie vraag word nie in die Bybel beantwoord nie. Abraham het sy vrou begrawe (Gen 23: 19-. 20). Isak en Ismael ..... ver gekom om die begrafnis 'n kerklike aangeleentheid te maak nie. Hierdie stap .... trou aan die sorg van God. * Die kerk ...

  4. Metodes in die Christelike etiek

    The basic question in Christian ethics is not primarily. 'What should I do?' The basic question is rather ' ... should therefore be accepted as being part of the method used in Christian ethics. 1. INLEIDEND ..... aan die kant van die onderdrukte' verkondig word, word die Christen opgeroep om horn te skaar aan die kant van die ...

  5. Early and late results of graft replacement for dissecting aneurysm of thoracoabdominal aorta in patients with Marfan syndrome.

    Omura, Atsushi; Tanaka, Akiko; Miyahara, Shunsuke; Sakamoto, Toshihito; Nomura, Yoshikatsu; Inoue, Takeshi; Oka, Takanori; Minami, Hitoshi; Okada, Kenji; Okita, Yutaka


    When treating dissecting aneurysm of the thoracoabdominal aorta surgically in patients with Marfan syndrome, we have usually performed graft replacement- including the entire thoracoabdominal aorta and reconstruction of all visceral branches, even if dilatation is mild in some segments-to avoid further aortic operations in the follow-up period. From October 1999 through July 2011, 20 consecutive patients with Marfan syndrome underwent repair of dissecting aneurysm of the thoracoabdominal aorta (median age, 45 years; range, 19-65 years). All patients underwent surgical intervention with cerebrospinal fluid (CSF) drainage and distal aortic and selective organ perfusion. Deep hypothermia was used in 13 patients for spinal cord protection. No in-hospital mortality was observed. One patient had temporary spinal cord ischemia but was fully recovered by discharge. Other complications included exploration for bleeding (n=1), prolonged ventilation (n=1), and graft infection (n=1). At a mean follow-up of 54 months (range, 9-129 months), 1 patient had died of interstitial pneumonia at 38 months postoperatively. Survival at 8% years was 91.2±9.0%. Two patients required additional aortic procedures (total arch replacement and aortic valve-sparing surgery). Actuarial rate of freedom from aortic operations at 8 years was 83.9%±10.5%, but no patient needed required repeated thoracotomy for an aortic procedure. Neither false nor patch aneurysms were observed using computed tomography (CT) during follow-up surveillance. Graft replacement for dissecting aneurysm of the thoracoabdominal aorta in Marfan syndrome offers good early and long-term results. We believe total aortic replacement including the entire thoracoabdominal aorta and reconstruction of all visceral arteries should be recommended for selected patients with Marfan syndrome. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Awareness of Dying Preface

    Barney G. Glaser, PhD, Hon. PhD


    Full Text Available Recently The New York Times reported: “VERY ILL CHILDREN TOLD OF DISEASE; Leukemia Patients at N.I.H. Not Shielded From Truth. . . . A child should always be told the truth, even when he has an incurable disease such as leukemia, according to two researchers who interviewed 51 children hospitalized at the National Cancer Institute, Bethesda, Maryland, for treat¬ment of leukemia.” This kind of news item reflects the growing concern among researchers and public about matters which touch on morality as much as on the technical aspects of medi¬cine. The rapidly increasing proportion of elderly people in the American population presents a range of personal and social questions; not the least is how they view their newly won longevity (often including anticipated years of chronic disease as well as their attitudes toward death. In consequence, many geriatric specialists are beginning to study American attitudes toward death, while others, spurred on by what seems a sense-less prolonging of life within hospital walls by medical tech¬nology run wild, are raising questions about death and dying in American life.

  7. Die teologiese skool in die P.U.K vir C.H.O.: met die betekenis van die teologiese skool vir die Christelike wetenskap

    F. Postma


    Full Text Available Die Teologiese Skool van die Gereformeerde Kerk gedink op 29 November 1944 sy vyf-en-sewentigjarige bestaan.Die Raad en Senaat van die P.U.K. vir C.H.O. wil ook langs hierdie weg die Teologiese Skool van harte gelukwens en die versekering gee dat daar by die outoriteite van die P.U.K. ’n diepgevoelde dankbaarheid heers dat hierdie inrigting sovele jare deur onse God en Vader gedra en gespaar is.

  8. Early death during chemotherapy in patients with small-cell lung cancer

    Lassen, U N; Osterlind, K; Hirsch, F R


    Based on an increased frequency of early death (death within the first treatment cycle) in our two latest randomized trials of combination chemotherapy in small-cell lung cancer (SCLC), we wanted to identify patients at risk of early non-toxic death (ENTD) and early toxic death (ETD). Data were s...

  9. Die Frage nach Gerechtigkeit.

    Martin Jäggle


    Full Text Available ENGLISH: In the first part six stages in the author’s path of life are described, which have influenced his engagement with justice. The second part gives an insight into his religious educational work, in which the issue of justice was especially significant on the example of ‘religion in the context of migration’ and of the ecumenic initiative ‘’ (school worth living. The vision of the Kingdom of God and the necessity of participation become apparent. DEUTSCH: Im ersten Teil werden sechs Stationen am Lebensweg des Autors beschrieben, die seine Auseinandersetzung mit Gerechtigkeit geprägt haben. Der zweite Teil gibt Einblick in seine religionspädagogische Arbeit, in der die Frage nach Gerechtigkeit besonders bedeutsam war am Beispiel ‚Religion im Kontext Migration‘ und der ökumenischen Initiative ‚‘. Die Vision vom Reich Gottes und die Notwendigkeit von Partizipation werden dabei deutlich.

  10. Die EG-Kabotageverordnung

    Basedow, Jürgen


    Die EG-Kabotageverordnung : e. Schritt zur Verwirklichung d. Dienstleistungsfreiheit im Straßengüterverkehr / Jürgen Basedow ; Ansgar Held. - In: Europäische Zeitschrift für Wirtschaftsrecht. 1. 1990. S. 305-308

  11. Practicing patients, compassion, and hope at the end of life: mining the passion of Jesus in Luke for a Christian model of dying well.

    Vogt, Christopher P


    Four centuries ago, Christian moral theologians addressed the issue of dying by turning to scripture and the virtues. This work revives that tradition by showing that careful theological reflection upon the nature of Christian patience, compassion, and hope illuminates the shape of the Good Death. The author draws upon Luke's passion narrative to develop a better understanding of these virtues. He also takes up the question of whether Jesus' death can be a model of dying well for contemporary Christians. Christians are often advised to look to Jesus in his dying as a model for themselves, but this recommendation typically leaves unanswered what exactly it is about Jesus' dying that is to be imitated. The understanding of patience, compassion, and hope developed here provides a means of sorting through this issue.

  12. Die Bibliothek des Bezirksmuseums Josefstadt

    Maria Ettl


    Josefstadt in Wien werden die Herkunft der Bibliotheksbestände und die beengte Raumsituation beschrieben. Abschließend wird auf die Erfassung der Medien mittels der Bibliothekssoftware „Biblioweb“ eingegangen.

  13. Die verband tussen die sielkundige kontrak en organisasieverbondenheid

    K. J. Stanz


    Full Text Available The relationship between the psychological contract and organisational commitment. The aim of this study is to design a measuring instrument with acceptable metric characteristics for the strength of the psychological contract within the South African context, and to determine empirically the relation between the strength of the psychological contract and organisational commitment. The Dhammanungune Model served as foundation for the design of the Strength of the Psychological Contract Questionnaire which consists of two scales namely, a needs expectation scale and a needs fulfilment expectation scale. The items of each scale have been formulated in the manner that ensures that the respondent reacts consecutively to two instructions namely, (a the level of the expectation and (b the importance of the expectation. This questionnaire was administered together with the Organisational Commitment Questionnaire to two population groups within the military environment. The Pearson Product Moment Correlation was calculated between the strength of the psychological contract and organisational commitment and the significance of the correlations was evaluated. Opsomming Die doel van die studie is om 'n meetinstrument met aanvaarbare metriese eienskappe vir die sterkte van die sielkundige kontrak vir Suid-Afrikaanse omstandighede te ontwerp en om empirics die verband tussen die sterkte van die sielkundige kontrak en organisasieverbondenheid te bepaal. Die sterkte van die sielkundige kontrak vraelys is op grond van die Dhammanungune-model ontwerp en het uit twee skale naamlik, die behoefteverwagting- en vervullingsverwagtingskale bestaan. Items vir eike skaal is sodanig geformuleer dat die respondent agteropeenvolgens op twee instruksies naamlik (a die vlak van die verwagting en (b die belangrikheid van die verwagting moet reageer. Die vraelys is saam met die organisasieverbondenheidsvraelys op twee populasies uit 'n militere omgewing toegepas. Die Pearson

  14. Die postpolitische Stadt

    Erik Swyngedouw


    Full Text Available Die Polis ist tot, es lebe die kreative Stadt! Während die Stadt, zumindest in Teilen des städtischen Raums, blüht und gedeiht, scheint die Polis im idealisierten griechischen Sinn dem Untergang geweiht; in diesem Verständnis ist sie der Ort der öffentlichen politischen Auseinandersetzung und demokratischen Unterhandlung und somit eine Stätte (oft radikaler Abweichung und Unstimmigkeit, an der die politische Subjektivierung buchstäblich ihren Platz hat. Diese Figur einer entpolitisierten (oder postpolitischen und postdemokratischen Stadt im Spätkapitalismus bildet das Leitmotiv des vorliegenden Beitrags. Ich lehne mich dabei an Jacques Rancière, Slavoj Žižek, Chantal Mouffe, Mustafa Dikeç, Alain Badiou und andere Kritiker jenes zynischen Radikalismus an, der dafür gesorgt hat, dass eine kritische Theorie und eine radikale politische Praxis ohnmächtig und unfruchtbar vor jenen entpolitisierenden Gesten stehen, die in der polizeilichen Ordnung des zeitgenössischen neoliberalen Spätkapitalismus als Stadtentwicklungspolitik [urban policy] und städtische Politik [urban politics] gelten. Ziel meiner Intervention ist es, das Politische wieder in den Mittelpunkt der zeitgenössischen Debatten über das Urbane zu stellen. [...

  15. Predisposing factors for early retirement in patients with schizophrenia in Germany.

    Schnabel, Reinhard; Friedel, Heiko; Erfurth, Andreas; Angermayer, Matthias; Clouth, Johannes; Eichmann, Florian


    Although early retirement causes major changes in the life of schizophrenic patients and is among the major cost factors to be covered by payers, the causes leading to early retirement of schizophrenic patients have not been investigated in detail. Therefore, the objective of this retrospective non-interventional case-control study was to generate hypotheses on predisposing factors for early retirement in schizophrenia. Logistic regression was used to explore potential predisposing parameters with regard to their effect on the outcome early retirement. As the study results indicate, schizophrenia severity, assistance or care in the patient's everyday life, age and antipsychotic treatment with typical antipsychotics are linked to the occurrence of early retirement. Further research should be planned to confirm or refute the hypotheses determined in this retrospective analysis and to determine whether atypical antipsychotics could help to avoid early retirement and to improve the situation of schizophrenic patients.

  16. Die histologie en ultrastruktuur van die hepatopankreas van die bloukurper Oreochromis mossambicus

    M. M. Nel


    Full Text Available Die histologie en ultrastruktuur van die hepatopankreas van die bloukurper Oreochromis mossambicus word beskryf. ’n Dun bindweefselkapsel omring die lewer. Die hepatosietrangskikking vertoon as lobules, met die koorde van hepatosiete wat vanaf ’n sentrale vene uitradieer en met mekaar anastomaseer. Indiwiduele lewerlohules vertoon nie duidelike grense nie, maar enkele duidelike triades word wel in die lewer van O. mossambicus aangetref. Die hepatosiete bevat ’n enkele ronde kern met ’n duidelike nukleolus en die growwe endoplasmiese retikula kom in twee of meer rye om die kerne en teen die selgrense van die hepatosiete voor. Die ander sitoplasmiese organelle kom verspreid in die hepatosietsitoplasma voor. Die eksokriene pankreasselle is om die portale venes gesetel. Die kerne van hierdie selle is rond en is hasaal in die kubies- tot silindervormige selle gelee. ’n Goedontwikkelde growwe endoplasmiese retikulum — vesikulêr, tubulêr en sirkulêr in vorm — en sektretoriese granules wat apikaal in die sel gelee is, kom voor.

  17. Die teologiese arbeid van Antonius HJ Gunneweg

    En dis 'n klein treetjie van klagte na aanklag en na protes teen die gode, die heersers wat die mens vernietig deur hom oor sy ware lewe te bedrieg. Die ideologie eis dan ook dienooreenkomstig die bevryding en emansipasie van die mens van die gode en van God (1983: 118—119). Volgens die Jahwis is dit die slang wat, ...

  18. ["Good dying"--definition and current state of research].

    Hutter, Nico; Stößel, Ulrich; Meffert, Cornelia; Körner, Mirjam; Bozzaro, Claudia; Becker, Gerhild; Baumeister, Harald


    The advances of modern medicine did not only result in prolongation of life expectancy, but also led to a shift from dying at home to dying in public institutions. In western countries most people die at advanced age in medical facilities. Hence, the question regarding the conditions, which should be provided by society and especially medicine, to allow terminally ill people to experience "good dying" is substantial. For this purpose, an examination of patients', family members' and health care providers' understanding of the term " good dying" is required. The present paper aims at shedding light on the term "good dying" and to summarize the current state of research. Therefore, the attributes of "good dying" will be described from the perspectives of patients, family members and health care providers, which are discussed and examined in current medical-sociological research. These attributes can be illustrated on three dimensions: Quality of life at the end of life (e. g. pain relief, mental well-being), quality of dying (e. g. avoiding prolonged dying, autonomy, presence of relatives) and quality of health care at the end of life (e. g. patient-oriented health care, positive communication between health care providers and patients, availability of guidelines). Although the attributes of "good dying" are described in detail in the existing literature, further studies have to clarify the relevance and impact of these attributes as predictors of "good dying". © Georg Thieme Verlag KG Stuttgart · New York.

  19. Die benutting van vraelyste met die oog op meer effektiewe ...


    effektiewe stresbeheer as een van die temas te hanteer. Op grond van die navorsing deur onder andere Lawson (1985) en Taylor (1999) sou ek graag die proses van differensiasie2 ook by genoemde lys voeg as tema vir bespreking tydens huweliksvoorbereiding. 2 Differensiasie kan beskryf word as die losmaakproses ...

  20. die aard van wetgewende diskresies by die suid-afrikaanse ...


    In enige moderne demokrasie is daar een of ander vorm van skeiding van magte tussen die wetgewende, uitvoerende en regsprekende gesag. Hierdie skeiding van magte, die sogenaamde trias politica, kan sover teruggevoer word as 1215, met die ondertekening van die Magna Carta deur Koning John van Engeland.

  1. die doeltreffendheid van die afrikaanse woordelys en spelreels

    sluiting by die reel vir die verdubbeling van medeklinkers na 'n kort, be- klemtoonde klinker, woorde soos ballet, ballon, terras, terrein, dissipel en dissipline slegs met een konsonant na die eerste vokaal gespel moes word, omdat daardie voorafgaande vokaal onbeklemtoon is. Ook hierdie uit- sondering op die reel word ...

  2. Die aanspraak op Goddelike steun in 'n konfliksituasie volgens die ...

    laws, and ethical or political principles. A synchronic investigation of relevant Old ... die toneel gebring met die vraag: 'aan wie se kant is God' (vgl bv The road to. Damascus 1979:6)? Volgens .... betrekking tot die Ou Testament: Hoe moet ons vasstel wie se kant God nou regtig kies, of wie veg aan die kant van God en wie ...

  3. Volumetric parameters on FDG PET can predict early intrahepatic recurrence-free survival in patients with hepatocellular carcinoma after curative surgical resection

    Lee, Jeong Won [Catholic Kwandong University College of Medicine, Department of Nuclear Medicine, Incheon (Korea, Republic of); Hwang, Sang Hyun; Kim, Hyun Jeong; Kim, Dongwoo; Cho, Arthur; Yun, Mijin [Yonsei University College of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of)


    This study assessed the prognostic values of volumetric parameters on {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting early intrahepatic recurrence-free survival (RFS) after curative resection in patients with hepatocellular carcinoma (HCC). A retrospective analysis was performed on 242 patients with HCC who underwent staging FDG PET and subsequent curative surgical resection. The tumor-to-non-tumorous liver uptake ratio, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the HCC lesions on PET were measured. The prognostic values of clinical factors and PET parameters for predicting overall RFS, overall survival (OS), extrahepatic RFS, and early and late intrahepatic RFS were assessed. The median follow-up period was 54.7 months, during which 110 patients (45.5%) experienced HCC recurrence and 62 (25.6%) died. Patients with extrahepatic and early intrahepatic recurrence showed worse OS than did those with no recurrence or late intrahepatic recurrence (p < 0.001). Serum bilirubin level, MTV, and TLG were independent prognostic factors for overall RFS and OS (p < 0.05). Only MTV and TLG were prognostic for extrahepatic RFS (p < 0.05). Serum alpha-fetoprotein and bilirubin levels, MTV, and TLG were prognostic for early intrahepatic RFS (p < 0.05) and hepatitis C virus (HCV) positivity and serum albumin level were independently prognostic for late intrahepatic RFS (p < 0.05). Intrahepatic recurrence showed different prognoses according to the time interval of recurrence in which early recurrence had as poor survival as extrahepatic recurrence. MTV and TLG on initial staging PET were significant independent factors for predicting early intrahepatic and extrahepatic RFS in patients with HCC after curative resection. Only HCV positivity and serum albumin level were significant for late intrahepatic RFS, which is mainly attributable to the de novo formation of new primary HCC. (orig.)

  4. Heart rate profile during exercise in patients with early repolarization.

    Cay, Serkan; Cagirci, Goksel; Atak, Ramazan; Balbay, Yucel; Demir, Ahmet Duran; Aydogdu, Sinan


    Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during exercise. A total of 84 subjects were included in the study. Comparable 44 subjects with early repolarization and 40 subjects with normal electrocardiogram underwent exercise stress testing. Resting heart rate, maximum heart rate, heart rate increment and decrement were analyzed. Both groups were comparable for baseline characteristics including resting heart rate. Maximum heart rate, heart rate increment and heart rate decrement of the subjects in early repolarization group had significantly decreased maximum heart rate, heart rate increment and heart rate decrement compared to control group (all P decrement (multiple-adjusted OR of the risk of presence of early repolarization was 2.98 (95%CI 1.21-7.34) (P = 0.018) and 7.73 (95%CI 2.84-21.03) (P decrement compared to higher levels, respectively. Subjects with early repolarization have altered heart rate profile during exercise compared to control subjects. This can be related to sudden death.

  5. The Liverpool Care Pathway for cancer patients dying in hospital medical wards: a before-after cluster phase II trial of outcomes reported by family members.

    Costantini, Massimo; Pellegrini, Fabio; Di Leo, Silvia; Beccaro, Monica; Rossi, Carla; Flego, Guia; Romoli, Vittoria; Giannotti, Michela; Morone, Paola; Ivaldi, Giovanni P; Cavallo, Laura; Fusco, Flavio; Higginson, Irene J


    Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Uncontrolled before-after intervention cluster trial. The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6-32.3; p family self-efficacy (+14.3; 95% confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests

  6. The clinical study of cerebral blood flow imaging in patients with early syphilis

    Liu Zengli; Shi Xin; Wu Jinchang; Tang Jun; Zhong Jijun


    Objective: To study the clinical value of cerebral blood flow imaging for evaluation of patients with early syphilis. Methods: Fifty-three patients with early syphilis underwent cerebral blood flow imaging using 99 Tc m -ethylenecysteinate dimer(ECD). Regional cerebral blood flow (rCBF) changes were analyzed. Results: The acquired images of 53 patients were graded as 5 types. The rCBF was significantly depressed in 48 of 53 patients mainly in the areas dominated by anterior cerebral artery and middle cerebral artery. Conclusion: Treponema pallidum (TP) could start invading central nervous system at the early stage of infection

  7. Killing, letting die and euthanasia.

    Husak, D N


    Medical ethicists debate whether or not the moral assessment of cases of euthanasia should depend on whether the patient is 'killed' or 'allowed to die'. The usual presupposition is that a clear distinction between killing and letting die can be drawn so that this substantive question is not begged. I contend that the categorisation of cases of instances of killing rather than as instances of letting die depends in part on a prior moral assessment of the case. Hence is it trivially rather than substantively true that the distinction has moral significance. But even if a morally neutral (ie non-question begging) distinction could be drawn, its application to the euthanasia controversy is problematic. I illustrate the difficulties of employing this distinction to reach moral conclusions by critically discussing Philippa Foot's recent treatment of euthanasia. I conclude that even if an act of euthanasia is an instance of killing, and there exists a prima facie moral duty not to kill, and no more stringent duty overrides this duty, one still cannot determine such an act to be morally impermissible.

  8. Killing, letting die and euthanasia.

    Husak, D N


    Medical ethicists debate whether or not the moral assessment of cases of euthanasia should depend on whether the patient is 'killed' or 'allowed to die'. The usual presupposition is that a clear distinction between killing and letting die can be drawn so that this substantive question is not begged. I contend that the categorisation of cases of instances of killing rather than as instances of letting die depends in part on a prior moral assessment of the case. Hence is it trivially rather than substantively true that the distinction has moral significance. But even if a morally neutral (ie non-question begging) distinction could be drawn, its application to the euthanasia controversy is problematic. I illustrate the difficulties of employing this distinction to reach moral conclusions by critically discussing Philippa Foot's recent treatment of euthanasia. I conclude that even if an act of euthanasia is an instance of killing, and there exists a prima facie moral duty not to kill, and no more stringent duty overrides this duty, one still cannot determine such an act to be morally impermissible. PMID:541821

  9. Die huwelik as identiteitsmerker in die Ou Testament


    Gen 2:18). Uit die woorde van Genesis 2:24 dat man en vrou een sal wees, lei die derde formulier af dat dit “getuig dat die huwelik 'n allesinsluitende gemeenskap is ..... die formule gebruik word: “Hier volg die vertelling oor X se nageslag.” (Gen ..... verwys daarna as “intertwining the principal value concepts of tradition”.

  10. Narratiwiteit en die Ou Testament

    INLEIDING. Die literêre benadering tot die Ou-Testamentiese narratiewe word algemeen as 'n alternatiewe paradigma in die Bybelwetenskappe aanvaar. Oor die filosofiese uit- gangspunte wat hierdie nuwe paradigma ten grondslag lê, bestaan daar egter nog weinig eenstemmigheid. Heelwat probleme van filosofiese en ...

  11. Eksistensialisme in die Franse letterkunde

    A. A. Teurlinckx


    Full Text Available Nooit sou die Franse jeug — en die van Europa en verder — in dié mate deur die eksistensialisme be'invloed gewees het nie, indien hierdie filosofie in wysgerige traktate sou begrawe gelê het. Die eksistensialiste het die koning van die filosofiese verhaal, Voltaire, met sukses op sy Candide- en Zadig-pad gevolg en hulle teorieë in letterkundige werke, ver- hale, romans en ook toneelstukke kwytgeraak, wat baie gelees is en waaruit ook ander literatore kragte en inspirasie geput het. Omrede daarvan is daar inderdaad baie eksistensialisme in die Franse letterkunde, maar ’n eintlike eksistensialistiese letterkunde was daar nie, en ’n Eksistensialistiese Letterkun­ dige skool het nooit bestaan nie. Ook sit hierdie eksistensialiste nie langs dieselfde vuur nie. Die Christelike eksistensialis Gabriel Marcel het op 21 April van hierdie jaar uitgevaar teen die „Sartriane” na aanleiding van die opvoering van Les Paravents, Die W indskerms van Jean Genêt in ’n Paryse staatsondersteunde teater. „Mens mag seker wees”, skryf Marcel in Les Nouvelles Littéraires, „dat die hele sartriaanse parogie sal skreeu: groot meesterwerk”. Voortgaande op sy distansiëring kan die literêre eksistensialiste in drie groepe ingedeel word: 1. Die Sartriane; 2. Die Christelike Eksistensialiste; 3. Die Onafhanklikes.

  12. Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya.

    Ayah, Richard


    Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care. A stratified sample of 31 health facilities in Nairobi County offering ART services were surveyed. Data of patients enrolled on ART and LTFU for the 12 months ending 30th June 2013 were abstracted. Mortality and LTFU were determined and used to rank health facilities. In the facilities with the lowest and highest mortality and LTFU key informant interviews were conducted using a tool adapted from team climate assessment measurement questionnaire and competing value framework tool to assess organizational culture. The strength of association between early mortality, LTFU and organizational culture was tested. Half (51.8%) of the 5,808 patients enrolled into care in 31 health facilities over the 12-month study period were started on ART. Of these 48 (1.6% 95% CI 0.8%-2.4%) died within three months of starting treatment, while a further 125 (4.2% 95% CI 2.1%-6.6%) were LTFU giving an attrition rate of 5.7% (95% CI 3.3%-8.6%). Tuberculosis was the most common comorbidity associated with high early mortality and high LTFU. Organizational culture, specifically an adhocratic type was found to be associated with low early mortality and low LTFU of patients enrolled for HIV care (P = 0.034). The use of ART clinical guidelines in a decentralized health systems are not sufficient to achieve required service delivery outcomes. The attrition rate above would mean 85,000 Kenyans missing care based on current

  13. Results of level-ii oncoplasty in breast cancer patients: an early experience from a tertiary care hospital in pakistan

    Qureshi, S.; Ghazanfar, S.; Quraishy, S.; Iqbal, S.


    Objective: To assess the oncologic and cosmetic outcomes for breast cancer patients who underwent breast conservation therapy using Level II oncoplasty techniques. Methods: The prospective, non-randomised and descriptive study was conducted at the Department of Surgery, Unit IV of Civil Hospital, Karachi, from December 2009 to November 2011 in which 21 consecutive women with breast carcinoma who underwent wide local excision with remodeling mammoplasty were enrolled. All patients were reviewed by the surgeon and medical oncologist every 3 months for the first year. A grading system of 5-1 (excellent to poor) was employed and those with 3 or more were considered to have acceptable results. Results: The mean patient age was 45.38+-10.09 years (range: 26-70); 11 (52.3%) were premenopausal and 10 (47.7%) were postmenopausal; and 5 (27.8%) had family history of breast cancer. The mean size of the tumour determined by histology was 59.9+-3.18 mm (range: 25-150). Eight (30%) patients received preoperative chemotherapy to downsize the tumour. Three (14.2%) patients received preoperative radiotherapy. Mean operative time was 1.59+-0.52 hours (range: 1-2.5 hours). Mean volume of breast tissue excised from the breast containing the tumour was 545.27+-412.06 cm3 (range: 43.70-1456). Assessment of excision margins showed no tumour at the margins of 19 (90.4%) patients. Two (9.5%) patients had close but negative margins. The mean hospital stay was 7.10+-3.30 days (range: 4-15). There were early complications in 4 (19%) patients. One (4.76%) patient had late complications. Two (9.5%) patients developed tumour recurrence; both had an ipsilateral tumour recurrence. None of the patients developed metastases and one died of cardiac problem. Twenty (95.2%) patients had an acceptable post-surgical cosmetic result. Conclusion: Level II oncoplasty was a safe option in breast conservation allowing large sized and difficult-location tumour excision with good cosmetic outcome in the study

  14. Assisted Dying in Canada.

    Schuklenk, Udo

    This paper makes an affirmative ethical case in favour of the decriminalization of assisted dying in Canada. It then proceeds to defending the affirmative case against various slippery-slope arguments that are typically deployed by opponents of assisted dying. Finally, a recent case of questionable professional conduct by anti-euthanasia campaigners cum academics is flagged as a warning to all of us not to permit the quality of the professional debate to deteriorate unacceptably, despite the personal emotional investments involved on all sides of the debate.

  15. Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia

    Georges, J.J.; Philipsen, B.D.; van der, Wal G.; van der, Heide A.; van der Maas, P.J.


    Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In

  16. Early supported discharge for patients with exacerbations of chronic obstructive pulmonary disease

    Ringbaek, T.J.; Nielsen, L.L.; Admasu, H.


    -29) days. While being cared for at home, one patient died and readmission was necessary in 19 (17.6%) cases. Within three months 51.4% of the patients were readmitted and 14.8% died. The income and costs related to ESD were approximately 120,000 EUR and 75,000 EUR, respectively. CONCLUSION: Almost 20......% of all admissions were eligible for ESD. Compared to British studies on ESD, our patients had more severe COPD. We cannot determine whether this model of care has reduced days in hospital, but costs and income seem to balance Udgivelsesdato: 2008/1/7...... the previous year; 159 (18.2%) admissions in 108 patients were suitable for ESD. Prior to ESD, the mean duration of in-hospital stay was 4.0 days. Patients selected for ESD had severe COPD with FEV1 31.8% (7-89%) of predicted value. They had on average 3.8 (1-11) home visits in a mean period of 10.5 (1...

  17. Videofluoroscopy of the pharynx and esophagus in patients with globus pharyngis. Comparison with static radiography; Die radiologische Abklaerung des Globus pharyngis. Vergleich der diagnostischen Wertigkeit von konventionellem Roentgen mit der Videokinematographie

    Schober, E. [Abt. Roentgen fuer Konservative Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Schima, W. [Abt. Roentgen fuer Konservative Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Pokieser, P. [Abt. Roentgen fuer Chirurgische Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)


    The symptom is associated with a multitude of pharyngoesophageal abnormalities. Our study compares the diagnostic yield of videofluoroscopy to that of static radiography in patients suffering from globus pharnygis. A total of 150 consecutive patients complaining of a lump in the throat, but without evidence of dysphagia, were studied in a standardized fashion with both methods. Videofluoroscopy combined with static radiography revealed morphological or functional abnormalities in 75% of our patients. The combination of the two methods yielded significantly more abnormalities in the pharynx and esophagus than videofluoroscopy or static radiography alone. Esophageal motor disorders, pharyngoesophageal sphincter dysfunction and pharyngeal residue of contrast material proved to be the most common abnormalities. In conclusion, videofluoroscopy combined with static radiography is mandatory in the radiological assessment of patients suffering from the globus sensation. (orig.) [Deutsch] Unsere Studie vergleicht die diagnostische Wertigkeit des konventionellen Roentgens mit jener der Videokineamtographie von Pharynx und Oesophagus bei der Abklaerung des Globusgefuehls. Wir haben 150 konsekutive Patienten mit Globusgefuehl, jedoch ohne Dysphagie mit beiden Methoden nach einem standardisierten Protokoll untersucht. Mittels der Kombination von konventionellem Roentgen mit der Videokinematographie fanden sich bei 75% der Patienten pathologische Veraenderungen. Durch die Kombination beider Methoden konnten signifikant mehr morphologische und funktionelle Stoerungen des Pharynx sowie Oesophagus aufgezeigt werden, als mit der alleinigen konventionellen Technik oder der alleinigen Videokinematographie. Die haeufigsten pathologischen Veraenderungen in unserem Kollektiv waren Oesophagusmotilitaetsstoerungen, eine Dyskinesie des pharyngooesophagealen Sphinkters sowie eine abnorme pharyngeale Kontrastmittelretention. Unsere Ergebnisse belegen eindeutig, dass die radiologische

  18. Early insulin therapy in patients with type 2 diabetes mellitus

    Type 2 diabetes mellitus (T2DM) is an insulin-insufficient disease characterised ... complications.1–4 Early in the onset of T2DM there is development of relative insulin ..... position statement of the American Diabetes Association (ADA) and.

  19. Early perfusion changes within 1 week of systemic treatment measured by dynamic contrast-enhanced MRI may predict survival in patients with advanced hepatocellular carcinoma

    Chen, Bang-Bin; Yu, Chih-Wei; Liang, Po-Chin [National Taiwan University College of Medicine and Hospital, Department of Medical Imaging and Radiology, Taipei City (China); Hsu, Chao-Yu [National Taiwan University College of Medicine and Hospital, Department of Medical Imaging and Radiology, Taipei City (China); Taipei Hospital, Ministry of Health and Welfare, Department of Radiology, New Taipei City (China); Hsu, Chiun; Hsu, Chih-Hung; Cheng, Ann-Lii [National Taiwan University College of Medicine and Hospital, Department of Oncology, Taipei City (China); Shih, Tiffany Ting-Fang [National Taiwan University College of Medicine and Hospital, Department of Medical Imaging and Radiology, Taipei City (China); Taipei City Hospital, Department of Medical Imaging, Taipei City (China); National Taiwan University Hospital, Department of Medical Imaging, Taipei (China)


    To correlate early changes in the parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) within 1 week of systemic therapy with overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC). Eighty-nine patients with advanced HCC underwent DCE-MRI before and within 1 week following systemic therapy. The relative changes of six DCE-MRI parameters (Peak, Slope, AUC, Ktrans, Kep and Ve) of the tumours were correlated with OS using the Kaplan-Meier model and the double-sided log-rank test. All patients died and the median survival was 174 days. Among the six DCE-MRI parameters, reductions in Peak, AUC, and Ktrans, were significantly correlated with one another. In addition, patients with a high Peak reduction following treatment had longer OS (P = 0.023) compared with those with a low Peak reduction. In multivariate analysis, a high Peak reduction was an independent favourable prognostic factor in all patients [hazard ratio (HR), 0.622; P = 0.038] after controlling for age, sex, treatment methods, tumour size and stage, and Eastern Cooperative Oncology Group performance status. Early perfusion changes within 1 week following systemic therapy measured by DCE-MRI may aid in the prediction of the clinical outcome in patients with advanced HCC. (orig.)

  20. Die afrikaner en sy pers*

    G. D. Scholtz


    Full Text Available Die versoek w at van u inrigting tot my gekom het om buitengewone professor in die Persw etenskap te word, was vir my deels vererend, m aar deels het dit my in 'n moeilike posisie gestel. Dit was vir my vererend, om dat dit gekom het van 'n universiteit m et wie se Christelik- Nasionale koers ek my ten voile kan vereenselwig. Dit was dan ook vir my vererend, om dat ek daardeur in staat gestel kan w ord om die volk w aartoe ek behoort, op 'n vir my nuwe terrein te dien. As sodanig is dit vir my im m ers m oontlik om ook ’n beskeie bydrae te lewer tot die geestelike vorm ing van die jeug van ons volk. Dit het my m oeilik geval om, w aar ek reeds die m iddeljarige leeftyd bereik het, nou vir die eerste maal as dosent op te tree, aangesien ek daarvan in die verlede nie die m inste kennis en ervaring opgedoen het nie. As joernalis rig ek my im m ers tot die breë publiek deur middel van die pen. As dosent m oet ek my deur middel van die mond tot die studente rig. Dit lê voor die hand dat die eise w at so aan my gestel word, totaal anders is as dié waar- aan ek oor 'n tydperk van m eer as 'n kw arteeu as joer­ nalis gewoond geraak het.

  1. Transarterial chemoembolization in very early and early-stage hepatocellular carcinoma patients excluded from curative treatment: A prospective cohort study

    Bargellini, Irene; Sacco, Rodolfo; Bozzi, Elena; Bertini, Marco; Ginanni, Barbara; Romano, Antonio; Cicorelli, Antonio; Tumino, Emanuele; Federici, Graziana; Cioni, Roberto; Metrangolo, Salvatore; Bertoni, Michele; Bresci, Giampaolo; Parisi, Giuseppe; Altomare, Emanuele; Capria, Alfonso; Bartolozzi, Carlo


    Aim: To assess clinical outcome of transarterial chemoembolization (TACE) in a series of patients with early-stage hepatocellular carcinoma (HCC), within Milan criteria, but clinically unfit for liver transplantation (OLT). Methods: From January 2006 to May 2009, 67 patients (43 males, mean age 70 ± 7.6 years) with very early or early-stage unresectable HCC, within Milan selection criteria but clinically unfit for OLT, underwent TACE. The primary endpoint of the study was overall survival. Secondary endpoints were: safety, liver toxicity, 1-month tumour response according to the amended RECIST criteria, time to local and distant intrahepatic tumour recurrence and time to radiological progression. Results: Two major periprocedural complications occurred (3%), consisting of liver failure. Periprocedural mortality rate was 1.5% (1 patient). A significant increase in ALT and bilirubin levels 24 h after treatment was reported, with progressive decrease at discharge. At 1-month follow-up, complete and partial tumour response rates were 67.2% and 29.8%, respectively, with two cases of progressive disease. Mean follow-up was 37.3 ± 15 months. The 1-, 2-, and 3-year overall survival rates were 90.9%, 86.1%, and 80.5%, respectively. Median expected time to local tumour recurrence and intrahepatic tumour recurrence were 7.9 and 13.8 months, respectively. Radiological disease progression was observed in 12 patients (17.9%) with a mean expected time of 26.5 months. Conclusion: In patients with early-stage HCC, clinically excluded from OLT and unfit for surgery or percutaneous ablation, TACE is a safe and effective option, with favourable long-term survival.

  2. Die vestiging van die Kerk in Natal, die Vrystaat en Transvaal na ...

    as eerste predikant van die Voortrekkers laat orden en bevestig. Daama het verskeie kerksake van tyd tot tyd aandag geniet. Met betrekking tot die bevestiging van huwelike stel Retief 'n meer ordelike reëling daar, naamlik dat die gebooie van voomemende egpa- re van nou af drie maal in die kerk afgekondig moes wrord ...

  3. Effect of lutein intervention on visual function in patients with early age-related macular degeneration

    Chan Li


    Full Text Available AIM: To study the effect of lutein intervention on visual function of patients with early age-related macular degeneration(AMD. METHODS: Totally 200 early AMD patients were divided into lutein intervention group(20mg/dand placebo group by a randomized, double-blind, placebo-controlled trail. Questionnaire investigation, serum lutein concentration and visual function were conducted at baseline, 12, 24, 36 and 48wk respectively. RESULTS: The serum lutein concentration in lutein intervention group was higher than the baseline(PPPPP>0.05. CONCLUSION: Lutein intervention can improve the visual function of patients with early AMD.

  4. Computed tomography: influence of varying tube current on patient dose and correctness of effective dose calculations; Computertomografie: Einfluss des variablen Roehrenstroms auf die Patientendosis und die Genauigkeit von Berechnungen der effektiven Dosis

    Hietschold, V. [Inst. und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl-Gustav-Carus der TU Dresden (Germany); Koch, A.; Laniado, M.; Abolmaali, N.D. [OncoRay, Molecular Imaging, TU Dresden (Germany)


    Purpose: determination of the influence of tube currents varying during a CT scan on organ doses and on the effective dose as a function of patient constitution. Evaluation of the accuracy of effective dose calculations based on summarizing parameters (effective mAs, dose length product [DLP]) compared to calculations based on slice-specific tube currents. Materials and methods: investigation of the CT datasets of 806 patients acquired from the skull base to the proximal thigh with respect to the body mass index (BMI). The effective dose was calculated by means of slice-specific as well as region-specific conversion factors. Results: dose optimization by means of variable tube current resulted in a reduction of the gonad dose in patients with BMI {<=} 20.. 21 kg/m{sup 2} and of the effective dose in patients with BMI {<=} 26 kg/m{sup 2}. Effective dose values calculated with the DLP for 90% of the patients are within an interval of {+-} 20% of the values calculated using slice-specific tube currents. Conclusion: if tube current optimization during the CT scan was applied, for the scan region under investigation, at a BMI already below the German mean value, an increased effective dose was observed. Calculations of the effective dose on the basis of summarizing values such as DLP or effective mAs are of sufficient accuracy. (orig.)

  5. Early recurrence in standard-risk medulloblastoma patients with the common idic(17)(p11.2) rearrangement

    Bien-Willner, Gabriel A.; López-Terrada, Dolores; Bhattacharjee, Meena B.; Patel, Kayuri U.; Stankiewicz, Paweł; Lupski, James R.; Pfeifer, John D.; Perry, Arie


    Medulloblastoma is diagnosed histologically; treatment depends on staging and age of onset. Whereas clinical factors identify a standard- and a high-risk population, these findings cannot differentiate which standard-risk patients will relapse and die. Outcome is thought to be influenced by tumor subtype and molecular alterations. Poor prognosis has been associated with isochromosome (i)17q in some but not all studies. In most instances, molecular investigations document that i17q is not a true isochromosome but rather an isodicentric chromosome, idic(17)(p11.2), with rearrangement breakpoints mapping within the REPA/REPB region on 17p11.2. This study explores the clinical utility of testing for idic(17)(p11.2) rearrangements using an assay based on fluorescent in situ hybridization (FISH). This test was applied to 58 consecutive standard- and high-risk medulloblastomas with a 5-year minimum of clinical follow-up. The presence of i17q (ie, including cases not involving the common breakpoint), idic(17)(p11.2), and histologic subtype was correlated with clinical outcome. Overall survival (OS) and disease-free survival (DFS) were consistent with literature reports. Fourteen patients (25%) had i17q, with 10 (18%) involving the common isodicentric rearrangement. The presence of i17q was associated with a poor prognosis. OS and DFS were poor in all cases with anaplasia (4), unresectable disease (7), and metastases at presentation (10); however, patients with standard-risk tumors fared better. Of these 44 cases, tumors with idic(17)(p11.2) were associated with significantly worse patient outcomes and shorter mean DFS. FISH detection of idic(17)(p11.2) may be useful for risk stratification in standard-risk patients. The presence of this abnormal chromosome is associated with early recurrence of medulloblastoma. PMID:22573308

  6. Where is God in My Dying?

    Moestrup, Lene; Hvidt, Niels Christian


    Despite increased focus on the role of spiritual care in palliative care, there is limited knowledge about spirituality / religiosity among dying patients in secularized cultures such as Denmark. This study aims through semi-structured interviews with Danish hospice patients and participant obser......, important faith although it was not something they knew much about, let alone discussed or practiced much....

  7. Die skool en die onderwyser as faktore in die geestesgesondheid van die kind*

    B. C. Schutte


    Full Text Available Ons hou geestesgesondheidsweke, stig beroepsentrums, samel geld in om mense wat geestelik siek is te genees, klae oor die tekort aan psigiaters, kliniese sielkundiges, bedryfsielkundiges, voorligters, skoolpsigoloë,ens. ’n Karige kwarteeu gelede het ons aan al hierdie dinge slegs akademiese aandag gewy. In hierdie kursus wordverskeie tipes kinders bespreek en geleer hoe om hulle probleme te benader.

  8. When Somebody Dies

    ... bottle became useless. The container is gone, but what's inside — the water — remains. The part of a person that's left after the body dies is often called the "soul" or "spirit." Some people believe the soul is the part ...

  9. Die Kunst des Scheiterns

    Juul, Jesper


    Menschen haben von Kindesbeinen an das Verlangen, Erfolge zu erzielen und Kompetenz zu erreichen. Computerspieler entscheiden sich jedoch fortlaufend für eine Aktivität, die oft und wiederholt zum Verlieren führen muss und ein taubes Gefühl der Unfähigkeit erzeugt. Im Kino, im Theatersaal und bei...

  10. Modelle in die onderrig van fisika

    J. J. A. Smit


    Full Text Available Die rol van modelle in die onderrig van fisika is sedert die vroeë tagtigerjare erken. In die onderrig word die absent op die kwantitaiewe aspekte van die vak geplaas, terwyl die kwatitatiewe aspekte min aandag kry.


    31 Okt 1977 ... stelling van 'n higiene afdeling het in 'n belang- rike behoefte voorsien. Die pligte van die SAGO het dus op hierdie stadium die ondersoek van soldate, die sanita- sie van kampe, die verpleging van pasiente in militere hospitale en die opleiding van lede be- hels. 'n Hoogtepunt was die opening van die.

  12. Dimensional control of die castings

    Karve, Aniruddha Ajit

    The demand for net shape die castings, which require little or no machining, is steadily increasing. Stringent customer requirements are forcing die casters to deliver high quality castings in increasingly short lead times. Dimensional conformance to customer specifications is an inherent part of die casting quality. The dimensional attributes of a die casting are essentially dependent upon many factors--the quality of the die and the degree of control over the process variables being the two major sources of dimensional error in die castings. This study focused on investigating the nature and the causes of dimensional error in die castings. The two major components of dimensional error i.e., dimensional variability and die allowance were studied. The major effort of this study was to qualitatively and quantitatively study the effects of casting geometry and process variables on die casting dimensional variability and die allowance. This was accomplished by detailed dimensional data collection at production die casting sites. Robust feature characterization schemes were developed to describe complex casting geometry in quantitative terms. Empirical modeling was utilized to quantify the effects of the casting variables on dimensional variability and die allowance for die casting features. A number of casting geometry and process variables were found to affect dimensional variability in die castings. The dimensional variability was evaluated by comparisons with current published dimensional tolerance standards. The casting geometry was found to play a significant role in influencing the die allowance of the features measured. The predictive models developed for dimensional variability and die allowance were evaluated to test their effectiveness. Finally, the relative impact of all the components of dimensional error in die castings was put into perspective, and general guidelines for effective dimensional control in the die casting plant were laid out. The results of

  13. Die transvaalse ontwerp-ordonnansie oor die onderwys

    J. C. Coetzee


    Full Text Available In ’n Buitengewone Provinsiale Koerant van die Provinsie Transvaal is onder datum 25 Junie 1952 gepubliseer ’n „Ontwerp-Ordonnansie tot samevatting en wysiging van die Wette betreffende die Sentrale Beheer van die Onderwys, die Plaaslike Beheer van Skole, Godsdiensonderrig in Openbare Skole, Taal en die Onderwys, Onderwyspersoneel, Verpligte Onderwys, Toelating van Leerlinge tot Skole, Klasse of Inrigtings, Openbare Onderwys, Private Skole, Onderwys vir Kleurlinge en Asiate en Onderwys vir Naturelle, en om vir sake in verband daarmee voorsiening te maak” .


    v a k t a a l k w a l i £ i k a s i e s ) neem d i e I n s t i t u t t a l l e take waar ter u i t b r e i d i n g van kennis van die Duitse taal in die buiteland. Sedert 1964 publiseer die. Institut die tydskrif Deutsch als Fremdsprache met die bylae Sprachpraxis, asook 'n handboek met die titel Deutsch - eln Lehrbuch Eur Auslander (Duits.

  15. Navigating "Assisted Dying".

    Schipper, Harvey


    Carter is a bellwether decision, an adjudication on a narrow point of law whose implications are vast across society, and whose impact may not be realized for years. Coupled with Quebec's Act Respecting End-of-life Care it has sharply changed the legal landscape with respect to actively ending a person's life. "Medically assisted dying" will be permitted under circumstances, and through processes, which have yet to be operationally defined. This decision carries with it moral assumptions, which mean that it will be difficult to reach a unifying consensus. For some, the decision and Act reflect a modern acknowledgement of individual autonomy. For others, allowing such acts is morally unspeakable. Having opened the Pandora's Box, the question becomes one of navigating a tolerable societal path. I believe it is possible to achieve a workable solution based on the core principle that "medically assisted dying" should be a very rarely employed last option, subject to transparent ongoing review, specifically as to why it was deemed necessary. My analysis is based on 1. The societal conditions in which have fostered demand for "assisted dying", 2. Actions in other jurisdictions, 3. Carter and Quebec Bill 52, 4. Political considerations, 5. Current medical practice. Leading to a series of recommendations regarding. 1. Legislation and regulation, 2. The role of professional regulatory agencies, 3. Medical professions education and practice, 4. Public education, 5. Health care delivery and palliative care. Given the burden of public opinion, and the legal steps already taken, a process for assisted-dying is required. However, those legal and regulatory steps should only be considered a necessary and defensive first step in a two stage process. The larger goal, the second step, is to drive the improvement of care, and thus minimize assisted-dying.

  16. Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer

    Knuttel, Floor; van den Bosch, Maurice A A J; Young-Afat, Danny A.; Emaus, Marleen J.; van den Bongard, Desirée H J G; Witkamp, Arjen J.; Verkooijen, Helena M.

    Background: Noninvasive or minimally invasive treatments are being developed as alternatives to surgery for patients with early-stage breast cancer. Patients' preferences with regard to these new treatments have not been investigated. Objectives: To assess preferences of patients with breast cancer

  17. Effectiveness of early adalimumab therapy in psoriatic arthritis patients from - EARLY PsA.

    Santos, Helena; Eusébio, Mónica; Borges, Joana; Gonçalves, Diana; Ávila-Ribeiro, Pedro; Faria, Daniela Santos; Lopes, Carina; Rovisco, João; Águeda, Ana; Nero, Patrícia; Valente, Paula; Cravo, Ana Rita; Santos, Maria José


    Objective To compare outcomes in psoriatic arthritis (PsA) patients initiating adalimumab (ADA), with short- and long-term disease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids. Methods Analyses included adult PsA patients registered in the Rheumatic Diseases Portuguese Register ( between June 2008-June 2016 who received ADA for ≥3 months. Psoriatic Arthritis Response Criteria (PsARC) response, tender and swollen joint count, inflammatory parameters, patient (PtGA) and physician global assessment (PhGA), Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire Disability Index (HAQ-DI) were compared between patients with PsA) and those with ≥5 years of disease duration (late PsA). Time to achieving PsARC response was estimated using the Kaplan-Meier method. Results Of 135 PsA patients treated with ADA, 126 had information on disease duration (earlyPsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs 62.2% late PsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs 75.9% late PsA; P=0.044). Early PsA patients achieved significantly less painful joints (2.7 vs 6.7, p=0.006), lower mean C-reactive protein (0.5 mg/dL vs 1.3 mg/dL; P=0.011), and PhGA (18.3 vs 28.1; P=0.020) at 3 months. In the long term, early PsA patients also had fewer swollen joints (0.3 vs 1.7; P=0.030) and lower PhGA (6.3 vs 21.9; PPsA, respectively. Early PsA patients obtained PsARC response more rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concomitant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs 60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC response over 2 years of follow-up. Persistence on ADA was similar in both groups. Conclusion Early PsA patients had a greater chance of improvement after ADA therapy and better functional outcome, and

  18. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U


    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  19. Differential Neurodevelopmental Trajectories in Patients With Early-Onset Bipolar and Schizophrenia Disorders

    Arango, Celso


    Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders. PMID:24371326

  20. A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions.

    Abbott, Tom E F; Torrance, Hew D T; Cron, Nicholas; Vaid, Nidhi; Emmanuel, Julian


    The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. This was a prospective cohort study of adult medical admissions to a single-centre over 20days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2days of hospital admission. The secondary outcome was hospital length of stay. After accounting for missing data, 15 patients out of 322 (4.7%) died or were escalated to the critical care unit. The median length of stay was 4 (IQR 7) days. When combined with lactate or base excess, NEWS was associated with the primary outcome (OR 1.18, p=0.01 and OR 1.13, p=0.03). However, NEWS alone was more strongly associated with the primary outcome measure (OR 1.46, pglucose was not associated with the primary outcome. Neither NEWS nor any combination of NEWS and a biomarker were associated with hospital length of stay. Admission NEWS is more strongly associated with death or critical care unit admission within 2days of hospital admission, compared to combinations of NEWS and blood-gas derived biomarkers. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  1. External validation of the Emergency Trauma Score for early prediction of mortality in trauma patients

    Joosse, Pieter; de Jong, Willem-Jan J.; Reitsma, Johannes B.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel


    The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and

  2. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base

  3. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer.

    Li, B; Liu, H Y; Guo, S H; Sun, P; Gong, F M; Jia, B Q


    The impact of early enteral nutrition (EEN) on clinical outcomes of gastric cancer patients was investigated. Three hundred pa-tients undergoing gastric cancer surgery from July 2010 to May 2014 were randomly divided into experimental and control groups (n = 150/group). Experimental group patients received enteral nutrition in water during the early postoperative period. Control group patients received conventional perioperative treatment. Patients' clinical outcomes, post-operative immune function, and nutritional statuses were compared, which revealed that the postoperative fever duration (80.2 ± 6.0 vs 88.1 ± 8.1 h, P 0.05]. At postoperative days 3 and 7, the CD3(+), CD4(+), natural killer cell, albumin, and prealbumin levels and CD4(+)/CD8(+) ra-tio were significantly higher in the experimental group than the control group (all P nutritional status and immune function and promote early recovery of intestinal function in patients with gastric cancer.

  4. Patient involvement in own rehabilitation after early discharge

    Hørdam, Britta; Boolsen, Merete Watt


    _en.pdf). Recent research suggests that patient involvement after hip replacement is a very effective strategy in older adults with regard to improving walking ability and reducing pain and thereby lessening loss of physical, mental and social aspects of the quality of life. The growing number of older adults all...... hospital and home. Population: Empirical data were collected by carrying out three randomised clinical trials (RCT) focusing on self-rated health and involvement of patients undergoing total hip replacement in three Danish orthopaedic clinics. Based on power calculation, 260 patients (mean age 67.5 years...

  5. Treatment outcome in patients with triple negative early stage breast cancers compared with other molecular subtypes

    Kim, Ja Young; Chang, Sei Kyung; Lee, Bo Mi; Shin, Hyun Soo; Park, Heily


    To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p 0.05). We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.

  6. [Working memory for music in patients with mild cognitive impairment and early stage Alzheimer's disease].

    Kerer, Manuela; Marksteiner, Josef; Hinterhuber, Hartmann; Mazzola, Guerino; Kemmler, Georg; Bliem, Harald R; Weiss, Elisabeth M


    A variety of studies demonstrated that some forms of memory for music are spared in dementia, but only few studies have investigated patients with early stages of dementia. In this pilot-study we tested working memory for music in patients with mild cognitive impairment (MCI) and early stage Alzheimer's disease (AD) with a newly created test. The test probed working memory using 7 gradually elongated tone-lines and 6 chords which were each followed by 3 similar items and 1 identical item. The participants of the study, namely 10 patients with MCI, 10 patients with early stage AD and 23 healthy subjects were instructed to select the identical tone-line or chord. Subjects with MCI and early AD showed significantly reduced performance than controls in most of the presented tasks. In recognizing chords MCI- participants surprisingly showed an unimpaired performance. The gradual increase of the impairment during the preclinical phase of AD seems to spare this special ability in MCI.

  7. Die historiese betroubaarheid van die aartsvadervertellinge. 'n Beknopte bespreking van die huidige debat na aanleiding van die jongste publikasie

    W. Vosloo


    Full Text Available Die afgelope twintig jaar was daar �n toenemende belangstelling in die aartsvadervertellinge in Genesis. Benewens die talle tydskrifartikels het skrywers soos die volgende ook boeke oor die onderwerp die lig laat sien: A. Parrot (1962, W. M. Clark (1964, R. Kilian (1966, R. E. Clements (1967, N. Lohfink (1967, H. Weidemann (1968, R. Martin-Achard (1969, T. L. Thompson (1974, J. van Seters (1975, J. P. Fokkelman (1975, C. Westermann (1976, R. Rendtorff (1977, J. Bright (1977, W. McKane (1979 en A. R. Millard en D. J. Wiseman (1980.

  8. 'n Kwalitatiewe ondersoek na die invloed van aspekte van die ...

    S Blignaut

    ISSN 0378-5254 Journal of Family Ecology and Consumer Sciences, Vol 26: No1, 1998. 15 ...... van byvoorbeeld die televisie en gedrukte media 'n invloed op die .... fashion promotion and advertising. New York. ... Consumer behaviour to-.

  9. Effect of deferred or no treatment with ursodeoxycholic acid in patients with early primary biliary cholangitis.

    Tanaka, Atsushi; Hirohara, Junko; Nakano, Toshiaki; Yagi, Minami; Namisaki, Tadashi; Yoshiji, Hitoshi; Nakanuma, Yasuni; Takikawa, Hajime


    As primary biliary cholangitis (PBC) is a heterogeneous disease, we hypothesized that there is a population of patients with early PBC who do not require prompt treatment with ursodeoxycholic acid (UDCA). In this study, we analyzed data from a large-scale PBC cohort in Japan, and retrospectively investigated whether outcomes of early PBC patients were affected with prompt or deferred/no UDCA treatment. We defined early PBC as asymptomatic, serum alkaline phosphatase early PBC patients between the treatment regimens; prompt treatment group (UDCA was initiated within 1 year after diagnosis) and deferred/no treatment group (UDCA initiated >1 year after diagnosis or never initiated). Furthermore, we examined the outcomes of early PBC patients alternatively defined only with symptomatology and biochemistry. We identified 562 early PBC patients (prompt: n = 509; deferred/no treatment: n = 53). Incidence rates (per 1000 patient-years) for liver-related mortality or liver transplantation and decompensating events were 0.5 and 5.4, respectively, in the prompt treatment group, and 0 and 8.7, respectively, in the deferred/no treatment group. Multivariate analyses showed that age and bilirubin were significantly associated with developing decompensating events, whereas the prompt and deferred/no treatments were not. We obtained similar results in early PBC patients defined without histological examination. We showed that deferred/no treatment for early PBC patients did not affect the outcomes. This study provides a rationale for a future prospective, randomized study. © 2018 The Japan Society of Hepatology.

  10. Antibodies to early EBV, CMV, and HHV6 antigens in systemic lupus erythematosus patients

    Rasmussen, N S; Draborg, A H; Nielsen, C T


    OBJECTIVES: We investigated the antibody levels against early antigens of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV6) in systemic lupus erythematosus (SLE) patients and healthy controls, and further correlated these antibodies to haematology/biochemistry, serol......OBJECTIVES: We investigated the antibody levels against early antigens of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV6) in systemic lupus erythematosus (SLE) patients and healthy controls, and further correlated these antibodies to haematology...

  11. Zonulin, inflammation and iron status in patients with early stages of chronic kidney disease

    Lukaszyk, Ewelina; Lukaszyk, Mateusz; Koc-Zorawska, Ewa; Bodzenta-Lukaszyk, Anna; Malyszko, Jolanta


    Background/aims Zonulin is the only known regulator of intestinal permeability. It is also considered as a potential inflammatory marker in several conditions such as diabetes and inflammatory bowel syndrome. The aim of the study was to investigate zonulin levels in patients with early stages of CKD and its possible correlation with inflammation, anemia and iron status parameters. Methods Eighty-eight patients with early stages of CKD and 23 healthy volunteers were enrolled in the study. Zonu...

  12. Modeling the Mechanical Performance of Die Casting Dies

    R. Allen Miller


    The following report covers work performed at Ohio State on modeling the mechanical performance of dies. The focus of the project was development and particularly verification of finite element techniques used to model and predict displacements and stresses in die casting dies. The work entails a major case study performed with and industrial partner on a production die and laboratory experiments performed at Ohio State.



    vergewe. Dit sou in orde gewees het as daar gestaan het, ReMomë- j^onta^is hepta?ds. wat die grieks is vir sewentig maal sewe. Die uitdrukking. heMom&ontabis heptd sien hoogswaarskynlik op Gen. 4 : 24 (LXX) waar. Lameg meedeel dat hy sewe-en-sewentig-maal gewreek sal word. Daar sit die Afr. Vert, die uitdrukking ...

  14. Film Presentation: Die Urknallmaschine

    Carolyn Lee


    Die Urknallmaschine, an Austrian film by Gerd Baldauf, narrated by Norbert Frischauf (Alpha Österreich - ORF, 2009).  In CERN’s gigantic complex particles are accelerated to almost the speed of light, brought to collision and made to divide into even smaller particles. Public opinion of CERN’s research is also divided. Sceptics fear that black holes may be created. Might the goal to study the origin of the world lead to its destruction? The Austrian researcher Norbert Frischauf worked at CERN for many years. With his guidance it is possible to explore the world’s largest research centre, get a glimpse of the fascinating work the scientists do there and take a crash course in particle physics. Die Urknallmaschine will be presented on Friday, 25 June from 13:00 to 14:00 in the Main Auditorium. Language: German

  15. Early rehabilitation outcome in patients with middle cerebral artery stroke.

    Balaban, Birol; Tok, Fatih; Yavuz, Ferdi; Yaşar, Evren; Alaca, Rıdvan


    Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation (Prehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation (P>0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.



    aangetoon het, 'n huis in Kapernaum gehad en hierdie geskiedenis speel in Kapernaum of daar digby af. Jesus en sy dissipele het namelik, volgens 6:35 geland by Gennesaret, net suid van Kapernaum Die gevolgtrekking word ondersteun deur Joh. 6:17 waarvolgens die dissi pele na die spysiging op Kapernaum gevaar ...

  17. 'n Verkenning van die soorte vennootskappe in die Amerikaanse reg ...

    In die Amerikaanse literatuur word talle verwysings gevind na die vennootskap in mynbou ("mining partnership"), familievennootskap ("family partnership", vennootskap in vaste eiendom ("partnership in real estate") en vennootskap vir boerdery ("farming partnership"). Hierdie onderskeiding is primer gebaseer op die tipe ...

  18. Geslagsverskille in die ouditiewe ontlokte potensiaal van die brein

    Anita D Stuart


    Full Text Available Gender differences in the auditory evoked potential of the brain. Based on literature indications of an association between temperament characteristics and the evoked potential of the brain, and indications of gender differences in certain temperament traits, the purpose of this study was to ascertain whether evoked responses also differentiated between the genders. A sample of 81 male and 210 female students was randomly selected. Two auditory evoked potential procedures were applied. The results indicated statistically significant differences in evoked potential responses between the genders. The results are interpreted against the background of sensory and neurological sources of the evoked potential responses and linked to the neurophysiological foundations of temperament. Opsomming: Gegrond op aanduidings in die literatuur van ’n assosiasie tussen temperamentskenmerke en die ontlokte potensiaal van die brein, sowel as aanduidings van geslagsverskille in sekere temperamentstrekke, was die doel van die huidige studie om te bepaal of ontloktepotensiaal-response ook tussen die geslagte onderskei. ’n Steekproef van 81 manlike en 210 vroulike studente is ewekansig geselekteer. Twee ouditiewe ontloktepotensiaal- prosedures is toegepas. Die resultate het op statisties beduidende verskille tussen die geslagte gedui. Die bevindinge word teen die agtergrond van die sensoriese en neurologiese oorsprong van ontloktepotensiaal–response geïnterpreteer en verbind aan die neurofisiologiese verankering van temperament.

  19. Die 'postmoderne' stempel in die Nuwe-Testamentiese hermeneutiek

    georiënteerde teorie en kritiek wat volgens Moore opbou tot 'n herhaling binne. Bybelnavorsing. Dit het reeds by Immanuel Kant begin. Sedert Kant is dit proble- maties cm die objek van kennis te beskou as iets wat kennis objektief in sigself bevat. Objektiwisme is prys gegee. Dialektiek het in die plek daarvan gekom. Die.

  20. duele verse sowel as die somtotaal die leser

    27 Jan 2006 ... selfs 'n landkaart afgedruk) terwyl dit ter- selfdertyd ver bo die lokale uitstyg. Die digter is sterk bewus van sy omgewing, geskiedenis en tradisies, maar veral van die algemene menslike kondisie wat binne hierdie referensiekader vergestalt word. Hy gebruik 'n bekende historiese slagveld as bundeltitel (en ...

  1. Die Leben Einsteins eine Reise durch die Geschichte der Physik



    Jeder kennt die Namen Einstein, Newton oder Galilei. aber was weiss man über sie? Hier ein Porträt Einsteins anhand von sechs Meilensteinen aus der Geschichte der Physik. Einstein tritt auf als Protagonist in verschiedenen Epochen und bei verschiedenen Entdeckungen, die die Welt verändert haben.



    Die offerfees te Gibeon was 'n plegtigheid, waaraan geheel Israel deelgeneem het. Die duisend. "brandoffers" wat sowel Kon. as Kron. vermeld, sal wel opgevat moet word as „brandoffers en dankoffers", sodat daar vir die aanwesiges. *n groot feesmaaltyd aangerig is, vgl. I Kon. 3:15. n Sodanige maal- tyd verbind vors en ...

  3. Ruimtelike beplanning: die rol van die stads - en streeksbeplanner ...

    Ruimtelike beplanning: die rol van die stads - en streeksbeplanner in die saw. R Erasmus. Abstract. Since 1978 regional and town planners are employed in the SADF on a permanent basis as well as in the capacity of national service men. These men are all academically qualified and as such satisfy a need that developed ...

  4. n opinie oor die behaviouristiese siening versus die fenomenologie ...

    verband die eksperimente van Pavlov, Thorndike,. Skinner, Tolmann en Hull.) Fenomenologie. Die fenomenologie is 'n essensie-openbarende denkrigting. Dit impliseer'n denkende soektog na dit wat 'n besondere verskynsel of werklikheid maak juis dit wat dit is en nie iets anders nie. In die fenomenologiese antropologie ...

  5. Die onderrigtaak van die verpleegpraktisyn in die saalsituasie

    M.E.C. Potgieter


    Full Text Available The ward sister, being the senior nurse practitioner on the ward, has an important teaching task. This teaching, although mainly directed towards the student nurse, also includes all categories of workers in the ward as well as the patient and his family. Teaching on the ward mainly takes place on an informal basis, but some methods of formal teaching can be used with excellent results.

  6. Research advances in indicators for early diagnosis of liver cirrhosis patients with renal impairment

    LU Lifang


    Full Text Available The liver is closely associated with the kidney, and liver injury in various stages can cause various kidney diseases to varying degrees, which further lead to renal impairment. Such renal impairment in the early stage is often functional and can be reversed by drugs, otherwise it can progress to hepatorenal syndrome, cause acute renal failure, and even threaten human life. The indicators such as serum creatinine and urea nitrogen have a limited effect in the early diagnosis of renal impairment and cannot be used for early monitoring and diagnosis of liver cirrhosis patients with renal impairment. Therefore, early monitoring of liver cirrhosis patients with renal impairment has always been a hot topic in this field. This article summarizes the research advances in the indicators for early diagnosis of renal impairment.

  7. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?

    Lau, Christine; Stilos, Kalli; Nowell, Allyson; Lau, Fanchea; Moore, Jennifer; Wynnychuk, Lesia


    Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P care and assessment across the organization is still required.

  8. Die Vier Typen von Projektmanagern

    Lund Pedersen, Carsten; Ritter, Thomas


    Bevor Sie einem Mitarbeiter die Leitung eines Projekts anvertrauen, sollten Sie sich über dessen Managementstil klar werden. Passt dieser nicht zur Art des Vorhabens, wird er scheitern. So treffen Sie die richtige Wahl....

  9. Die historiese Jesus as wondenverker

    Biblical Association, te wete 'The social sciences and second Testament exegesis'. John Pilch is die leier van die Society of Biblical Literature se 'Social sciences and ..... Hollenbach, P 1982. ... Stauffer, E 1982. Jesus ... London: Collins.

  10. Early insulin therapy in patients with type 2 diabetes mellitus ...

    Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. 'Clinical inertia' in T2DM, defined as lack of initiation or ...

  11. Early interim 18F-FDG PET in Hodgkin's lymphoma: evaluation on 304 patients

    Zinzani, Pier Luigi; Stefoni, Vittorio; Broccoli, Alessandro; Argnani, Lisa; Baccarani, Michele; Rigacci, Luigi; Puccini, Benedetta; Castagnoli, Antonio; Vaggelli, Luca; Zanoni, Lucia; Fanti, Stefano


    The use of early (interim) PET restaging during first-line therapy of Hodgkin's lymphoma (HL) in clinical practice has considerably increased because of its ability to provide early recognition of treatment failure allowing patients to be transferred to more intensive treatment regimens. Between June 1997 and June 2009, 304 patients with newly diagnosed HL (147 early stage and 157 advanced stage) were treated with the ABVD regimen at two Italian institutions. Patients underwent PET staging and restaging at baseline, after two cycles of therapy and at the end of the treatment. Of the 304 patients, 53 showed a positive interim PET scan and of these only 13 (24.5%) achieved continuous complete remission (CCR), whereas 251 patients showed a negative PET scan and of these 231 (92%) achieved CCR. Comparison between interim PET-positive and interim PET-negative patients indicated a significant association between PET findings and 9-year progression-free survival and 9-year overall survival, with a median follow-up of 31 months. Among the early-stage patients, 19 had a positive interim PET scan and only 4 (21%) achieved CCR; among the 128 patients with a negative interim PET scan, 122 (97.6%) achieved CCR. Among the advanced-stage patients, 34 showed a persistently positive PET scan with only 9 (26.4%) achieving CCR, whereas 123 showed a negative interim PET scan with 109 (88.6%) achieving CCR. Our results demonstrate the role of an early PET scan as a significant step forward in the management of patients with early-stage or advanced-stage HL. (orig.)

  12. Risk Factors for Early-Onset Peritonitis in Southern Chinese Peritoneal Dialysis Patients.

    Wu, Haishan; Huang, Rong; Yi, Chunyan; Wu, Juan; Guo, Qunying; Zhou, Qian; Yu, Xueqing; Yang, Xiao

    ♦ BACKGROUND: Early peritonitis was confirmed to be associated with a higher risk of early technique failure. However, literature concerning peritonitis within the first 3 months of peritoneal dialysis (PD) initiation is scarce. The present study was to investigate risk factors associated with early-onset peritonitis in PD patients. ♦ METHODS: In this retrospective observational cohort study, all incident PD patients from January 1, 2006, to December 31, 2013, were recruited and followed up until December 31, 2014. According to time-to-first episode of peritonitis, patients were divided into early-onset (≤ 3 months) peritonitis and late-onset (> 3 months) peritonitis. Baseline demographic, clinical, and laboratory data, as well as episodes of peritonitis, were collected. Risk factors associated with early-onset peritonitis were evaluated using logistic regression model. ♦ RESULTS: Of 1,690 patients on PD, 503 (29.8%) developed at least 1 episode of peritonitis and 118 (7.0%) patients presented the first episodes of peritonitis within the first 3 months. A multivariate logistic analysis showed that higher body mass index (BMI) (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01 - 1.15, p = 0.034), hypoalbuminemia (OR 1.75, 95% CI 1.11 - 2.78, p = 0.017), and catheter exit-site infection (OR 4.14, 95% CI 2.45 - 7.00, p peritonitis. Compared to those with late-onset, patients with early-onset peritonitis had a higher overall peritonitis rate (0.76 vs 0.38 per patient-year, p 0.05). ♦ CONCLUSIONS: Higher BMI, hypoalbuminemia, and catheter exit-site infection were the risk factors associated with early-onset peritonitis in PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

  13. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    Dankiewicz, J; Nielsen, N; Annborn, M


    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...

  14. Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients.

    Lee, J-H; Koo, C-H; Lee, S-Y; Kim, E-H; Song, I-K; Kim, H-S; Kim, C-S; Kim, J-T


    Few studies investigated the optimal timing for tracheostomy and its influence on the clinical outcomes in critically ill pediatric patients. This study evaluated the differences in clinical outcomes between early and late tracheostomy in pediatric intensive care unit (ICU) patients. We assessed 111 pediatric patients. Patients who underwent a tracheostomy within 14 days of mechanical ventilation (MV) were assigned to the early tracheostomy group, whereas those who underwent tracheostomy after 14 days of MV were included in the late tracheostomy group. Clinical outcomes, including mortality, duration of MV, length of ICU and hospital stays, and incidence of ventilator-associated pneumonia (VAP) were compared between the groups. Of the 111 pediatric patients, 61 and 50 were included in the early and late tracheostomy groups, respectively. Total MV duration and the length of ICU and hospital stay were significantly longer in the late tracheostomy group than in the early tracheostomy group (all P tracheostomy was 2.6 and 3.8 in the early and late tracheostomy groups, respectively. There were no significant differences in mortality rate between the groups. No severe complications were associated with tracheostomy itself. Tracheostomy performed within 14 days after the initiation of MV was associated with reduced duration of MV and length of ICU and hospital stay. Although there was no effect on mortality rate, children may benefit from early tracheostomy without severe complications. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  15. Early onset facioscapulohumeral dystrophy - a systematic review using individual patient data.

    Goselink, Rianne J M; Voermans, Nicol C; Okkersen, Kees; Brouwer, Oebele F; Padberg, George W; Nikolic, Ana; Tupler, Rossella; Dorobek, Malgorzata; Mah, Jean K; van Engelen, Baziel G M; Schreuder, Tim H A; Erasmus, Corrie E


    Infantile or early onset is estimated to occur in around 10% of all facioscapulohumeral dystrophy (FSHD) patients. Although small series of early onset FSHD patients have been reported, comprehensive data on the clinical phenotype is missing. We performed a systematic literature search on the clinical features of early onset FSHD comprising a total of 43 articles with individual data on 227 patients. Additional data from four cohorts was provided by the authors. Mean age at reporting was 18.8 years, and 40% of patients were wheelchair-dependent at that age. Half of the patients had systemic features, including hearing loss (40%), retinal abnormalities (37%) and developmental delay (8%). We found an inverse correlation between repeat size and disease severity, similar to adult-onset FSHD. De novo FSHD1 mutations were more prevalent than in adult-onset FSHD. Compared to adult FSHD, our findings indicate that early onset FSHD is overall characterized by a more severe muscle phenotype and a higher prevalence of systemic features. However, similar as in adults, a significant clinical heterogeneity was observed. Based on this, we consider early onset FSHD to be on the severe end of the FSHD disease spectrum. We found natural history studies and treatment studies to be very scarce in early onset FSHD, therefore longitudinal studies are needed to improve prognostication, clinical management and trial-readiness. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Precision die design by the die expansion method

    Ibhadode, A O Akii


    This book presents a new method for the design of the precision dies used in cold-forging, extrusion and drawing processes. The method is based upon die expansion, and attempts to provide a clear-cut theoretical basis for the selection of critical die dimensions for this group of precision dies when the tolerance on product diameter (or thickness) is specified. It also presents a procedure for selecting the minimum-production-cost die from among a set of design alternatives. The mathematical content of the book is relatively simple and will present no difficulty to those who have taken basic c

  17. Die Dokter-Pasient Rolverwantskap

    17 Aug 1974 ... en as sodanig 'n ral sped in die persoon se siektegedrag en uiteindelike patroon van hulpsoeke. SIEKEROL EN SOSIALISERING IN DIE. PASIENTROL ..... more cumulative, resulting in a more gradual social and professional maturation.' Vit die voorafgaande word dit duidelik dat Dewy se pragmatiese ...

  18. prosesseringsmetodes op die voedingswaarde van

    gebring is, kon geen betekenisvolle verskille tussen die drie monsters gevind word nie. Volgens Opstvedt (1976) kan ME waardes ook dien as 'n kriteria van proteien- kwaliteit, hoofsaaklik a.g.v. die verhoogde stikstofuit- skeiding in die urine wat sal plaasvind a.g.v. beskadiging van aminosure. De Groote (1968) het gevind ...


    wei die verdediging van die landsgrense teen 'n vyand wat die orde, gesag, vrede, stabiliteit en welvaart in Suidwes-Afrika en die Republiek van. Suid-Afrika wil vernietig. Hierdie oorlog moet nie ge'lsoleerd gesien word nie, maar in perspektief geplaas word teen die agtergrond van 'n nag groter konflik, naamlik die van die ...

  20. Die Subjektiewe en Objektiewe doelwitte van Arbeid

    T. H. Veldsman


    Die artikel gee aandag aan die subjektiewe en objektiewe doelwitte van arbeid. Hul plek en funksie binne 'n voorgestelde geïntegreerde motiveringsmodel word eerstens aangedui. Vervolgens word die verwantskap tussen die twee doelwitte uitgelig, gevolg deur 'n bespreking van die aard van die objektiewe doel. Laastens word die invloed van moderne arbeid op hierdie doelwitte uitgestippel.



    Kierkegaard en Nietzsche, Max Weber en Dilthey, om maar enkeles te noem, en 5.) Jaspers se persoonlike beskouing oor die roe ping en die taak van die Filosofie, sy aanvoeling van die filosofiese problematiek en sy grondhouding teenoor die eksistensiële verbonden- hede. Die woord van Fichte, naamlik dat die Filosofie ...

  2. Die apologetiese taak van die kerk

    I.W.C. van Wyk


    In 2001, the Nederduitsch Hervormde Church decided that apologetics should be part of its apostolate. The author introduces the subject of apologetics to the church. This he does by means of a historical overview of the development of the subject. Special attention is given to the early apologetic fathers and theologians of the 19th and 20th centuries. The emphasis falls on the problematic relationship between faith and science, questions concerning the truth of the gospel, the mission of the church and the problem of multi-religiosity.

  3. Early complications after pneumonectomy: retrospective study of 168 patients.

    Alloubi, Ihsan; Jougon, Jacques; Delcambre, Frédéric; Baste, Jean Marc; Velly, Jean François


    The purpose of this study was to assess the mortality and risk factors of complications after pneumonectomy for lung cancer. Between 1996 and 2001, we reviewed and analysed the demographic, clinical, functional, and surgical variables of 168 patients to identify risk factors of postoperative complications by univariate and multivariate analyses with Medlog software system. The mean age was 60+/-10 years, overall mortality and morbidity rates were 4.17% and 41.6%, respectively. All frequencies of respiratory complications were 1.2% for acute respiratory failure, 10.1% for pneumonia, 2.4% for acute pulmonary oedema, 4.17% for bronchopleural fistula, 2.4% for thoracic empyema and 18.5% for left recurrent nerve injuries. Postoperative arrhythmias developed in 46% of our patients. The risk factors for cardiopulmonary morbidity and mortality with univariate analysis were advanced age (P<0.01), preoperative poor performance status (P<0.015), and chronic artery disease (P<0.008). Factors adversely affecting morbidity with multivariate analysis included age (P=0.0001), associated cardiovascular disease (P=0.001), and altered forced expiratory volume in 1 s (P=0.0005). Complications after pneumonectomy are associated with high mortality. Careful attention must be paid to patients with advanced age and heart disease. Chest physiotherapy is paramount to have uneventful outcomes.

  4. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis

    DARA, Naghi; SAYYARI, Ali-Akbar; IMANZADEH, Farid


    Objective As acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy. Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complication typically occurs in patients with severe comorbidities and needs multidisciplinary evaluation and care. Hepatic encephalopathy should be considered in any patient with acute liver failure and cirrhosis who presents with neuropsychiatric manifestations, decrease level of consciousness (coma), change of personality, intellectual and behavioral deterioration, speech and motor dysfunction. Every cirrhotic patient may be at risk; potential precipitating factors should be addressed in regular clinic visits. The encephalopathy of liver disease may be prominent, or can be present in subtle forms, such as decline of school performance, emotional outbursts, or depression. “Subtle form” of hepatic encephalopathy may not be obvious on clinical examination, but can be detected by neurophysiologic and neuropsychiatric testing. PMID:24665321

  5. Early and delayed Tc-99m ECD brain SPECT in SLE patients with CNS involvement

    Kikukawa, Kaoru; Toyama, Hiroshi; Katayama, Masao


    We compared early and delayed Tc-99m ECD SPECT scans in 32 SLE patients (Group 1, definite neuropsychiatric disorders; Group 2, minor neurologic symptoms or normal) with those of normal controls by visual inspection and semi-quantitative evaluation. With visual interpretation, 13 out of 14 patients in Group 1 (93%) and 7 out of 18 patients in Group 2 (39%) had diffuse uneven decrease in early scans. Seven patients in Group 2 (39%) who had normal early scans demonstrated focal decrease in the medial frontal lobe in delayed scans. With cerebral region to cerebellar ratios, in early scans, the medial frontal lobe in Group 1 and Group 2 was significantly lower than in normal controls, and lateral frontal lobe and occipital lobes in Group 1 were significantly lower than in normal controls. Nevertheless, in delayed scans, every cortical region except for the parietal lode in Groups 1 and 2 was significantly lower than in normal controls. The retention rates in all regions in SLE patients were significantly lower than in normal controls. No case showed SPECT improvement on follow-up studies in either group in spite of clinical improvement. Delayed Tc-99m ECD brain SPECT of high sensitivity might be useful in detecting CNS involvement. Although the SPECT findings did not correlate with the neuropsychiatric symptoms, early and delayed Tc-99m ECD SPECT seems to provide useful objective diagnostic information in SLE patients. (author)

  6. Patients' views on early sensory relearning following nerve repair-a Q-methodology study.

    Vikström, Pernilla; Carlsson, Ingela; Rosén, Birgitta; Björkman, Anders


    Descriptive study. Early sensory relearning where the dynamic capacity of the brain is used has been shown to improve sensory outcome after nerve repair. However, no previous studies have examined how patients experience early sensory relearning. To describe patient's views on early sensory relearning. Statements' scores were analyzed by factor analysis. Thirty-seven consecutive adult patients with median and/or ulnar nerve repair who completed early sensory relearning were included. Three factors were identified, explaining 45% of the variance: (1) "Believe sensory relearning is meaningful, manage to get an illusion of touch and complete the sensory relearning"; (2) "Do not get an illusion of touch easily and need support in their sensory relearning" (3) "Are not motivated, manage to get an illusion of touch but do not complete sensory relearning". Many patients succeed in implementing their sensory relearning. However, a substantial part of the patient population need more support, have difficulties to create illusion of touch, and lack motivation to complete the sensory relearning. To enhance motivation and meaningfulness by relating the training clearly to everyday occupations and to the patient's life situation is a suggested way to proceed. The three unique factors indicate motivation and sense of meaningfulness as key components which should be taken into consideration in developing programs for person-centered early sensory relearning. 3. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  7. Antibody response to pneumococcal vaccine in patients with early stage Hodgkin's disease

    Frederiksen, B; Specht, L; Henrichsen, J


    response to pneumococcal type antigens was similar in healthy adults and in patients with early stage HD before therapy. After treatment, postvaccination antibody response became negligible. Even up to 7 years after cessation of therapy patients were not able to raise a significant antibody response....

  8. Developing a Mobility Protocol for Early Mobilization of Patients in a Surgical/Trauma ICU

    Meg Zomorodi


    Full Text Available As technology and medications have improved and increased, survival rates are also increasing in intensive care units (ICUs, so it is now important to focus on improving the patient outcomes and recovery. To do this, ICU patients need to be assessed and started on an early mobility program, if stable. While the early mobilization of the ICU patients is not without risk, the current literature has demonstrated that patients can be safely and feasibly mobilized, even while requiring mechanical ventilation. These patients are at a high risk for muscle deconditioning due to limited mobility from numerous monitoring equipment and multiple medical conditions. Frequently, a critically ill patient only receives movement from nurses; such as, being turned side to side, pulled up in bed, or transferred from bed to a stretcher for a test. The implementation of an early mobility protocol that can be used by critical care nurses is important for positive patient outcomes minimizing the functional decline due to an ICU stay. This paper describes a pilot study to evaluate an early mobilization protocol to test the safety and feasibility for mechanically ventilated patients in a surgical trauma ICU in conjunction with the current unit standards.

  9. Stromal cell markers are differentially expressed in the synovial tissue of patients with early arthritis

    Choi, Ivy Y.; Karpus, Olga N.; Turner, Jason D.; Hardie, Debbie; Marshall, Jennifer L.; de Hair, Maria J. H.; Maijer, Karen I.; Tak, Paul P.; Raza, Karim; Hamann, Jörg; Buckley, Christopher D.; Gerlag, Danielle M.; Filer, Andrew


    Previous studies have shown increased expression of stromal markers in synovial tissue (ST) of patients with established rheumatoid arthritis (RA). Here, ST expression of stromal markers in early arthritis in relationship to diagnosis and prognostic outcome was studied. ST from 56 patients included

  10. Patients' preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

    Jansen, S. J.; Kievit, J.; Nooij, M. A.; de Haes, J. C.; Overpelt, I. M.; van Slooten, H.; Maartense, E.; Stiggelbout, A. M.


    When making decisions about adjuvant chemotherapy for early-stage breast cancer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of the present study were: (1) to determine the minimum benefits that patients

  11. Physical activity patterns in patients with early and late age-related macular degeneration

    Subhi, Yousif; Sørensen, Torben Lykke


    INTRODUCTION: Age-related macular degeneration (AMD) leads to visual impairment that affects visual functioning and thereby the ability to be physically active. We investigated physical activity patterns in patients with AMD. METHODS: Patients with early and late AMD and elderly controls were...

  12. The Role Of Multidetector Computed Tomography In The Early Diagnosis Of Invasive Pulmonary Aspergıllosis In Patients With Febrile Neutropenia Undergoing Hematopoietic Stem Cell Transplantation

    Nazan Çiledağ


    Full Text Available OBJECTIVE: To evaluate the vessel involvement and the role of multidedector computed tomograpy (MDCT in the early diagnosis of invasive pulmonary aspergillosis (IPA at MDCT in autologous bone morrow transplantation patients with febrile neutropenia and antibiotic-resistant fever of unknown origin with clinically suspected IPA. METHODS: 74 pulmonary MDCT examinations of 37 consecutive hematopoietic stem cell transplantation patients with febrile neutropenia with clinically suspected IPA were retrospectively evaluated. RESULTS: The diagnosis of IPA was made according to according to the Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Consensus Group criteria and 0, 14, 11 patients were diagnosed as proven, probable, possible IPA, respectively. Among 25 cases accepted as probable and possible IPA, all patients had pulmonary MDCT findings consistent with IPA. Remaining 12 patients were accepted as having fever of unknown origin (FUO and in these 12, MDCT showed patent vessel. In patients with probable/possible IPA, 72 focal pulmonary lesions were detected. In 41 of 72 (57%, vascular occlusion was detected. The CT halo sign was present in 25 of 41 (61% lesions. A clinical improvement, resolution of fever was observed following antifungal therapy in 19 (76% of 25 patients with probable/possible IPA. Six (25% patients diagnosed as IPA died during follow-up. Transplant related mortality at day 100 in patients with IPA and FUO were found to be 24% and 0%, respectively. CONCLUSION: In conclusion, MDCT has a potential role in early diagnosis of IPA by detection of vessel occlusion.

  13. [Early exercise training after exacerbation in patients with chronic respiratory failure].

    Takahashi, Hiromitsu; Molleyres, Sandrine; Dousse, Nicolas; Contal, Olivier; Janssens, Jean-Paul


    Patients who suffered from an exacerbation of a chronic respiratory disorder are often very limited in terms of their exercise capacity because of severe dyspnea and amyotrophy of peripheral muscles. Early implementation of pulmonary rehabilitation may help these patients to avoid the complications of a prolonged bedridden period, and increase more rapidly their mobility. Early rehabilitation has become more frequent, but requires special skills from the care givers (chest therapists). Techniques which enhance muscular performance and motility of patients who are recovering from an exacerbation such as electromoystimulation or mobilisation under non-invasive ventilation, give encouraging results; their impact on length of hospital stay requires further studies.

  14. Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients

    Lee, Y.-H.; Wu, C.-H.; Wang, L.-J.; Wong, Y.-C.; Chen, H.-W.; Wang, C.-J.; Lin, B.-C.; Hsu, Y.-P.


    Aim: To evaluate the early success of transarterial embolization (TAE) in patients with traumatic liver haemorrhage and to determine independent factors for its failure. Materials and methods: From January 2009 to December 2012, TAE was performed in 48 patients for traumatic liver haemorrhage. Their medical charts were reviewed for demographic information, pre-TAE vital signs and laboratory data, injury grade, type of contrast medium extravasation (CME) at CT, angiography findings, and early failure. “Early failure” was defined as the need for repeated TAE or a laparotomy for hepatic haemorrhage within 4 days after TAE. Variables were compared between the early success and early failure groups. Variables with univariate significance were also analysed using multivariate logistic regression for predictors of early failure. Results: Among 48 liver TAE cases, nine (18.8%) were early failures due to liver haemorrhage. Early failure was associated with injury grade (p = 0.039), major liver injury (grades 4 and 5; p = 0.007), multiple CMEs at angiography (p = 0.031), incomplete TAE (p = 0.002), and elevated heart rate (p = 0.026). Incomplete embolization (OR = 8; p = 0.042), and heart rate >110 beats/min (bpm; OR = 8; p = 0.05) were independent factors for early failure of TAE in the group with major liver injuries. Conclusion: Major hepatic injury is an important factor in early failure. Patients with a heart rate >110 bpm and incomplete embolization in the major injury group have an increased rate of early failure. The success rate of proximal TAE was comparable to that of the more time-consuming, superselective, distal TAE. - Highlights: • Early failure of TAE is associated with a higher grade of liver injury. • Incomplete embolization is more likely to suffer early failure of TAE. • A heart rate greater than 110 bpm is more likely to suffer early failure of TAE. • We recommend proximal embolization to prevent early failure of TAE

  15. Early warning scores: a sign of deterioration in patients and systems

    Fox, A


    The early warning score is a decision-making tool that has a simple design, yet its implementation in healthcare organisations is proving complex. This article reports the results of a survey that evaluated the nurses’ experiences of using the NEWS (National Early Warning Score) in an acute hospital in Ireland. Staff reported that the NEWS was easy to use, did not increase workload and enhanced their ability to identify deteriorating patients. However, they also identified problems related to doctors’ delayed response times, doctors lack of training in the use of the tool, and a failure by doctors to modify parameters for patients with chronic conditions. NEWS enhances nurses’ role in early detection of patient deterioration but delays in response times by doctors, exposes systematic flaws in healthcare. This suggests that it is not only an indicator of patient deterioration but also of deteriorating healthcare systems.

  16. Sal die ‘ewolusie’ vanaf biologie na lewenswetenskappe ‘uitsterwing’ van die vakgebied voorkom?

    Johanna G. Ferreira


    Full Text Available In hierdie artikel word die wysiging van die skoolvak van ‘biologie’ na ‘lewenswetenskappe’ bespreek, asook die gepaardgaande en verwagte implikasies van die verandering. Die vraag word gestel of die beoogde wysiging wel noemenswaardig is en of dit enigsins ‘n verskil aan die dalende belangstelling in die lewenswetenskappe op tersiêre vlak sal maak. Die wysigings in die nuwe kurrikula verhoog die relevansie van die vakinhoud vir leerders en vir die gemeenskap, maar sekere kwessies kry nie aandag nie. Voorstelle word gemaak om die kurrikulum te wysig en onderrigmetodes aan te pas om die nodige vaardighede by leerders te vestig.

  17. The impact of early specialist management on outcomes of patients with in-hospital stroke.

    Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit


    Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I.  = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

  18. enkele fasette van die problematiek van die akademikus by die skryf

    Om verskeie redes het dit van die allergrootste belong geword dot 'n his- tories korrekte, wetenskaplike weerga- we van bogenoemde gebeure opge- teken moet word. Die sluier, in sommige gevalle am logiese redes toegepas, moes eenvoudig gelig word am gebeure wat die gewone man op stroot in Suid-Afrika dikwels ...

  19. Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode

    Kessing, Lars Vedel


    OBJECTIVE: It is unclear whether patients with late onset and patients with early onset present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of ICD-10 single depressive episodes for patients with late onset (age >65 years) and patient...... with early onset (age single depressive episode in a period from 1994-2002 at the end of the first outpatient treatment or at the first discharge from...... psychiatric hospitalisation ever in Denmark were identified in a nationwide register. RESULTS: In total, 18.192 patients were given a diagnosis of a single depressive episode at the first outpatient contact and 8.396 patients were given a diagnosis of a single depressive episode at the first psychiatric...

  20. Correlates and prevalence of hypogonadism in patients with early- and late-onset type 2 diabetes.

    Li, Y; Zhang, M; Liu, X; Cui, W; Rampersad, S; Li, F; Lin, Z; Yang, P; Li, H; Sheng, C; Cheng, X; Qu, S


    This study aims to compare the prevalence of hypogonadism between male patients with early-onset type 2 diabetes mellitus (T2DM) and late-onset type 2 diabetes. A total of 122 male patients with early-onset T2DM (diagnosis age ≤40 years) and 100 male patients with late-onset T2DM (diagnosis age >40 years) were recruited from our in-patient department between 1 January 2013 and 28 December 2015. Serum FSH, LH, testosterone, lipid profile, uric acid, HbA1c, and beta-cell function were determined in blood samples. The diagnosis of hypogonadism was based on the levels of LH, FSH, and total testosterone. The mean onset age was 29.86 ± 6.31 and 54.47 ± 9.97 years old in the early-onset group and late-onset group, respectively. Compared with late-onset T2DM, those with early-onset T2DM had a higher proportion of new-onset diabetes, were more likely to be obese, and had worse glycemic control, lipid control, and lower sex hormone-binding globulin (SHBG). The prevalence of hypogonadism was much higher in the early-onset group than in the late-onset group (48.0% vs. 26.7%, p hypogonadism in the early-onset group and late-onset group were 44.3% and 25.0%, respectively (p hypogonadism was higher in the patients with early-onset T2DM than that of late-onset T2DM. This prevalence might be attributable to greater obesity, worse lipid control, and lower SHBG levels in those patients. © 2017 American Society of Andrology and European Academy of Andrology.

  1. Swallowing assessment in early laryngeal cancer patients treated either with surgery or radiotherapy

    Celedon L, Carlos; Gambi A, Galo; Royer F, Michel; Esquivel C, Patricia; Arteaga J, Patricia; Valdes P, Constanza


    Swallowing is a complex neuromuscular process that requires anatomical indemnity and an adequate coordination of several organs. Laryngeal cancer treatment may cause swallowing disorders. Traditionally, a high frequency of this type of disorder after surgery has been reported, but no actual data concerning its incidence in patients undergoing radiotherapy for early laryngeal cancer has been published. Aim. To compare swallowing disorders frequency posterior to treatment in early laryngeal cancer patients. Material and Method. Two groups of early laryngeal cancer patients were transversally studied, one treated with vertical partial surgery (CP), and the other treated exclusively with radiotherapy. Each patient had otorhinolaryngological, nasofibroscopic and video fluoroscopic evaluations after treatment. Differences between groups were compared using the - square test. Results. Twenty patients per group were entered in this study, predominantly males of similar age. Both groups presented a high incidence of aspiration symptoms (55% in RT and 35% in CP). There were no significant differences between both groups. Discussion and Conclusion. A high incidence of swallowing disorders in patients treated for early laryngeal cancer was found. It should then be considered as a frequent alteration in this group of patients, either treated with RT or CP

  2. Die Defects and Die Corrections in Metal Extrusion

    Sayyad Zahid Qamar


    Full Text Available Extrusion is a very popular and multi-faceted manufacturing process. A large number of products for the automotive, aerospace, and construction sectors are produced through aluminum extrusion. Many defects in the extruded products occur because of the conditions of the dies and tooling. The problems in dies can be due to material issues, design and manufacturing, or severe usage. They can be avoided by maintaining the billet quality, by controlling the extrusion process parameters, and through routine maintenance. Die problems that occur on a day-to-day basis are mostly repairable and are rectified through various types of die correction operations. These defects and repair operations have not been reported in detail in the published literature. The current paper presents an in-depth description of repairable die defects and related die correction operations in metal extrusion. All major die defects are defined and classified, and their causes, preventive measures, and die correction operations are described. A brief frequency-based statistical study of die defects is also carried out to identify the most frequent die corrections. This work can be of direct benefit to plant engineers and operators and to researchers and academics in the field of metal extrusion.

  3. Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery

    Ji, Qiang; Zhao, Hang; Mei, YunQing; Shi, YunQing; Ma, RunHua; Ding, WenJun


    Background To evaluate the impact of persistent smoking versus smoking cessation over one month prior to surgery on early clinical outcomes in Chinese patients undergoing isolated coronary artery bypass grafting (CABG) surgery in a retrospective study. Methods The peri-operative data of consecutive well-documented patients undergoing isolated CABG surgery from January 2007 to December 2013 were investigated and retrospectively analyzed. All included patients were divided into either a non-smo...

  4. Periarticular and generalised bone loss in patients with early rheumatoid arthritis

    Jensen, T W; Hansen, M S; Hørslev-Petersen, Kim


    )). PATIENTS AND METHODS: A hundred and sixty patients with early, active rheumatoid arthritis (RA) received methotrexate, intra-articular betamethasone and ciclosporin /placebo-ciclosporin. Patients with Z-score ≤0 also started alendronate 10 mg/day. BMD of the hand (digital x-ray radiogrammetry (DXR...... in hand, lumbar spine and femoral neck was negatively associated with the dose of intra-articular betamethasone (p...

  5. Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

    Aly Saber


    Full Text Available Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A and delayed (B cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient’s satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient’s satisfaction was 92.66±6.8 in group A compared with 75.34±12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.

  6. Die hermeneutiek van gereformeerde kerkreg

    Andries le Roux du Plooy


    Full Text Available Die artikel het op die belangrikheid en noodsaaklikheid van ‘n hermeneutiek vir die gereformeerde kerkreg gefokus. Die kerkregtelike dokument wat besonderlik ter sake was, is die kerkorde van die Gereformeerde kerke in Suid-Afrika, met sy besondere band met die Dordtse kerkorde van 1618 en 1619. Agtereenvolgens is aandag gegee aan die volgende aspekte soos (1 die eiesoortige aard van ‘n kerkorde as ‘n teologiese dokument en teks, in onderskeiding van regsdokumente; (2 die aard van die hermeneutiek van kerkreg; (3 enkele teorieë oor die interpretasie of uitleg van tekste, veral regstekste en (4 normatiewe vooronderstellings en reëls vir die interpretasie en verstaan van die teks en artikels van die kerkorde asook besluite van kerklike vergaderinge. Die gevolgtrekking was dat weinig indringende navorsing gedoen is oor die saak van hermeneutiek vir kerkreg, hoewel dit noodsaaklik is. Duidelike hermeneutiese reëls is gesuggereer en verduidelik, wat sou kon meehelp dat kerke en kerklike vergaderinge die artikels van die kerkorde asook besluite en reglemente wat daarop berus het, kan interpreteer en toepas. The hermeneutics of reformed church polity. The article focused on the importance and urgency of a design for reformed hermeneutics on church polity. The Church Order referred to in the article is the Church Order of the Reformed Churches in South Africa, which are closely related to the Church Order of Dordt of 1618 and 1619. The following aspects received attention namely (1  the unique character of a Church Order, in comparison to and distinguished from legal documents and statutes; (2 the character and nature of hermeneutics of church polity; (3 theories of interpretation in the common law tradition and their relevance to church polity and (4 normative presuppositions and marks for the interpretation and understanding of the text and articles of the Church Order, as well as the resolutions of church assemblies. It was found that

  7. Early detection of lung cancer using ultra-low-dose computed tomography in coronary CT angiography scans among patients with suspected coronary heart disease.

    Zanon, Matheus; Pacini, Gabriel Sartori; de Souza, Vinicius Valério Silveiro; Marchiori, Edson; Meirelles, Gustavo Souza Portes; Szarf, Gilberto; Torres, Felipe Soares; Hochhegger, Bruno


    To assess whether an additional chest ultra-low-dose CT scan to the coronary CT angiography protocol can be used for lung cancer screening among patients with suspected coronary artery disease. 175 patients underwent coronary CT angiography for assessment of coronary artery disease, additionally undergoing ultra-low-dose CT screening to early diagnosis of lung cancer in the same scanner (80kVp and 15mAs). Patients presenting pulmonary nodules were followed-up for two years, repeating low-dose CTs in intervals of 3, 6, or 12 months based on nodule size and growth rate in accordance with National Comprehensive Cancer Network guidelines. Ultra-low-dose CT identified 71 patients with solitary pulmonary nodules (41%), with a mean diameter of 5.50±4.00mm. Twenty-eight were >6mm, and in 79% (n=22) of these cases they were false positive findings, further confirmed by follow-up (n=20), resection (n=1), or biopsy (n=1). Lung cancer was detected in six patients due to CT screening (diagnostic yield: 3%). Among these, four cases could not be detected in the cardiac field of view. Most patients were in early stages of the disease. Two patients diagnosed at advanced stages died due to cancer complications. The addition of the ultra-low-dose CT scan represented a radiation dose increment of 1.22±0.53% (effective dose, 0.11±0.03mSv). Lung cancer might be detected using additional ultra-low-dose protocols in coronary CT angiography scans among patients with suspected coronary artery disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Die verband tussen lokus van beheer en die werks prestasie van swart bemarkers in die lewensversekeringsbedryf

    E. L. Coetzer


    Full Text Available The relationship between locus of control and the work performance of black marketers in the life assurance industry. The aim of the study was to establish the relationship between locus of control and the work performance of black marketers in the life assurance industry. These constructs were selected by virtue of the lack of empirical research regarding the assumed relationship between them. The Locus of Control Scale of Schepers (1995 was used for measuring locus of control. Work performance was measured by the commission earned per month by the marketer, the number of policies generated by the marketer, as well as the percentage of lapsed policies. The relevant measurements were obtained in respect of a sample of 149 black marketing personnel. The results indicated a modest but statistically significant relationship between external locus of control and the work performance of black marketers. Opsomming Die doel van die studie was om die verband tussen lokus van beheer en die werksprestasie van swart bemarkers in die lewensversekeringsbedryf te bepaal. Hierdie konstrukte is gekies op grond van die gebrek aan empiriese navorsing rakende die veronderstelde verband tussen genoemde konstrukte. Die Lokus van Beheer-vraelys van Schepers (1995 is in die meting van lokus van beheer gebruik. Werksprestasie is aan die hand van kommissie per maand verdien, aantal polisse gegenereer deur 'n bemarker en die persentasie vervalde polisse, gemeet. Die tersaaklike metinge is verkry ten opsigte van 'n steekproef van 149 swart bemarkers. Die resultate toon 'n klein, dog statisties beduidende verband tussen eksterne lokus van beheer en die werksprestasie van swart bemarkers in die lewensversekeringsbedryf.

  9. Is die ortodoksie se verstaan van die sondeval belemmerend vir die gesprek tussen teologie en natuurwetenskap?

    Johan Buitendag


    Full Text Available In hierdie artikel is betoog dat die Gereformeerde Ortodoksie se begrip van die sondeval ’n  belemmering  was  vir  die  gesprek  tussen  teologie  en  natuurwetenskap.  Die  rede hiervoor was dat dit ten eerste ’n bepaalde verstaan van liniêre tyd nahou en ten tweede dat dit ’n bonatuurlike ingryp veronderstel het. Albei hierdie aspekte het die debat onnodig problematiseer. Die argument is ontwikkel deur eerstens die probleem te definieer, gevolg deur ’n uiteensetting van die standpunte van Augustinus en Calvyn onderskeidelik oor die sondeval. As ’n heuristiese sleutel is die konsepte van infralapsarisme en supralapsarisme aangewend om die tema te ontleed. Die artikel is afgesluit met die oortuiging dat die imago Dei ’n beliggaamde menslike persoon is wat biologies in die geskiedenis in terme van selfbewussyn en morele verantwoordelikheid ontluik het. Is the Orthodoxy’s notion of the Fall inhibitory for the dialogue between theology and science? In this article it was argued that the Reformed Orthodoxy’s interpretation of the Fall had become an impediment in the dialogue between theology and science. The reason was that it assumed firstly a specific understanding of linear time and secondly a metaphysical intervention. Both events were unnecessarily problematising the debate. The argument was deployed by stating the problem, followed by an exposition of the views of Augustine and Calvin on the Fall. As a heuristic key, the concepts of infralapsarism and supralapsarism were applied respectively to analyse the topic. The article concluded with the conviction that the imago Dei is an embodied human person that had biologically emerged in history as a center of self-awareness, and moral responsibility.

  10. Algorithm for the early diagnosis and treatment of patients with cross reactive immunologic material-negative classic infantile pompe disease: a step towards improving the efficacy of ERT.

    Suhrad G Banugaria

    Full Text Available OBJECTIVE: Although enzyme replacement therapy (ERT is a highly effective therapy, CRIM-negative (CN infantile Pompe disease (IPD patients typically mount a strong immune response which abrogates the efficacy of ERT, resulting in clinical decline and death. This study was designed to demonstrate that immune tolerance induction (ITI prevents or diminishes the development of antibody titers, resulting in a better clinical outcome compared to CN IPD patients treated with ERT monotherapy. METHODS: We evaluated the safety, efficacy and feasibility of a clinical algorithm designed to accurately identify CN IPD patients and minimize delays between CRIM status determination and initiation of an ITI regimen (combination of rituximab, methotrexate and IVIG concurrent with ERT. Clinical and laboratory data including measures of efficacy analysis for response to ERT were analyzed and compared to CN IPD patients treated with ERT monotherapy. RESULTS: Seven CN IPD patients were identified and started on the ITI regimen concurrent with ERT. Median time from diagnosis of CN status to commencement of ERT and ITI was 0.5 months (range: 0.1-1.6 months. At baseline, all patients had significant cardiomyopathy and all but one required respiratory support. The ITI regimen was safely tolerated in all seven cases. Four patients never seroconverted and remained antibody-free. One patient died from respiratory failure. Two patients required another course of the ITI regimen. In addition to their clinical improvement, the antibody titers observed in these patients were much lower than those seen in ERT monotherapy treated CN patients. CONCLUSIONS: The ITI regimen appears safe and efficacious and holds promise in altering the natural history of CN IPD by increasing ERT efficacy. An algorithm such as this substantiates the benefits of accelerated diagnosis and management of CN IPD patients, thus, further supporting the importance of early identification and treatment

  11. Case report physiotherapy care of a patient diagnosed with polyarthritis with early rheumatoid arthritis

    Michálková, Kateřina


    Title of bachelor's thesis: Case report physiotherapy care of a patient diagnosed with polyarthritis with early rheumatoid arthritis. Summary: The bachelor thesis deals with polyarthritis disease with early rheumatoid arthritis and its physiotherapy care. It consists of two parts. The general part contains a general joint anatomy, deals with the major problems of disease and polyarthritis rheumatoid arthritis, its diagnosis, treatment and physiotherapy care. Special part includes a case repor...

  12. Sedimentêre omgewings van die Inhaca-eilandstelsel met spesiale verwysing na die petrografiese en geochemiese eienskappe van die sedimente spesiale verwysing na die petrografiese en geochemiese eienskappe van die sedimente

    Marieke Peché


    Full Text Available Die Inhaca-eilandstelsel is geleë langs die suidooskus van Mosambiek. Die oostekant van die stelsel grens aan die Indiese Oseaan en die westekant aan die Baai van Maputo. Hierdie eilandstelsel bestaan uit Inhaca- en Portugese eiland, asook ’n groep sandbanke wat van die noordlike punt van Inhaca na Portugese eiland strek. Die doel van hierdie studie is om die verskillende moderne en oer-sedimentêre omgewings op die eilandstelsel te identifiseer en te beskryf, die invloed van getye en golfaksie op die moderne sedimentêre omgewing vas te stel en die geochemiese en petrografiese samestelling van die geologiese eenhede te bepaal.

  13. Radiotherapy-induced Early ECG Changes and Their Comparison with Echocardiography in Patients with Early-stage Breast Cancer.

    Tuohinen, Suvi Sirkku; Keski-Pukkila, Konsta; Skyttä, Tanja; Huhtala, Heini; Virtanen, Vesa; Kellokumpu-Lehtinen, Pirkko-Liisa; Raatikainen, Pekka; Nikus, Kjell


    Early electrocardiogram (ECG) changes after breast cancer radiotherapy (RT) have been reported, but their characteristics and associated factors are largely unknown. This study aimed to explore early RT-induced ECG changes and to compare them with echocardiography changes. Sixty eligible patients with chemotherapy-naïve left-sided and 20 with right-sided breast cancer were evaluated with echocardiography, blood samples and ECG before and after RT. RT-induced ECG changes in the anterior leads. T-Wave changes were most frequent. T-Wave decline was associated independently with patient age (β=-0.245, p=0.005), mean heart radiation dose (β=1.252, p=0.001) and global systolic strain rate change (β=7.943, p=0.002). T-Wave inversion was associated independently with mean heart radiation dose (β=0.143, pECG changes were prevalent and associated with functional and structural changes in echocardiography. ECG could be used for post-RT cardiac screening. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  14. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up.

    Pozza, Edoardo Dalla; D'Souza, Gehaan F; DeLeonibus, Anthony; Fabiani, Brianna; Gharb, Bahar Bassiri; Zins, James E


    While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission:

  15. The use of early warning scores to recognise and respond to patient deterioration in district nursing.

    Tucker, Guy; Lusher, Adele


    This discussion article focuses on the literature surrounding early warning scoring systems and their use in primary care, specifically within district nursing. Patient deterioration is a global concern, associated with high mortality rates and avoidable deaths. Early recognition and response by nursing and other health care staff has been attributed to early warning scoring systems (EWSS) and tools. However, the use of equivalent tools in the community appears to be lacking. This review concludes that there is no consensus over the use of EWSS in district nursing and culture of practice is varied, rather than standardised.

  16. [Offer early attention and intervention to patients with valvular heart disease].

    Jiang, Shengli; Ren, Chonglei


    As a key feature of the updates, early intervention of valvular heart disease is highlighted in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. This article reviewed the new guideline in regards to the issue of early intervention of diseases such as aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency, tricuspid insufficiency, and infective endocarditis, with discussion on the related topics according to the authors' understanding and practical experience in China. We conclude that valvular heart disease should receive early intervention and attention should also be paid on the progress of disease.

  17. Outcome of Early Initiation of Peritoneal Dialysis in Patients with End-Stage Renal Failure

    Oh, Kook-Hwan; Hwang, Young-Hwan; Cho, Jung-Hwa; Kim, Mira; Ju, Kyung Don; Joo, Kwon Wook; Kim, Dong Ki; Kim, Yon Su; Ahn, Curie


    Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone. PMID:22323864

  18. [Right to die with dignity?].

    Ruiz, Alvaro


    The right to die with dignity is an ill-defined concept, with multiple, often inappropriate, interpretations. The current proposition is that the physician take full responsibility for protecting the patients rights, for ensuring a rational use of resources and for overseeing the decision-making process such that the information is adequate and the steps proportioned. This responsibility extends not only to the health status of the patient situation, to the patients prognosis, and to his/her expectations and wishes, but also to the benefits foreseen and to the cost-benefit ratio. Emphasis is placed on two aspects of this relationship. First, dignity can be interpreted in many ways and sometimes, in the name of dignity, the patient is exposed (or exposes him/herself) to suffering, pain and complications that can be avoided. Second, when no reasonable probability of survival is present and a better quality of life is impossible, efforts are better redirected to offering a better quality of death.

  19. Die vangnet van die woord: forensies-linguistiese getuienis in 'n ...

    Een van die redes daarvoor is waarskynlik die gepaardgaande sleurwerk verbonde aan die verwerking van die betrokke taaldata — iets wat egter deur die onlangse meteoriese vooruitgang in tegnologiese tegnieke op die agtergrond geskuif is en nuwe moontlikhede na vore laat kom het. In die lig van die kompleksiteit van ...

  20. het om die Woord van God aan die gemeente te bedien. A. D. P ont ...


    Sizoo vertel met die vlotheid van die ervare skrywer en die ver antwoordelikheid van die wetenskaplike ... Maar in stiptelike trou aan die feitelikheid, verlaat die skrywer hom uitsluitlik op die outentieke bronne om ... de leser; in sy rykdom van gegewens en wetenskaplike betroubaarheid kan dit met vrug gelees word deur die ...

  1. Patients' and Parents' Needs, Attitudes, and Perceptions About Early Palliative Care Integration in Pediatric Oncology.

    Levine, Deena R; Mandrell, Belinda N; Sykes, April; Pritchard, Michele; Gibson, Deborah; Symons, Heather J; Wendler, David; Baker, Justin N


    Early palliative care integration for cancer patients is now touted as the optimal care model, yet significant barriers often prevent its implementation. A perceived barrier, especially for pediatric oncology patients, is the notion that patients and their families may not need or want palliative care involvement early in the disease trajectory. To determine the perception of symptom burden early in treatment and assess attitudes toward early integration of palliative care in pediatric oncology patient-parent pairs. Novel but pretested survey tools were administered to 129 patient-parent dyads of hospital-based pediatric oncology ambulatory clinics and inpatient units between September 2011 and January 2015. All patient participants were aged between 10 and 17 years and were diagnosed as having an oncologic condition 1 month to 1 year before enrollment. Both the patient and the parent in the dyad spoke English, and all participating parents provided written informed consent. A convenience sample was used for selection, with participants screened when otherwise presenting at a participating site. A total of 280 eligible participants were approached for study inclusion, 258 of whom were enrolled in the study (92.1% positive response-rate). Degree of perceived suffering from early symptom-related causes, attitudes toward early palliative care integration, and patient-parent concordance. Statistical analysis included descriptive statistics, calculation of concordance, McNemar test results, and Cochran-Armitage trend test results. Of the 129 patients in the dyads, 68 were boys, and 61 girls; of the 129 parents, 15 were men, and 114 women. Patients reported the following symptoms in the first month of cancer therapy: nausea (n = 109; 84.5%), loss of appetite (n = 97; 75.2%), pain (n = 96; 74.4%), anxiety (n = 77; 59.7%), constipation (n = 69; 53.5%), depression (n = 64; 49.6%), and diarrhea (n = 52; 40.3%). A large proportion of those

  2. Early use of non invasive ventilation in patients with amyotrophic lateral sclerosis: what benefits?

    Terzano, C; Romani, S


    The aim of this study was to analyze the efficacy of an early start of NIV in ALS patients, evaluating respiratory and ventilatory parameters. Functional respiratory parameters and arterial blood gas analysis were evaluated in forty-six patients. All patients were informed about the benefits and possible adverse effects of therapeutic support with NIV and divided in two groups based on the compliance to early start therapy with NIV (Group A) or not (Group B). Among 46 ALS patients consecutively visited in our Unit, we included 20 patients in the Group A and 16 in the Group B. We have emphasized the importance of the early use of NIV stressing the difference between two groups analyzed, particularly in terms of pulmonary function tests and arterial blood gas analysis. Significant correlation was observed between Vital Capacity (VC), Forced Expiratory volume in one second (FEV1), and maximal inspiratory pressures (PImax). Our study highlights the importance of noninvasive mechanical ventilation as a treatment for ALS patients and also shows the early start of NIV as an important approach in order to postpone the functional decline and the decrease of respiratory muscle strength.

  3. Patients with old age or proximal tumors benefit from metabolic syndrome in early stage gastric cancer.

    Xiao-li Wei

    Full Text Available BACKGROUND: Metabolic syndrome and/or its components have been demonstrated to be risk factors for several cancers. They are also found to influence survival in breast, colon and prostate cancer, but the prognostic value of metabolic syndrome in gastric cancer has not been investigated. METHODS: Clinical data and pre-treatment information of metabolic syndrome of 587 patients diagnosed with early stage gastric cancer were retrospectively collected. The associations of metabolic syndrome and/or its components with clinical characteristics and overall survival in early stage gastric cancer were analyzed. RESULTS: Metabolic syndrome was identified to be associated with a higher tumor cell differentiation (P=0.036. Metabolic syndrome was also demonstrated to be a significant and independent predictor for better survival in patients aged >50 years old (P=0.009 in multivariate analysis or patients with proximal gastric cancer (P=0.047 in multivariate analysis. No association was found between single metabolic syndrome component and overall survival in early stage gastric cancer. In addition, patients with hypertension might have a trend of better survival through a good control of blood pressure (P=0.052 in univariate analysis. CONCLUSIONS: Metabolic syndrome was associated with a better tumor cell differentiation in patients with early stage gastric cancer. Moreover, metabolic syndrome was a significant and independent predictor for better survival in patients with old age or proximal tumors.

  4. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review


    Introduction Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. Methods The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay. Results Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of

  5. Die invloed van herbivorie en vuur op die oorlewing van sekere meerjarige kruide langs die Sabierivier, Kruger Nasionale Park

    H. Myburgh


    Full Text Available Die groot vloede wat in die jaar 2000 in die Kruger Nasionale Park plaasgevind het, het dierivieroewerplantegroei versteur. Dit het die geleentheid gebied om heinings op te rig langsdie Sabierivier om herbivore uit sekere gebiede uit te sluit en sodoende die herstel van die rivieroewerekosisteme te monitor.

  6. Quantitative measurement of cerebral blood flow on patients with early syphilis

    Zhong Jijun; Wu Jinchang; Yang Yi; Tang Jun; Liu Zengli; Shi Xin


    To study quantitative change of cerebral blood flow (CBF) on patients with early syphilis, the authors have established a method on absolute measurement of rCBF by using SPECT with Ethyl Cysteinate Dimmer (ECD) as imaging agent, and the method was applied to measure rCBF on patients with early syphilis. The rCBF values measured by this method are highly consistent with the values measured by other classical methods such as SPECT ( 123 I-IMP) and PET( 15 O-H 2 O). The rCBF values for early syphilis patients and the normal control show some statistical differences. A routine quantitative absolute measurement of rCBF featured with simple procedures is therefore on the way of maturation. (authors)

  7. Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.

    An Vandervoort

    Full Text Available Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1 advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2 the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia.Cross-sectional study of deaths (2010 using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires.We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate. A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1-11 than for those without either (AOR 2.99; CI,1.1-8.3. We found no association between verbal communication or having a GP order and quality of dying.For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

  8. Die heelal en sy onstaan (II

    D. J. Van Rooy


    Full Text Available Ons kennis en wetenskap van die hemelliggame word volkome bepaal deur die lig wat ons van hulle ontvang, d.w.s. as ons die feite wat die Bybel daaromtrent meedeel, buite rekening laat.

  9. Versoening tussen leerders: Is parallelmediumskole die antwoord op die rassismeprobleem?

    Du Plessis, Elize; Marais, Petro


    Die Suid-Afrikaanse Grondwet stel dit duidelik dat enige vorm van diskriminasie nie toegelaat mag word nie. In ons skole beteken dit dat elke leerder ʼn reg het op goeie opvoeding en ʼn veilige skoolomgewing. Die fokus van hierdie navorsing is gerig op bestaande parallelmediumskole. Die uiteindelike vraagstuk is dus hoe multikulturele onderwys bevorder word en hoe rassisme aangespreek kan word? As teoretiese raamwerk is Kohlsberg se kognitiewe ontwikkelingsbenadering en Whitehouse se univerele ...

  10. Die ontmaskering van die bose: Eksegetiese perspektiewe op ...


    2 Yarbro Collins (1983) bied tans nog die beste agtergrond vir 'n besinning oor geweld in ..... John's grammatical howlers are intentionally designed to alert listerners ..... 26 In die Nuwe Testament word Paul se snydende opmerking teenoor die Korintiërs as ..... rnt g0r`m nh8 ldfhrs`}m du sg}u fg}u + n2sh d/m sg>}} e`ql`jdh.

  11. Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective.

    Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta


    Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of the lifeworld" enables the patient to feel trust. Trust in the early chain of healthcare entails caregivers' ability to pay attention to both medical and existential issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

  12. Accurate defect die placement and nuisance defect reduction for reticle die-to-die inspections

    Wen, Vincent; Huang, L. R.; Lin, C. J.; Tseng, Y. N.; Huang, W. H.; Tuo, Laurent C.; Wylie, Mark; Chen, Ellison; Wang, Elvik; Glasser, Joshua; Kelkar, Amrish; Wu, David


    Die-to-die reticle inspections are among the simplest and most sensitive reticle inspections because of the use of an identical-design neighboring-die for the reference image. However, this inspection mode can have two key disadvantages: (1) The location of the defect is indeterminate because it is unclear to the inspector whether the test or reference image is defective; and (2) nuisance and false defects from mask manufacturing noise and tool optical variation can limit the usable sensitivity. The use of a new sequencing approach for a die-to-die inspection can resolve these issues without any additional scan time, without sacrifice in sensitivity requirement, and with a manageable increase in computation load. In this paper we explore another approach for die-to-die inspections using a new method of defect processing and sequencing. Utilizing die-to-die double arbitration during defect detection has been proven through extensive testing to generate accurate placement of the defect in the correct die to ensure efficient defect disposition at the AIMS step. The use of this method maintained the required inspection sensitivity for mask quality as verified with programmed-defectmask qualification and then further validated with production masks comparing the current inspection approach to the new method. Furthermore, this approach can significantly reduce the total number of defects that need to be reviewed by essentially eliminating the nuisance and false defects that can result from a die-to-die inspection. This "double-win" will significantly reduce the effort in classifying a die-to-die inspection result and will lead to improved cycle times.

  13. Die pastorale sielkundige as diakonale pastor

    A. J. Smuts


    Full Text Available In die bedieningspatroon van die Ned. Geref. Kerk het die pastorale sielkundige die afgelope aantal jare steeds meer op die voorgrond begin tree. Hy is egter 'n problematiese figuur, wie se identiteit van meer as een kant onder bespreking is. In ander lande, selfs in die VSA waar die kerk veel gebruik maak van die sielkunde, is dit moeilik om 'n presiese parallel vir hom te vind. Sowel binne as buite die kerk word hy deur sommige bevraagteken. Daarom is dit noodsaaklik om vanuit die teologie te kyk na die werk wat hy doen.

  14. Prevalence and severity of sleep disturbances among patients with early breast cancer

    Rami Fakih


    Full Text Available Context: Data regarding health-related quality of life in breast cancer patients in the Middle East are limited with fatigue and sleep disturbance being the most distressing symptoms reported by patients treated for early breast cancer. Aims: The aim of this study was to examine the prevalence and incidence of insomnia among patients with early-stage breast cancer patients treated with chemotherapy. Subjects and Methods: This was a prospective cohort study. We enrolled patients with stage I-III breast cancer patients treated with chemotherapy at the American University of Beirut Medical Center. At three different time points (prior to, during, and following chemotherapy, we assessed the severity of sleep disturbances using the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. The Institution Review Board approved the study. Results: Fifty-two patients were recruited. There was a significant increase in sleep disturbances during chemotherapy which improved to below baseline levels on completion of therapy. Prior to chemotherapy, 36% of patients reported poor sleep versus 58% during chemotherapy. The percentage of patients reporting clinical insomnia rose from 11% pretreatment to 36% during chemotherapy reflecting a significant symptomatic burden that is poorly documented and managed in routine clinical practice. Conclusions: Patients with nonmetastatic breast cancer experience an increase in sleep disturbances during the treatment phase. Physicians should be aware of the need to routinely screen for sleep disturbance in breast cancer patients undergoing chemotherapy.

  15. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Gabriele Falzarano


    Full Text Available The “ideal“ timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of “damage control orthopedics” is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser's Type A, ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma. All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  16. Irradiation of the tumor bed alone after lumpectomy in selected patients with early stage breast cancer treated with breast conserving therapy

    Vicini, F.; Chen, P; Benitez, P.; Johnson, P.; Gustafson, G.; Horwitz, E.; McCarthy, K.; Lacerna, M.; Goldstein, Neil; Martinez, A.


    Purpose: We present the initial findings of our in-house protocol treating the tumor bed alone after lumpectomy with low dose rate (LDR) interstitial brachytherapy in selected patients with early stage breast cancer treated with breast conserving therapy (BCT). Materials and Methods: Since 1/1/93, 50 women with early stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma ≤ 3 cm in maximum diameter, pathologic margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with ≤ 3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hours to the lumpectomy bed plus a 1-2 cm margin. Local control, cosmetic outcome, and complications were assessed. Results: Patients ranged in age from 40 to 84 years (median 65). The median tumor size was 10 mm (range, 1-25). Seventeen patients (34%) had well differentiated tumors, 22 (4%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node negative while 5 (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up is 40 months (range 29-50). No patient has experienced a local, regional, or distant failure. One patient died from colorectal carcinoma with no evidence of recurrent breast cancer. Good-to-excellent cosmetic results have been observed in all 50 patients (median cosmetic follow-up 36 months). No patient has experienced significant sequelae related to their implant. Conclusions: Early results with treatment of the tumor bed alone with a LDR interstitial implant appear promising. Long-term follow-up of these patients will be

  17. Early Activation of Patients after Surgery for Coronary Heart Disease under Extracorporeal Circulation

    I. A. Kozlov


    Full Text Available Objective: to analyze the safety and clinical efficiency of early activation of patients operated on for coronary heart disease under extracorporeal circulation. Subjects and methods. The data available in the case histories of 673 patients aged 29—76 years, operated on in 1995, 2004, and 2006, were analyzed. The study excluded patients with severe intraoperative complications (acute myocardial infarction, a need for extracorporeal circulation, and surgical bleeding. Early activation was made on an operating table if there were no contraindications. Some sections of the study were performed in the matched patient groups. Results. With early activation, the dosages of fentanyl were reduced by 2.5-3 times as compared with the 1995 data; the use of ketamine and diazepam was stopped. Instead of the latter, the currently available inhalational agents are coming into use: midazolam has been introduced and the rate of propofol use has increased. The higher activation rate required the use of flumazenil, naloxone, and proserin. The goal-oriented study of central hemodynamics with emphasis on early activation has indicated that lower dosages of fentanyl have no negative impact on cardiac pump function or myocardial oxygen balance. When the trachea was extubated on the operating table, there was appropriate central hemodynamic stabilization. It was found that the incidence of postoperative myocardial infarctions did not depend on the rate of activation. The frequency of cardiovascular complications was 38.8±5.9% and 22.9±5.0% in the prolonged artificial ventilation (AV and early activation groups, respectively (p<0.05; that of pulmonary complications was 16.4±4.5% and 5.7±2.8%, respectively (p<0.05. Early activation halved the length of stay at an intensive care unit (p<0.05 and reduced postoperative hospitalization at surgery units by 5 days (p< 0.05. Introduction of early activation caused a decrease in the duration of postoperative AV in the

  18. Digilanid C by die behandeling van hartlyers

    Snyman, Hendrik Willem


    In die voorafgaande word 'n literatuur studie oor die ontwikkeling en huidige stand van die chemie en farmakologie van die Digitalis purpurea en Digitalis lanata gegee, waarin spesiaal gelet word op die chemiese samestelling en farmakologiese aktiwiteit van die Digitalis lanata glikoside. Daarna


    In 1933 belas Rykskanselier. Hitler vir. Goering, Minister van Lugvaart, in die geheim met die skepping van die Luftwaffe. Die basis in Rusland is gesluit en toekomstige vlieeniers is nou in die geheim na Italie waar hulle elke aspek van moderne oorlog- voering oefen en die Blitzkrieg-gedagte, deur op ondersteuning van 'n.


    rang. In Assiries beteken die woord “hoof-eunug”. Soos reeds vermeld (by 2), vorm die eunug 'n belangrike deel van die Assiriese burokrasie. Dokumente dui aan ... rang in die Babiloniese weermag, en so 'n amptenaar het saam met die rabsag ..... baie laat, in die inter-testamentêre periode, gebruik is vir 'n gekastreerde.


    Carroll, Ty B; Javorsky, Bradley R; Findling, James W


    To assess the performance of biochemical markers in the detection of recurrent Cushing disease (CD), as well as the potential benefit of early intervention in recurrent CD patients with elevated late-night salivary cortisol (LNSC) and normal urinary free cortisol (UFC). The design was a single-center, retrospective chart review. Patients treated by the authors from 2008-2013 were included. Recurrence was defined by postsurgical remission of CD with subsequent abnormal LNSC, UFC, or dexamethasone suppression test (DST). We identified 15 patients with postsurgical recurrent CD after initial remission; all but one underwent testing with LNSC, DST, and UFC. Although 12 of 15 patients had normal UFC at time of recurrence, DST was abnormal in 11 of 15, and all 14 patients with LNSC results had ≥1 elevated measurement. Nine patients (7 with normal UFC) showed radiologic evidence of a pituitary tumor at time of recurrence. Among the 14 patients with available follow-up data, 12 have demonstrated significant improvement since receiving treatment. Five patients underwent repeat pituitary surgery and 4 achieved clinical and biochemical remission. Eight patients received mifepristone or cabergoline, and 6 showed clinical and/or biochemical improvement. Three patients (2 with prior mifepristone) underwent bilateral adrenalectomy and 2 demonstrated significant clinical improvements. LNSC is more sensitive than UFC or DST for detection of CD recurrence. Prompt intervention when LNSC is elevated, despite normal UFC, may yield significant clinical benefit for many patients with CD. Early treatment for patients with recurrent CD should be prospectively evaluated, utilizing LNSC elevation as an early biochemical marker. ACTH = adrenocorticotropic hormone CD = Cushing disease CS = Cushing syndrome CV = coefficient of variation DST = dexamethasone suppression test IPSS = inferior petrosal sinus sampling LNSC = late-night salivary cortisol QoL = quality of life TSS = transsphenoidal


    Simpson, Sue; Cook, Alison; Miles, Kathryn


    The aim of this study is to report on the experiences, benefits, and challenges of patient and public involvement and engagement (PPIE) from a publicly funded early awareness and alert (EAA) system in the United Kingdom. Using email, telephone, a Web site portal, Twitter and focus groups, patients and the public were involved and engaged in the recognized stages of an EAA system: identification, filtration, prioritization, early assessment, and dissemination. Approaches for PPIE were successfully integrated into all aspects of the National Institute for Health Research Horizon Scanning Research and Intelligence Centre's EAA system. Input into identification activities was not as beneficial as involvement in prioritization and early assessment. Patients gave useful insight into the Centre's Web site and engaging patients using Twitter has enabled the Centre to disseminate outputs to a wider audience. EAA systems should consider involving and engaging with patients and the public in identification, prioritization, and assessment of emerging health technologies where practicable. Further research is required to examine the value and impact of PPIE in EAA activities and in the early development of health technologies.

  3. Understanding the Problems of Death and Dying: A Health Professionals' Attitude Survey.

    Green, Joseph S.; And Others


    Attitudes of health practitioners and others toward death and dying and their emotional reactions to dying patients were surveyed both before and after a Veterans Administration workshop. Some attitude changes were noted, with implications for future workshops. (MF)

  4. The Frequency and Severity of Gastrointestinal Symptoms in Patients with Early Parkinson’s Disease

    Hye-Young Sung


    Full Text Available Objective Although gastrointestinal dysfunctions occur in the majority of patients with Parkinson’s disease (PD, they are often unrecognized because many patients remain relatively asymptomatic in the early stage. We investigated the frequency of gastrointestinal symptoms in patients with PD using newly developed gastrointestinal symptom questionnaires. Methods Early PD patients with a symptom duration not exceeding 3 years were included in this study. All PD patients were evaluated using a questionnaire, which consisted of three relevant domains: oropharyngoesophageal (10 items; gastric (3 items; and intestinal-anorectal (7 items. The frequency of symptoms was calculated as a proportion with an item score ≥ 2. Results Of the 54 patients enrolled, 48 patients (88.9% responded that bowel symptoms developed before the onset of Parkinsonian motor symptoms, and four patients reported that the onset of two types of symptoms (i.e., bowel and neurological occurred approximately simultaneously, with only months between them. The frequencies of gastrointestinal symptoms are as follows: speech disturbance (40.7%, drooling (24.1%, sense of getting stuck (31.5%, choking (27.8%, globus pharyngis (16.7%, repetitive deglutition (29.6%, pain during swallowing (5.6%, food regurgitation (3.7%, acid reflux (7.4%, nausea/vomiting (11.1%, early satiety (16.7%, postprandial fullness (14.8%, epigastric soreness (9.3%, abdominal pain (3.7%, constipation (46.3%, excessive strain during defecation (33.3%, fecal incontinence (7.4%, tenesmus (20.4%, loose stool or diarrhea (3.7%, and difficulty in relaxing anal sphincter (11.1%. Two patients were scored at zero. Conclusions Our findings confirm that gastrointestinal dysfunction occurs in early PD in relatively high frequency.

  5. Abnormal early gamma responses to emotional faces differentiate unipolar from bipolar disorder patients.

    Liu, T Y; Chen, Y S; Su, T P; Hsieh, J C; Chen, L F


    This study investigates the cortical abnormalities of early emotion perception in patients with major depressive disorder (MDD) and bipolar disorder (BD) using gamma oscillations. Twenty-three MDD patients, twenty-five BD patients, and twenty-four normal controls were enrolled and their event-related magnetoencephalographic responses were recorded during implicit emotional tasks. Our results demonstrated abnormal gamma activity within 100 ms in the emotion-related regions (amygdala, orbitofrontal (OFC) cortex, anterior insula (AI), and superior temporal pole) in the MDD patients, suggesting that these patients may have dysfunctions or negativity biases in perceptual binding of emotional features at very early stage. Decreased left superior medial frontal cortex (smFC) responses to happy faces in the MDD patients were correlated with their serious level of depression symptoms, indicating that decreased smFC activity perhaps underlies irregular positive emotion processing in depressed patients. In the BD patients, we showed abnormal activation in visual regions (inferior/middle occipital and middle temporal cortices) which responded to emotional faces within 100 ms, supporting that the BD patients may hyperactively respond to emotional features in perceptual binding. The discriminant function of gamma activation in the left smFC, right medial OFC, right AI/inferior OFC, and the right precentral cortex accurately classified 89.6% of patients as unipolar/bipolar disorders.

  6. Die Transition zur pflegenden Tochter

    Dagmar Dräger


    Full Text Available Das Buch aus der Reihe „Studien zur Gesundheits- und Pflegewissenschaft“ beschreibt den theoretischen Hintergrund, das methodische Vorgehen und die Ergebnisse einer biografischen Untersuchung, die sich dem Übergang von der Tochter zur pflegenden Tochter widmete. Grundlage der Publikation ist die Dissertation (2002 der Autorin. Mit der Berücksichtigung biographischer und familiärer Hintergründe wird eine neue Perspektive in der Forschung zu pflegenden Angehörigen eingenommen.

  7. Maintaining Low Voiding Solder Die Attach for Power Die While Minimizing Die Tilt

    Hamm, Randy; Peterson, Kenneth A.


    This paper addresses work to minimize voiding and die tilt in solder attachment of a large power die, measuring 9.0 mm X 6.5 mm X 0.1 mm (0.354” x 0.256” x 0.004”), to a heat spreader. As demands for larger high power die continue, minimizing voiding and die tilt is of interest for improved die functionality, yield, manufacturability, and reliability. High-power die generate considerable heat, which is important to dissipate effectively through control of voiding under high thermal load areas of the die while maintaining a consistent bondline (minimizing die tilt). Voiding was measured using acoustic imaging and die tilt was measured using two different optical measurement systems. 80Au-20Sn solder reflow was achieved using a batch vacuum solder system with optimized fixturing. Minimizing die tilt proved to be the more difficult of the two product requirements to meet. Process development variables included tooling, weight and solder preform thickness.

  8. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty

    Luna, I E; Kehlet, H; Peterson, B


    AIMS: The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy). PATIENTS AND METHODS: A total of 80...... patients aged 55 to 80 years undergoing THA or TKA for osteoarthritis were included in this prospective cohort study. The main outcome measure was change in patient reported hip or knee injury and osteoarthritis outcome score (HOOS/KOOS) from pre-operatively until post-operative day 13 (THA) or 20 (TKA...


    Kolevski Goran; Korneti-Pekevska Kostandina


    Introduction:The aim of this study is to evaluate early brain ischemic changes on CT scan in stroke patients in correlation with the clinical outcome, as well as to evaluate if there is prognostic and predictive features that can be used. Patients and methods: We examined 20 patients with acute ischemic stroke, from which 12 were male and 8 were female, at the age from 47 to 76 years. Results: The hyperdense medial artery (HMA) sign was present in 10 (50%) patients. Concerning the ASPECTS s...

  10. Early Prediction of Sepsis Incidence in Critically Ill Patients Using Specific Genetic Polymorphisms.

    David, Vlad Laurentiu; Ercisli, Muhammed Furkan; Rogobete, Alexandru Florin; Boia, Eugen S; Horhat, Razvan; Nitu, Razvan; Diaconu, Mircea M; Pirtea, Laurentiu; Ciuca, Ioana; Horhat, Delia; Horhat, Florin George; Licker, Monica; Popovici, Sonia Elena; Tanasescu, Sonia; Tataru, Calin


    Several diagnostic methods for the evaluation and monitoring were used to find out the pro-inflammatory status, as well as incidence of sepsis in critically ill patients. One such recent method is based on investigating the genetic polymorphisms and determining the molecular and genetic links between them, as well as other sepsis-associated pathophysiologies. Identification of genetic polymorphisms in critical patients with sepsis can become a revolutionary method for evaluating and monitoring these patients. Similarly, the complications, as well as the high costs associated with the management of patients with sepsis, can be significantly reduced by early initiation of intensive care.

  11. Neurokognitiewe integrasie en die leerproses

    Du Preez, Johan J.


    Full Text Available The purpose of this article, "Neuro-cognitive integration and the learning process'; is to find principles and strategies for the development of brain potential and the optimal integration of subject matter. Eight neuro-cognitive systems are identified and their importance to the integration of subject matter is emphasized. These systems are cortical energy, coding, planning and controlling, as well as the verbal sequential, non-verbal holistic, physical-motor, social effective and the subconscious. The relevant principles and strategies can serve as basis for mainstream and special education, guidance as well as psychotherapy. Die doe! met hierdie artikel is om beginsels en strategiee te vind om breinpotensiaal te ontsluit en leerstof optimaal te integreer. Aan die hand van 'n neurokognitiewe model word 'n aantal beginsels en strategiee bespreek en die verband met die leerproses word aangetoon. Agt neurokognitiewe sisteme is gei'dentifiseer en die belangrike rot wat dit speel ten opsigte van die integrasie van leerstof word beklemtoon. Genoemde sisteme sluit die volgende in: kortikale energie, kodering, beplanning en kontrolering, asook die verbaal-sekwensiele, nieverbaal-holistiese, fisiek-motoriese, sosio-affektiewe en die subbewuste. Genoemde beginsels en strategiee kan oak dien as grondslag vir hoofstroomonderwys, spesialiseringsonderwys, voorligting sowel as psigoterapie.


    Vamsidhar Reddy Manne


    Full Text Available BACKGROUND Since 2009, swine influenza outbreaks have been recorded virtually every year, although their extent and severity have varied widely. Localised outbreaks are taking place at variable intervals, usually every 1-3 years. The most recent outbreak has been from December 2016 through April 2017. We still are in the midst of one. This study of factors influencing early clinical and radiological improvement and reversion to normoxia in swine flu patients with respiratory failure helps in saving precious lives. MATERIALS AND METHODS This is a cross-sectional study conducted at RICU, Department of Pulmonary Medicine, S.V.R.R. Government General Hospital/S.V. Medical College, Tirupathi, Andhra Pradesh, between January 2017 and April 2017. Study sample was the total number of swine flu patients admitted to the RICU of the Department of Pulmonary Medicine with respiratory failure. RESULTS Out of 42 patients who tested positive for swine flu, 37 had respiratory failure and were immediately admitted in RICU. Oxygen support, oseltamivir and higher antibiotics were immediately started, injectable steroids given where necessary. Comorbidities were meticulously managed. 19 were males and 18 were females. 21 patients (>50% were above 50 years. Cough and breathlessness were present in all patients (100%. At admission, all 37 showed SpO2 <85% and at discharge all of them were normoxic. 18 patients had either multilobar pneumonia or ARDS on CXR, which had resolved by the time of discharge. The shortest duration of stay was 7 days and the longest duration of stay was 11 days. 35 patients were discharged and 2 patients died. CONCLUSION Good oxygenation, starting of oseltamivir on day 1 of admission prevents further complications and hastens recovery. Swine flu patients with normal chest x-ray and no comorbidities can still end up with respiratory failure. Steroids decrease cough and breathlessness, but have no role in hastening recovery. No residual symptoms

  13. A deformation-based morphometry study of patients with early-stage Parkinson's disease

    Borghammer, P; Østergaard, Karen; Cumming, P


    BACKGROUND AND PURPOSE: Previous volumetric magnetic resonance imaging (MRI) studies of Parkinson's disease (PD) utilized primarily voxel-based morphometry (VBM), and investigated mostly patients with moderate- to late-stage disease. We now use deformation-based morphometry (DBM), a method...... purported to be more sensitive than VBM, to test for atrophy in patients with early-stage PD. METHODS: T1-weighted MRI images from 24 early-stage PD patients and 26 age-matched normal control subjects were compared using DBM. Two separate studies were conducted, where two minimally-biased nonlinear...... intensity-average were created; one for all subjects and another for just the PD patients. The DBM technique creates an average population-based MRI-average in an iterative hierarchical fashion. The nonlinear transformations estimated to match each subject to the MRI-average were then analysed. RESULTS...

  14. Early results of metal on metal articulation total hip arthroplasty in young patients.

    Mohamad, J A; Kwan, M K; Merican, A M; Abbas, A A; Kamari, Z H; Hisa, M K; Ismail, Z; Idrus, R M


    We report our early experience of 20 cases of metal on metal articulation total hip arthroplasty in 19 young patients. Avascular necrosis of the femoral head (63%) was the commonest diagnosis for patients undergoing this procedure, followed by osteoarthritis (21%). In general, most of the patients were young and physically active with an average age of 43.1 years (range, 25 to 58 years). The average follow-up period was 18 months (range, 7 to 46 months). The mean total Harris Hip Score preoperatively and at final follow-up was 31 points and 89 points respectively. The mean total Pain Score improved from an average of 11.5 to 41.1 points at final follow-up. Sixteen (84%) of the patients had a good to excellent hip score. There was one dislocation, which stabilized after reduction and conservative management. One case of early infection underwent a two-staged revision.

  15. Approaches to the History of Patients: From the Ancient World to Early Modern Europe.

    Stolberg, Michael


    This chapter looks from an early modernist's perspective at some of the major questions and methodological issues that writing the history of patients in the ancient world shares with similar work on Patientengeschichte in medieval and early modern Europe. It addresses, in particular, the problem of finding adequate sources that give access to the patients' experience of illness and medicine and highlights the potential as well as the limitations of using physicians' case histories for that purpose. It discusses the doctor-patient relationship as it emerges from these sources, and the impact of the patient's point of view on learned medical theory and practice. In conclusion, it pleads for a cautious and nuanced approach to the controversial issue of retrospective diagnosis, recommending that historians consistently ask in which contexts and in what way the application of modern diagnostic labels to pre-modern accounts of illness can truly contribute to a better historical understanding rather than distort it.

  16. Transfusion-associated circulatory overload in adult, medical emergency patients with perspectives on early warning practice

    Gosmann, Fanny; Nørgaard, Astrid; Rasmussen, Maj-Britt


    of transfusion-associated dyspnoea. Vital signs and changes in dyspnoea and blood pressure were registered within the frame of the Early Warning Score, and one case was documented as being transfusion-related in the medical record. No cases were reported to the haemovigilance system. DISCUSSION: The incidence...... to the haemovigilance system. The clinical implications are discussed within the frame of the Early Warning Score. METHODS: We conducted a retrospective audit of electronic hospital medical records of patients receiving blood transfusion in a single medical emergency unit. Patients were admitted during a 6-month period...... and data on symptoms and vital signs were extracted from the records. RESULTS: Of 4,353 consecutively admitted patients, 156 patients were transfused with a total of 411 blood components. The audit identified five cases of transfusion-associated circulatory overload (incidence 3.2%) and four cases...

  17. Modifications of the National Early Warning Score for patients with chronic respiratory disease

    Pedersen, N. E.; Rasmussen, L. S.; Petersen, J. A.


    System (CROS), the Chronic Respiratory Early Warning Score (CREWS) and the Salford NEWS (S-NEWS) affected NEWS total scores and NEWS performance. METHODS: In an observational study, we included patients with chronic respiratory disease. The frequency of use of CROS and the NEWS total score changes caused...... and specialist consultation' total score intervals to lower intervals. CONCLUSION: Capital Region of Denmark NEWS Override System was frequently used in patients with chronic respiratory disease. CROS, CREWS and S-NEWS reduced sensitivity for 48-h mortality and ICU admission. Using the methodology prevalent......BACKGROUND: The National Early Warning Score (NEWS) uses physiological variables to detect deterioration in hospitalized patients. However, patients with chronic respiratory disease may have abnormal variables not requiring interventions. We studied how the Capital Region of Denmark NEWS Override...

  18. Postmenopausal osteoporosis: early screening of risk patients by spinal biphotonic absorptiometry

    Sabatier, J.P.; Guaydier-Souquieres, G.; Loyau, G.


    With quantification techniques of the spinal bone condition, especially with spinal biphotonic absorptiometry, early screening of patients risking subsequent development of osteoporosis complicated with vertebral compression is possible. An investigation was conducted in Lower Normandy, in 386 women who had undergone menopause or an ovariectomy, with ages ranging between 40 and 56 years; 274 were in a peri-menopausal state. A curve of the bone mineral content according to age was previously established. From this curve, in semilogarithmic representation, each patient risk was assessed. This risk is considered as high in 30 p. cent of the patients, non existent in 52 p. cent and 18 p. cent are borderline. The percentage of high risk patients increases with the number of years since menopause. It is hoped that the incidence of osteoporosis will decrease with early screening and preventive therapeutic measures [fr

  19. The Negative Impact of Early Peritonitis on Continuous Ambulatory Peritoneal Dialysis Patients

    Hsieh, Yao-Peng; Wang, Shu-Chuan; Chang, Chia-Chu; Wen, Yao-Ko; Chiu, Ping-Fang; Yang, Yu


    ♦ Background: Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD). ♦ Methods: A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes. ♦ Results: Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0

  20. Numerical optimization of die geometry in open die forging

    Christiansen, Peter; Hattel, Jesper Henri; Bay, Niels


    This paper deals with numerical optimization of open die forging of large metallic ingots made by casting implying risk of defects, e.g. central pores. Different material hardening properties and die geometries are combined in order to investigate, which geometry gives rise to maximum closure...

  1. die geskiedenis van die saw gedenkteken te fort klapperkop militere ...

    As gevolg van enige optrede, op enige plek, te enige tyd, deur enige vyand van die RSA of deur enige terroris(te), insurgent(e) of ander persoon of persone wat die RSA en sy volkere kwaadgesind is. h. Binne twee jaar (vyfhondred-en-dertig dae) nadat hy/sy met 'n ongeskiktheids- pensioen uit diens getree het agv siekte,.

  2. Die adversatiewe stelsel van bewyslewering en die beste belang ...

    MJM Venter

    weeg. Hierdie vraag word teen die agtergrond daarvan beoordeel dat veral dispute ..... restructuring family into the highly polarized positions of court-based dispute resolution.16. Talle alternatiewe om tekortkominge in die adversatiewe proses te ..... De Jong M "Mediation and Other Appropriate Forms of Alternative Dispute.

  3. Die teologiese debat: Die waarde of betekenis daarvan

    Ego vero hoc libro non contuli sed asservi et assero, ac penes nullum vo- lo esse iudicium, sed omnibus suadeo, ut praestent obsequium. (M Luther, De servo arbitrio, 1525). 1. INLEIDING. In ons dae is dit hoe mode om oor alles debat te voer. Een van die towerwoorde van ons tyd, veral op die politiek-staatkundige terrein, ...

  4. Die konteks vir die keuse van geriefsvoedsel van bepaalde ...


    70. Die konteks vir die keuse van geriefsvoedsel van bepaalde beroepsvroue *. Martha Kok en Priscilla Botha. ABSTRACT. The purpose of this research is to understand and describe the context in which career women choose, purchase and use convenience food (CF). A person is rarely isolated from or unaffected by.

  5. Die vlugtige taal van vergeet: Die metafoor by Breyten Breytenbach ...

    From his first book of poetry, die ysterkoei moet sweet (“the iron cow must sweat”, 1964), till his most recent one, die windvanger (“the windcatcher”, 2007), metaphor has been a central means towards the creation of meaning for Breytenbach. This article will investigate the use of metaphor particularly in this recent book.

  6. Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain

    Foster, Nadine E; Hartvigsen, Jan; Croft, Peter R


    ABSTRACT: Musculoskeletal pain is common across all populations and costly in terms of impact on the individual and, more generally, on society. In most health-care systems, the first person to see the patient with a musculoskeletal problem such as back pain is the general practitioner, and acces......, and underpinning evidence, for reconsidering who should take responsibility for the early assessment and treatment of patients with musculoskeletal problems....

  7. Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui


    Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with...

  8. Patients' preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

    Jansen, S J T; Kievit, J; Nooij, M A; Haes, J C J M de; Overpelt, I M E; Slooten, H van; Maartense, E; Stiggelbout, A M


    When making decisions about adjuvant chemotherapy for early-stage breast cancer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of the present study were: (1) to determine the minimum benefits that patients need to find chemotherapy acceptable, and (2) to explore potential preference determinants, namely: positive experience of the treatment, reconciliation with the treatment decision, and demographic...

  9. Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?

    Slor, Chantal J.; Witlox, Joost; Adamis, Dimitrios; Meagher, David J.; Ploeg, Tjeerd van der; Jansen, Rene W. M. M.; van Stijn, Mireille F. M.; Houdijk, Alexander P. J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.


    Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium) are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing deliriu...

  10. Efficacy of tofacitinib monotherapy in methotrexate-naive patients with early or established rheumatoid arthritis

    Fleischmann, Roy M; Huizinga, Tom W J; Kavanaugh, Arthur F; Wilkinson, Bethanie; Kwok, Kenneth; DeMasi, Ryan; van Vollenhoven, Ronald F


    Introduction Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). Tofacitinib monotherapy was previously shown to inhibit structural damage, reduce clinical signs and symptoms of RA, and improve physical functioning over 24?months in methotrexate (MTX)-naive adult patients with RA. In this post hoc analysis, we compared efficacy and safety of tofacitinib in patients with early (disease duration

  11. Is tamoxifen associated with an increased risk for thromboembolic complications in patients undergoing microvascular breast reconstruction? [Ist die Einnahme von Tamoxifen zum Zeitpunkt der mikrovaskulären Brustrekonstruktion mit einer erhöhten Rate an thrombembolischen Komplikationen assoziiert?

    Krämer, Robert


    Full Text Available [english] Introduction: Tamoxifen is associated with a twofold increased risk of thromboembolic events. Third generation aromatase inhibitors (AIs, such as letrozole, anastrozole, and exemestane have therefore replaced tamoxifen in the adjuvant therapy of hormone receptor-positive breast cancer. A retrospective review was performed in patients who underwent delayed microvascular breast reconstruction and received tamoxifen at the time of surgery in order to assess the risk of both minor and major flap complications including thromboembolic events.Patients and methods: Twenty-nine patients who underwent delayed microsurgical breast reconstruction with autologous tissue between 2006 and 2012 were included in the study. The overall complication rates were compared between patients who did versus those who did not receive tamoxifen at the time of microsurgical breast reconstruction. Results: Breast reconstruction was performed with a DIEP flap in and with a TRAM flap in 4 patients. Overall, the complication rate was 37.9% (n=11 consisting of 5 major (including one total flap loss and 6 minor complications. In patients receiving tamoxifen (n=5, we observed one minor complication and one major complication with a total flap loss due to thrombus formation at the anastomosis site. In one patient pulmonary embolism occurred without association to tamoxifen. The number of thromboembolic events was equivalent in both groups (p=0.642. No increase of major (p=0.858 or minor (p=0.967 complications in the tamoxifen group could be observed. Taking the overall complication rate into account there was no statistically difference between the two groups (p=0.917.Conclusion: In our study we could not observe an increased risk for thromobembolic events in patients receiving tamoxifen while undergoing autologous microvascular breast reconstruction.[german] Aromatasehemmer der dritten Generation haben mittlerweile Tamoxifen in der neoadjuvanten und adjuvanten Therapie

  12. The effects of early hypothyroidism of different 131I administration modes for Graves' patients treatment

    Deng Minbin; San Hanqing; Bo Jingli


    Objective: Exploring how to decrease the early hypothyroidism rate in 131 I treatment of Graves' disease. Methods: 165 Graves' patients in our department from May 1999 to April 2000 were divided into two groups according to the patients' voluntariness. The first group used convention one time administration. The second group used multiple small dosage therapy (interval 3 month). After one year the treatment effects were evaluate. Results: The curing rate (95.0%) in the second group is higher than the first group (87.1%), P<0.05. The early hypothyroidism rate (5.0%) is significantly lower than the first group (20%), P<0.01. Conclusions: Comparing with convention one time therapy, multiple small dosage (may be one time) therapy not only can raise the curing rate, but also can decrease the early hypothyroidism rate

  13. FLT-PET for early response evaluation of colorectal cancer patients with liver metastases

    Mogensen, Marie Benzon; Loft, Annika; Aznar, Marianne


    BACKGROUND: Fluoro-L-thymidine (FLT) is a positron emission tomography/computed tomography (PET/CT) tracer which reflects proliferative activity in a cancer lesion. The main objective of this prospective explorative study was to evaluate whether FLT-PET can be used for the early evaluation...... standardised uptake values (SUVmax, SUVmean) were measured. After three cycles of chemotherapy, treatment response was assessed by CT scan based on RECIST 1.1. RESULTS: Thirty-nine consecutive patients were included of which 27 were evaluable. Dropout was mainly due to disease complications. Nineteen patients...... between the response according to RECIST and the early changes in FLT uptake measured as SUVmax(p = 0.24). CONCLUSIONS: No correlation was found between early changes in FLT uptake after the first cycle of treatment and the response evaluated from subsequent CT scans. It seems unlikely that FLT-PET can...

  14. Identification of relevant ICF categories by geriatric patients in an early post-acute rehabilitation facility.

    Grill, Eva; Stucki, Gerold; Boldt, Christine; Joisten, Susanne; Swoboda, Walter

    To describe functioning and health of elderly patients in an early post-acute rehabilitation facility and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF). Cross-sectional survey in a convenience sample of elderly patients requiring rehabilitation in an early post-acute rehabilitation facility. The second-level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation, absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. The mean age in the sample was 79.9 years. Sixty-nine percent of the patients were female. In 150 patients, 82 ICF categories (34%) had a prevalence of 30% or above. The 82 categories included 22 categories (45%) of the component Body Functions, six categories (15%) of the component Body Structures, 25 categories (34%) of the component Activities and Participation and 29 (57%) categories of the component Environmental Factors. This study is a first step towards the development of ICF Core Sets for geriatric patients in early post-acute rehabilitation facilities.

  15. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

    Koene, Bart M.; Hamad, Mohamed A. Soliman; Bouma, Wobbe; Mariani, Massimo A.; Peels, Kathinka C.; van Dantzig, Jan-Melle; van Straten, Albert H.


    Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG). Methods:

  16. Early home-supported discharge for patients with stroke in Portugal

    Santana, Silvina; Rente, José; Neves, Conceição


    Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17...

  17. Predictive value of early near-infrared spectroscopy monitoring of patients with traumatic brain injury

    Alina Vilkė


    Conclusions: NIRS plays an important role in the clinical care of TBI patients. Regional brain saturation monitoring provides accurate predictive data, which can improve the allocation of scarce medical resources, set the treatment goals and alleviate the early communication with patients’ relatives.

  18. Complexity Analysis of Resting-State MEG Activity in Early-Stage Parkinson's Disease Patients

    Gómez, C.; Olde Dubbelink, K.T.E.; Stam, C.J.; Abasolo, D.; Berendse, H.W.; Hornero, R.


    The aim of the present study was to analyze resting-state brain activity in patients with Parkinson's disease (PD), a degenerative disorder of the nervous system. Magnetoencephalography (MEG) signals were recorded with a 151-channel whole-head radial gradiometer MEG system in 18 early-stage

  19. Integration of early specialist palliative care in cancer care: Survey of oncologists, oncology nurses, and patients

    Naveen Salins


    Conclusion: Oncologists, oncology nurses, and patients felt that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. The perceptions of benefit of the palliative care intervention in the components surveyed, differed among the three groups.

  20. Behaviour and school achievement in patients with early and continuously treated phenylketonuria

    Stemerdink, B.A.; Kalverboer, A.F.; Meere, J.J. van der; Molen, M.W. van der; Huisman, J.; Jong, L.W.A. de; Slijper, F.M.E.; Verkerk, P.H.; Spronsen, F.J. van


    Thirty patients with early and continuously treated phenylketonuria (PKU) between 8 and 20 years of age were compared with 30 controls, matched individually for age, sex, and educational level of both parents, on behaviour rating scales for parents and teachers as well as a school achievement scale.

  1. Predicting delirium duration in elderly hip-surgery patients: does early symptom profile matter?

    Slor, C.J.; Witlox, J.; Adamis, D.; Meagher, D.J.; van der Ploeg, T.; Jansen, R.W.M.M.; van Stijn, M.F.M.; Houdijk, A.P.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.


    Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology


    Е.I. Alexeeva


    Full Text Available The article presents results of a study of effectiveness and safety of infliximab — monoclonal antibodies to the tumor necrotizing factor (TNF in treatment of 100 patients11 months — 17 years old with early and late articular types of juvenile rheumatoid arthritis. The duration of treatment was 3 months — 2 years. Infliximap was delivered intravenously by scheme: infusion on 0, 2nd, 6th weeks and then every 8th week. The single dose of infliximab in patients with early rheumatoid arthritis was 6.7 (5.5; 9.0 mg/kg, with late type — 6.0 (5.0; 7.0 mg/kg of body weight. 102 weeks of treatment with anti-TNF-agent provided development of clinical remission, decrease and normalization of laboratory tests of disease’s activity, total restoration of joint’s function, increase of quality of life (on 97% in patients with early type, and 72% 0 in ones with late type. The drug was abolished in 39 (39% of patients, 23% — due to the development of secondary inefficiency, and 11% — due to the development of unfavorable effects.Key words: children, early and late rheumatoid arthritis, treatment, infliximab.(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3:30-42

  3. Clinical practice of adjuvant chemotherapy in patients with early-stage epithelial ovarian cancer

    Frielink, Lindy M J; Pijlman, Brenda M; Ezendam, N.P.M.; Pijnenborg, Johanna M A


    BACKGROUND: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The

  4. Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

    Frielink, L.M.; Pijlman, B.M.; Ezendam, N.P.; Pijnenborg, J.M.A.


    BACKGROUND: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The

  5. Pylstertmotte (Lepidoptera: Sphingidae van die Nasionale Krugerwildtuin

    M. A. van den Berg


    Full Text Available 'n Totaal van 42 spesies van pylstertmotte is in die Nasionale Krugerwildtuin versamel. Die bekendste hiervan is die patatrusper (Herse convolvuli (L en die dood-skedelmot (Acherontia atropos (L. Die volgende spesies wat versamel is, se voorkoms is nog nie voorheen vir die Republiek van Suid-Afrika aangemeld nie nl. Pemba flavillacea (Walk., Praedora plagiata (R. &J., Leptoclanis basalis (Walk., Polyptychus calcareus (R. &J., Polyptychus compar (R. &J., Nephele aequivalens (Walk., Nephele peneus (Cram., Hippotion roseipennis (Butler en Xenosphingia jansei (Jord.. Die verspreiding van Oligographa juniperi (Bsd. wat langs die kusgebiede van Natal en die Oos-Kaap aangetrefword, is op verskeie plekke in die Krugerwildtuin versamel.

  6. Cardiac safety of trastuzumab as adjuvant treatment for Japanese patients with early breast cancer

    Ishihara, Mikiya; Mukai, Hirofumi; Nagai, Shunji; Mukohara, Toru


    Recently, randomized trials revealed that trastuzumab as adjuvant treatment was effective in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients. Safety information on adjuvant trastuzumab use in Japanese patients, especially cardiac toxicity data, is needed. We retrospectively reviewed 48 patients with early-stage HER2-positive breast cancer who were treated with curative surgery and adjuvant trastuzumab at the National Cancer Center Hospital East (Kashiwa, Japan). The cardiac safety as well as the short-term efficacy of trastuzumab were evaluated. The median age of the patients was 54 years. All patients received adjuvant or neoadjuvant cytotoxic chemotherapy. Twenty-seven patients (56%) received adjuvant radiation therapy. Forty-four patients (92%) received trastuzumab without concurrent cytotoxic chemotherapy and 4 patients (8%) on taxanes received trastuzumab concurrently. Twenty-five patients completed 1 year of trastuzumab treatment and 5 patients completed 2 years of trastuzumab treatment. Nine patients discontinued trastuzumab treatment, because of progressive disease (1 patient), decrease in left ventricular ejection fraction (LVEF; 2 patients), patient's refusal (4 patients), and other reasons (2 patients). There were five cardiac events. A decrease in LVEF to less than 50% was seen in 2 patients. The relationship between trastuzumab treatment and the cardiac events was unclear in 3 patients. The median follow-up time was 21.2 months. The disease-free survival (DFS) was 97.5% at 1 year and 92.9% at 2 years. The incidence of cardiac events caused by trastuzumab treatment was low in our analysis. Adjuvant trastuzumab treatment for up to at least 1 year should be safe for Japanese breast cancer patients. (author)

  7. Study participation rate of patients with acute spinal cord injury early during rehabilitation.

    Krebs, J; Katrin Brust, A; Tesini, S; Guler, M; Mueller, G; Velstra, I M; Frotzler, A


    Retrospective observational study. To investigate the study participation rate of patients with acute spinal cord injury (SCI) early during rehabilitation after conveying preliminary study information. Single SCI rehabilitation center in Switzerland. Newly admitted acute SCI patients receive a flyer to inform them concerning the purpose of clinical research, patient rights and active studies. Upon patient request, detailed study information is given. The rate of patients asking for detailed information (study interest) and the rate of study participation was evaluated from May 2013 to October 2014. Furthermore, the number of patients not withdrawing consent to the utilization of coded health-related data was determined. The flyer was given to 144 of the 183 patients admitted during the observation period. A total of 96 patients (67%) were interested in receiving detailed information, and 71 patients (49%) finally participated in at least one study. The vast majority of patients (that is, 91%) did not withdraw consent for retrospective data analysis. An age over 60 years had a significantly (P⩽0.023) negative effect on study interest and participation, and the consent rate to retrospective data analysis was significantly (Pinterest and participation were reduced more than 5 and 14-fold, respectively, in patients older than 60 years. The relatively low (approximately 50%) study participation rates of acute SCI patients should be considered when planning clinical trials. The recruitment of patients older than 60 years may be reduced substantially.

  8. Skin toxicity during hypo fractionated breast irradiation in patient with early breast cancer

    Petrova, Deva; Smichkoska, Snezhana


    Radiotherapy is an important component in the treatment of breast cancer. (1) Many women with an early stage of breast cancer are candidates for a breast conservation therapy, which combines both conservative surgery and radiotherapy. (2) According to the data from some series, an estimated 90% of the patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis. (3) The severity of the skin reactions during and following the breast irradiation is influenced by both treatment-related and patient-related factors. The treatment - related factors include the fraction size (the dose delivered with each treatment), the total dose delivered, the volume of tissue treated, the type of radiation (4) and the addition of chemotherapy. (5) The patient-related factors include breast size, smoking, axillary lymphocele drainage before treatment, age, and infection of the surgical wound. (6) A hypo fractionation radiotherapy is alternative for a standard fractionation radiotherapy for women with early stage of breast cancer after conservative surgery. The aim of the study was to analyse the acute skin reactions during a hypo fractionated radiotherapy in patients with early breast cancer at our institution. Materials and methods: Twenty patients with early stage of breast cancer (Stadium I and II) and conservative surgery (quadrantectomy of breast with ipsilateral axillary dissection) were analysed. The patients were treated with 6MV x rays on LINAC, using tangential fields with 2.65Gy per fraction and the total dose prescribed to target volume was 42,4 Gy. These patients were observed for acute skin toxicity during the second week and at the end of the treatment. We evaluated dryness, epilation, pigmentation, changes and eritema, dry desquamation (clinically characterized by scaling and pruritus) and moist desquamation (characterized by serious oozing and exposure of the dermis). By using the radiation therapy oncology group’s (RTOG

  9. Early versus late pulmonary valve replacement in patients with transannular patch-repaired tetralogy of Fallot.

    Dobbels, Bieke; Herregods, Marie-Christine; Troost, Els; Van De Bruaene, Alexander; Rega, Filip; Budts, Werner; De Meester, Pieter


    Although the effects of pulmonary regurgitation after tetralogy of Fallot repair are detrimental, timing of pulmonary valve replacement (PVR) is unclear. Our goal was to evaluate the midterm efficacy and safety of early PVR. Patients with tetralogy of Fallot who underwent repair from 1962 to 2015 were included from the local database. Statistical analyses compared patients who underwent early PVR (age ≤16 years), late PVR and no PVR. The timing of the intervention was compared for efficacy-all-cause mortality and the combined end-point of all-cause mortality, ventricular tachycardia and defibrillator implantation-and for safety-the combined end-point of 1-year postoperative mortality after PVR, endocarditis and reintervention. Echocardiographic and electrocardiographic data at the last follow-up examination were compared across the 3 groups. Two hundred seventy-three patients (age 21 ± 5 years; 52% female) were included. The mean follow-up was 24 (95% confidence interval 22.7-26.2) years; the observed median was 21 years (interquartile range 11-31). No significant difference in survival was found between the early PVR (n = 106; 39%), the late PVR (n = 47; 17%) and the no PVR groups (n = 120; 44%) (P = 0.990). No significant difference in the combined efficacy end-point was noted between patients who underwent early PVR compared with patients who underwent late PVR (P = 0.247). Worse event-free survival for the 3-point safety end-point was observed after early PVR (P < 0.001). Right ventricular morphology (P < 0.001) and function (P < 0.001) were better preserved in the patient group that underwent PVR before the age of 16 years. As expected, PVR-related morbidity was higher in patients who underwent early PVR but the midterm outcome was similar. Nevertheless, better preservation of right ventricular morphology and function in the early PVR group might result in better long-term survival. © The Author 2017. Published by Oxford

  10. Die faktore gemeenskaplik aan die selfondersoekvraelys van Holland en die nuwe Suid-Afrikaanse beroepsbelangstellingsvraelys

    C. Swanevelder


    Full Text Available The factors common to the Self Directed Search of Holland (SDS and the new South African Vocational Interest Inventory (SAVII. The new South African Vocational Interest Inventory was locally developed with the purpose to create a single vocational interest inventory for all population groups in the RSA. In this study the common factors underlying the SDS and the SAVII were determined with the aid of interbattery factor analysis. The results indicate that there are six common factors underlying the two instruments for both the standard nine boys and girls, and that these factors agree with the six factors built into the SDS by Holland. Opsomming Die nuwe Suid-Afrikaanse Beroepsbelangstellingsvraelys (SABBV is plaaslik ontwikkel met die doel om 'n enkele beroepsbelangstellingsvraelys vir alle bevolkingsgroepe binne die RSA, daar te stel. In hierdie studie is daar ondersoek ingestel na die gemeenskaplike faktore onderliggend aan die SABBV en die Selfondersoekvraelys (SOV van Holland met behulp van 'n interbatteryfaktorontleding. Daar is bevind dat daar ses gemeenskaplike faktore onderliggend aan die twee instrumente is vir sowel standerd nege seuns as dogters, en dat hierdie faktore ooreenstem met die ses faktore wat deur Holland in die SOV ingebou is.

  11. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

    Wei-Hua Tang

    Full Text Available Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD. In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  12. Thrombopoietin as Early Biomarker of Disease Severity in Patients With Acute Pancreatitis.

    Lupia, Enrico; Pigozzi, Luca; Pivetta, Emanuele; Bosco, Ornella; Vizio, Barbara; Loiacono, Maria; Lucchiari, Manuela; Battista, Stefania; Morello, Fulvio; Moiraghi, Corrado; Mengozzi, Giulio; Montrucchio, Giuseppe


    To study the concentrations of thrombopoietin (TPO), a growth factor recently involved in the pathogenesis of experimental acute pancreatitis (AP), and its potential role as an early diagnostic and prognostic biomarker in patients with AP. Thrombopoietin was measured in 44 AP patients, 18 patients with nonpancreatic acute abdominal pain, and 18 healthy volunteers. Acute pancreatitis severity was classified on the basis of the 2012 International Atlanta Symposium on Acute Pancreatitis criteria. Thrombopoietin levels did not differ between AP patients and control subjects, whereas these were higher in patients with moderately severe or severe AP compared with those with mild AP. Receiver operating characteristic curve analysis of TPO for severe AP diagnosis showed an area under the curve of 0.80. A cutoff value of 31.48 pg/mL showed the highest sensitivity, allowing to rule out severe AP when TPO was lower, whereas TPO higher than 98.23 pg/mL was associated with severe AP with high specificity (93.5%). Furthermore, TPO levels were greater in AP patients developing organ dysfunction or sepsis and in nonsurvivors compared with survivors. Our data provide the first evidence for TPO as potential early prognostic biomarker in AP patients. High TPO levels at hospital admission may predict organ dysfunction, sepsis, and fatal outcome in AP patients.

  13. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma.

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui


    Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.

  14. Limited vaginal hysterectomy after brachytherapy in patients with early stage cervix carcinoma

    Resbeut, M.; Honnoun-Levi, J.M.; Alzieu, C.; Cowen, D.; Cravello, L.; Agostini, A.


    In patients with early cervix carcinoma, both radiotherapy and surgery or combined modalities provide effective therapies. In the two last modalities, recommended surgery is radical hysterectomy. The purpose of this prospective study was to assess the value of a limited vaginal hysterectomy after brachytherapy in patients without any unfavorable prognostic factor. Twenty-two patients (stage la2 with vascular invasion: three patients, stage lb1:19 patients) with 1 cm median maximal tumor size and with previous negative laparoscopic lymphadenectomy (median number of lymph nodes:12) underwent a limited vaginal hysterectomy 6 weeks after utero-vaginal brachytherapy. Two mild intra-operative complications were noted. Venous hemorrhage (100 mL) occurred in one patient during lymphadenectomy and another patient presented bladder injury during hysterectomy. These two complications were successfully controlled with no need for laparotomy. Only one late complication was observed: bladder grade G2(b). With a 29 months follow-up (20-48 months), no recurrence was reported. These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale. (authors)

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