End-of-Life Inventory Decisions of Service Parts

NARCIS (Netherlands)

M. Pourakbar (Morteza)

2011-01-01

textabstractWith the spurt of technology and innovation the life cycles of parts and products have become shorter and service parts enter their final phases earlier. Final phase of a typical service part starts once the part production is ceased and ends when the last service or warranty contract

A Label Correcting Algorithm for Partial Disassembly Sequences in the Production Planning for End-of-Life Products

Directory of Open Access Journals (Sweden)

Pei-Fang (Jennifer Tsai

2012-01-01

Full Text Available Remanufacturing of used products has become a strategic issue for cost-sensitive businesses. Due to the nature of uncertain supply of end-of-life (EoL products, the reverse logistic can only be sustainable with a dynamic production planning for disassembly process. This research investigates the sequencing of disassembly operations as a single-period partial disassembly optimization (SPPDO problem to minimize total disassembly cost. AND/OR graph representation is used to include all disassembly sequences of a returned product. A label correcting algorithm is proposed to find an optimal partial disassembly plan if a specific reusable subpart is retrieved from the original return. Then, a heuristic procedure that utilizes this polynomial-time algorithm is presented to solve the SPPDO problem. Numerical examples are used to demonstrate the effectiveness of this solution procedure.

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

Science.gov (United States)

DʼAntonio, Jocelyn

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

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

Directory of Open Access Journals (Sweden)

Agata Mesjasz-Lech

2017-06-01

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

Calculation of noninformative prior of reliability parameter and initiating event frequency with Jeffreys method

International Nuclear Information System (INIS)

He Jie; Zhang Binbin

2013-01-01

In the probabilistic safety assessment (PSA) of nuclear power plants, there are few historical records on some initiating event frequencies or component failures in industry. In order to determine the noninformative priors of such reliability parameters and initiating event frequencies, the Jeffreys method in Bayesian statistics was employed. The mathematical mechanism of the Jeffreys prior and the simplified constrained noninformative distribution (SCNID) were elaborated in this paper. The Jeffreys noninformative formulas and the credible intervals of the Gamma-Poisson and Beta-Binomial models were introduced. As an example, the small break loss-of-coolant accident (SLOCA) was employed to show the application of the Jeffreys prior in determining an initiating event frequency. The result shows that the Jeffreys method is an effective method for noninformative prior calculation. (authors)

End-of-life flows of multiple cycle consumer products

International Nuclear Information System (INIS)

Tsiliyannis, C.A.

2011-01-01

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

Challenges in end-of-life communication.

Science.gov (United States)

Galushko, Maren; Romotzky, Vanessa; Voltz, Raymond

2012-09-01

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

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

Science.gov (United States)

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

2018-04-01

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

Pricing end-of-life components

Science.gov (United States)

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

2005-11-01

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

Reducing environmental burdens of solid-state lighting through end-of-life design

International Nuclear Information System (INIS)

Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C

2010-01-01

With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

Reducing environmental burdens of solid-state lighting through end-of-life design

Energy Technology Data Exchange (ETDEWEB)

Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C, E-mail: cth@cmu.ed [Green Design Institute, Carnegie Mellon University (United States)

2010-01-15

With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

George Jeffreys: Pentecostal and Contemporary Implications

Directory of Open Access Journals (Sweden)

William K Kay

2018-02-01

Full Text Available The life and work of the Welsh evangelist George Jeffreys resulted in the planting of two denominations in the UK between 1915 and 1962, when he died. The Elim churches continue to this day to be one of the larger classical Pentecostal denominations in the UK, while the Bible Pattern Fellowship dispersed on Jeffreys’ death. The disputes that led to Jeffreys’ departure from Elim were said to have arisen from his adherence to British Israel doctrine, though his supporters believed they arose from his championing of local church ownership and democracy. This paper considers sociological and other reasons for Jeffreys’ remarkable success in the interwar years and his eventual departure from a denomination he founded. It concludes by reflecting on topics (such as the importance of debate and law that have relevance for contemporary Pentecostalism.

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

International Nuclear Information System (INIS)

2015-01-01

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

End-of-life decisions: Christian perspectives.

Science.gov (United States)

Stempsey, William E

1997-12-01

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

Mistress Joyce Jeffreys and her physician, Dr Bridstock Harford (1607-1695).

Science.gov (United States)

Connor, Henry

2016-11-01

The notebooks of Joyce Jeffreys, a wealthy Hereford businesswoman in the mid-17th century, provide information about the medicines she purchased and the fees she paid to her medical advisors. Her physician, Dr Bridstock Harford, was a successful doctor but a troublesome neighbour, who was often the subject of litigation. As an ardent parliamentarian, he held public offices during the Commonwealth. Later his opinions mellowed and he ended his days as a loyal subject of the king and a benefactor to his city. © The Author(s) 2014.

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

DEFF Research Database (Denmark)

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

2008-01-01

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

The Effect of Uncertain End-of-Life Product Quality and Consumer Incentives on Partial Disassembly Sequencing in Value Recovery Operations

OpenAIRE

Rickli, Jeremy Lewis

2013-01-01

This dissertation addresses gaps in the interaction between End-of-Life (EoL) product acquisition systems and disassembly sequencing. The research focuses on two remanufacturing research problems; 1) modeling uncertain EoL product quality, quantity, and timing in regards to EoL product acquisition and disassembly sequencing and 2) designing EoL product acquisition schemes considering EoL product uncertainty. The main research objectives within these areas are; analyzing, predicting, and contr...

Pharmacotherapy at the end-of-life.

LENUS (Irish Health Repository)

O'Mahony, Denis

2011-07-01

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

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

International Nuclear Information System (INIS)

Ouhib, Z.

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Leah M. Omilion-Hodges

2017-03-01

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

On the viscoelastic characterization of the Jeffreys-Lomnitz law of creep

OpenAIRE

Mainardi, Francesco; Spada, Giorgio

2011-01-01

In 1958 Jeffreys proposed a power law of creep, generalizing the logarithmic law earlier introduced by Lomnitz, to broaden the geophysical applications to fluid-like materials including igneous rocks. This generalized law, however, can be applied also to solid-like viscoelastic materials. We revisit the Jeffreys-Lomnitz law of creep by allowing its power law exponent $\\alpha$, usually limited to the range [0,1] to all negative values. This is consistent with the linear theory of viscoelastici...

Life's end: Ethnographic perspectives.

Science.gov (United States)

Goodwin-Hawkins, Bryonny; Dawson, Andrew

2018-01-01

In this introduction to the special issue, Life's End: Ethnographic Perspectives, we review the field of anthropological studies of death and dying. We make the argument that, largely because of its sub-disciplining into the larger field of the anthropology of religion, ritual and symbolism, the focus of anthropological research on death has been predominantly on post- rather than pre-death events, on death's beginnings rather than life's ends. Additionally, we argue that an anthropological aversion to the study of dying may also lie in the intimacy of the discipline's principal method, ethnography. Contrastingly, we argue that this very methodological intimacy can be a source of insight, and we offer this as a rationale for the special issue as a whole, which comprises eight ethnographic studies of dying and social relations at life's end from across Africa, Australia, Europe, and North America. Each of these studies is then summarized, and a rationale for their presentation around the themes of "structures of dying," "care for the dying," "hope in dying," and "ending life" is presented.

Praegust mälubuumi iseloomustab utoopiliste tulevikuvisioonide puudumine : intervjuu Jeffrey Olickuga / Jeffrey Olick ; küsitles Siobhan Kattago, inglise k. tõlkinud Piret Peiker

Index Scriptorium Estoniae

Olick, Jeffrey

2007-01-01

Virginia Ülikooli sotsioloogia- ja ajalooprofessor Jeffrey K. Olick on kollektiivse mälu uurimise vallas kujunemas üheks tänapäeva kõige tuntumaks ja viljakamaks autoriks. Jeffrey Olick osales ettekandega Tallinna Ülikooli teadussümpoosionil "Kellele kuulub mälu?" ja TLÜ suvekoolis "Kuidas kollektiivid mäletavad?" Temaga vestles kollektiivsest mälust sotsioloogiadoktor ja TLÜ Eesti Humanitaarinstituudi dotsent Siobhan Kattago

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-07-01

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

End of Life: An Overview

Science.gov (United States)

Toner, Mary Ann; Shadden, Barbara B.

2012-01-01

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

Sheila Jeffreys: The Industrial Vagina. The Political Economy of the Global Sex Trade. London: Routledge 2008.

Directory of Open Access Journals (Sweden)

Susanne Hofmann

2010-03-01

Full Text Available Sheila Jeffreys analysiert die Prozesse, die zu einer Industrialisierung und Globalisierung von Prostitution im späten 20. und 21. Jahrhundert geführt haben. Hauptverantwortlich für die gegenwärtige Diskursverschiebung um Prostitution ist für Jeffreys zum einen die sexuelle Revolution der 1970er Jahre und zum anderen die massive Finanzierung von Unterstützer/-innen der Sexarbeiterinnen zur HIV-Prävention in den 1980ern. Jeffreys legt wie in früheren Arbeiten ihre radikal-feministische Position dar und fordert eine Abschaffung der Prostitution. In ihrer Abrechnung mit dem liberalen feministischen Diskurs, für den eine Unterstützung von Sexarbeiterinnen prioritär ist, ignoriert sie die Widersprüchlichkeiten und Komplexitäten der gelebten Realitäten. An vielen Stellen ihres Buches bekräftigt Jeffreys stereotypische Männlichkeitsvorstellungen, was durch einen Blick über den Tellerrand des ihr vertrauten wissenschaftlichen Bezugsrahmens hätte vermieden werden können.Sheila Jeffreys analyzes the processes that led to the industrialization and globalization of prostitution in the late 20th and 21th centuries. Jeffreys considers those primary factors responsible for the current shift in discourse on prostitution, which can be attributed to the sexual revolution of the 1970s on the one hand, and to massive financing of HIV prevention in the 1980s by sex worker supporters on the other. As in earlier studies, Jeffreys presents readers with her radical-feminist position and demands prostitution be abolished. In her confrontation with liberal-feminist discourse, in which the support of sex workers takes priority, she ignores the inconsistencies and complexities of real lived experience. At many points throughout her book, Jeffreys affirms stereotypical male conceptions, which could have been avoided had she looked beyond the theoretical frame of reference that makes up her comfort zone.

Environmental assessment of end-of-life textiles in Denmark

DEFF Research Database (Denmark)

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

2018-01-01

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

Secondary indium production from end-of-life liquid crystal displays

Energy Technology Data Exchange (ETDEWEB)

Amato, Alessia; Rocchetti, Laura; Fonti, Viviana; Ruello, Maria Letizia; Beolchini, Francesca [Universita Politecnica of Marche, DISVA, Via Brecce Bianche, 60131 Ancona (Italy)

2016-12-15

In 2014, the European Union identified 20 raw materials critical for economic importance and high supply risk. Indium, used in several innovative technologies, is among such critical raw materials. Generally, it is mined as a by-product of zinc from a mineral named sphalerite, with a concentration between 1 and 100 ppm. Currently, the largest producer of indium is China and about 84% of the worldwide indium consumption is used for liquid crystal display (LCD) production, in particular to form an indium-tin-oxide (ITO) film with transparent conductor properties. The fast evolution of LCD technologies caused a double effect: the growth of indium demand and an increase of waste electrical and electronic equipment (WEEE). Considering these two factors, the aim of this study is to make the end-of-life LCDs a secondary indium resource. With this purpose, an indium recovery process was developed carrying out an acidic leaching, followed by a zinc cementation. The first step allowed a complete indium extraction using 2M sulfuric acid at 80 C for 10 min. The problem of low indium concentration in the scraps (around 150 ppm) was overcome using a cross-current configuration in the leaching phase that allowed an increase of metal concentration and a decrease of reagents consumption. An indium recovery higher than 90% was obtained in the final cementation step, using 5 g/L of zinc powder at pH 3 and 55 C for 10 min. Considering its high efficiency, this process is promising in a context of circular economy, where a waste becomes a resource. (copyright 2016 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

End of Life Care

Science.gov (United States)

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

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

Science.gov (United States)

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

2011-06-15

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

Pruning dwarf mistletoe brooms reduces stress on Jeffrey pines, Cleveland National Forest, California

Science.gov (United States)

Robert F. Scharpf; Richard S. Smith; Detlev Vogler

1987-01-01

Western dwarf mistletoe (Arceuthobium campylopodum) is a damaging parasite of Jeffrey pines (Pinus jeffreyi) in southern California. Infected branches that develop into brooms are believed to reduce tlee vigor and increase mortality. Brooms were pruned from Jeffrey pines with varying levels of dwarf mistletoe infection and live...

The Environmental Impact of Industrial Bamboo Products : Life-cycle Assessment and Carbon Sequestration

NARCIS (Netherlands)

Vogtlander, J.G.; Van der Lugt, P.

2014-01-01

This report gives a Life-Cycle Assessment (LCA) and carbon footprint analysis on a selection of industrial bamboo products. The LCA is made for cradle-to-gate, plus the end-of-life stages of the bamboo products. For end-of-life it is assumed that 90% of the bamboo products are incinerated in an

Issues surrounding end-of-life decision-making

Directory of Open Access Journals (Sweden)

Tejwani V

2013-08-01

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

Labelling of end-of-life decisions by physicians

NARCIS (Netherlands)

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

2014-01-01

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

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

Science.gov (United States)

Broeseker, Amy E.

2010-01-01

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

QUALITY OF LIFE OF PATIENTS WITH END-STOMA IN MEDAN: A PHENOMENOLOGICAL STUDY

Directory of Open Access Journals (Sweden)

Fahrizal Alwi

2018-02-01

Full Text Available Background: Colorectal cancer continues to be a serious problem in Indonesia. A common colorectal treatment is surgical removal of the diseased colon, followed by the creation of a colostomy through the abdominal wall to bypass the colorectal function of emptying waste products. Those who require permanent colostomy are likely to have quality of life issues impacting their physical, psychological, social, and spiritual needs. There issues impact persons’ life satisfaction, happiness, and overall quality of life. Objective: The aim of study was to describe the experiences of patients with end-stoma regarding their quality of life. Methods: The study design used descriptive phenomenology following the approach of Collaizzi. There were 12 participants who qualified using purposive sampling based on the inclusion criteria. The data were gathered in-depth interviews. Analysis and interpretation used verbatim descriptions in Bahasa Indonesia and subsequently translated into English language. Results: The research emerged seven themes, namely: (i becoming limited in doing daily activity, (ii having limitation during sexual and social intercourse, (iii having various negative feelings after the existence of end-stoma, (iv having financial difficulties, (v attempting to survive with end-stoma, (vi experiencing changes in fulfilling rest and sleep, physic, and complication, and (vii having expectation which has to be achieved after having end-stoma. Conclusion: The results show that patients with end-stoma run into spiritual, social, psychological and physical disorder that affect the quality of their life. This study provides an understanding of the quality of life of patients with end-stoma and nurses are able to provide appropriate nursing care.

Uncharted terrain: preference construction at the end of life.

Science.gov (United States)

White, Mary T

2014-01-01

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

Cross-current leaching of indium from end-of-life LCD panels

Energy Technology Data Exchange (ETDEWEB)

Rocchetti, Laura; Amato, Alessia; Fonti, Viviana [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Ubaldini, Stefano [Institute of Environmental Geology and Geoengineering IGAG, National Research Council, Via Salaria km 29300, 00015 Montelibretti, Rome (Italy); De Michelis, Ida [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Kopacek, Bernd [ISL Kopacek KG, Beckmanngasse 51, 1140 Wien (Austria); Vegliò, Francesco [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Beolchini, Francesca, E-mail: f.beolchini@univpm.it [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy)

2015-08-15

Graphical abstract: Display Omitted - Highlights: • End-of-life LCD panels represent a source of indium. • Several experimental conditions for indium leaching have been assessed. • Indium is completely extracted with 2 M sulfuric acid at 80 °C for 10 min. • Cross-current leaching improves indium extraction and operating costs are lowered. • Benefits to the environment come from reduction of CO{sub 2} emissions and reagents use. - Abstract: Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2 M sulfuric acid at 80 °C for 10 min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100 ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85–90%, and with 6 steps it was about 50–55%. Indium concentration in the leachate was about 35 mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO{sub 2} (with 10 steps we assessed that the emission of about 90 kg CO{sub 2}-Eq. could be avoided) thanks to the recovery of indium

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

International Nuclear Information System (INIS)

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

2011-01-01

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

End-of-life decisions in the intensive care unit

DEFF Research Database (Denmark)

Jensen, Hanne Irene

2012-01-01

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

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

Science.gov (United States)

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

2015-12-01

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

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

Science.gov (United States)

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

2014-03-01

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

Symptomatic Control in End-of-Life Patients

Directory of Open Access Journals (Sweden)

Mariana Alves

2017-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2013-03-15

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

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

International Nuclear Information System (INIS)

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

2013-01-01

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

Cross-current leaching of indium from end-of-life LCD panels.

Science.gov (United States)

Rocchetti, Laura; Amato, Alessia; Fonti, Viviana; Ubaldini, Stefano; De Michelis, Ida; Kopacek, Bernd; Vegliò, Francesco; Beolchini, Francesca

2015-08-01

Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2M sulfuric acid at 80°C for 10min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85-90%, and with 6 steps it was about 50-55%. Indium concentration in the leachate was about 35mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO2 (with 10 steps we assessed that the emission of about 90kg CO2-Eq. could be avoided) thanks to the recovery of indium. This new strategy represents a useful approach for secondary production of indium from waste LCD panels. Copyright © 2015 Elsevier Ltd. All rights reserved.

On the Relationships between Jeffreys Modal and Weighted Likelihood Estimation of Ability under Logistic IRT Models

Science.gov (United States)

Magis, David; Raiche, Gilles

2012-01-01

This paper focuses on two estimators of ability with logistic item response theory models: the Bayesian modal (BM) estimator and the weighted likelihood (WL) estimator. For the BM estimator, Jeffreys' prior distribution is considered, and the corresponding estimator is referred to as the Jeffreys modal (JM) estimator. It is established that under…

Advanced glycation end-products and skin autofluorescence in end-stage renal disease : a review

NARCIS (Netherlands)

Arsov, Stefan; Graaff, Reindert; van Oeveren, Wim; Stegmayr, Bernd; Sikole, Aleksandar; Rakhorst, Gerhard; Smit, Andries J.

Chronic kidney disease (CKD), especially in its end stage, is marked by extremely high cardiovascular rates of morbidity and mortality; hemodialysis patients have a five-fold shorter life expectancy than healthy subjects of the same age. In CKD the metabolic products that accumulate in the body are

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

Science.gov (United States)

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

2004-12-01

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

End of Life: Suicide Grief

Science.gov (United States)

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

47 CFR 25.283 - End-of-life disposal.

Science.gov (United States)

2010-10-01

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

Thermo-Catalytic Pyrolysis of Waste Plastics from End of Life Vehicle

Directory of Open Access Journals (Sweden)

Miskolczi Norbert

2016-01-01

Full Text Available Pyrolysis of waste plastics is widely used recycling method. Owing to the end-of-life vehicles regulations, 95% of passenger cars and vehicles must reused/recovered after the dismantling. Pyrolysis of waste polyethylene and polypropylene obtained from end-of-life vehicles was investigated in a continuously stirred batch reactor using 500 and 600°C temperatures. To ensure the pyrolysis reactions the tested catalysts (5% of ZSM-5, HZSM-5, Ni-ZSM-5 and Fe-ZSM-5 were added directly to the mixtures of raw materials. Products of pyrolysis were separated into gases, pyrolysis oil and heavy oil, which was further analyzed by gas-chromatography, Fourier transformed infrared spectroscopy and other standardized methods. Based on the results it was concluded, that the catalysts significantly increase the yields of volatile products, and modify their composition. Especially the alkane/alkene ratio, the methane concentration and the concentration of branched hydrocarbon could be affected by the applied catalysts. Ni-ZSM-5 catalyst had the highest activity in methane production, while HZSM-5 catalyst proved effective in isomerization reactions. Using H-ZSM-5, Ni-ZSM-5, and Fe-ZSM-5 catalyst notably decreased average molecular weight of pyrolysis oils and significantly higher aromatic content was observed.

TU-D-201-01: Definition and Purpose of End-Of-Life for Brachytherapy Devices and Software

International Nuclear Information System (INIS)

Melhus, C.

2015-01-01

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

Elytroderma disease reduces growth and vigor, increases mortality of Jeffrey pines at Lake Tahoe Basin, California

Science.gov (United States)

Robert R Scharpf; Robert V. Bega

1981-01-01

A disease of Jeffrey pines (Pinus jeffreyi Grev. and Balf.) at Lake Tahoe Basin, California, caused by Elytrodenna disease (Elytroderma deformans) was studied for 7 years after a severe outbreak ofthe fungus in 1971. Among 607 Jeffrey pines on six plots, about one-half were heavily infected and about one-half were moderately or lightly infected in 1971. No uninfected...

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

Science.gov (United States)

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

2017-10-01

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

End of life and life after death - issues to be addressed

Directory of Open Access Journals (Sweden)

Poojar Sridhar

2012-01-01

Full Text Available Being an Oncologist, I have seen many patients suffering from cancer. It pains a lot looking at them fighting the battle of life, though knowing that they would lose miserably and surrender meekly as majority of the patients report to the hospital at an advanced stage of disease and only palliative care may be the option. There is an urgent need to create - Cancer Awareness in the villages and also about the end of life care in all terminally ill patients. 20 patients in the terminal phase were questioned regarding end of life care. The common questions they asked are, why has God punished me like this? Why me on earth? Should I die so early? Why should I leave my near and dear ones and go far away, from the point of no return? Do I ever see them again? With deep sorrow and sigh, they suffer till the last breath, having the feeling of insecurity as what would happen to their dear ones. In the terminal phase, the patients wishes must be respected and their needs must be fulfilled. The health care professionals should plan an appropriate care for each patient. Most of them feel that the best place to be in end of life is the home. Research has shown that Hospice care may improve the quality of life of a patient who is dying and of the patient′s family. Communication about end of life care and decision making during the final moments of a person′s life are very important. The patients suffering are mainly due to the physical, psychological, social and spiritual issues. Death of a terminally ill patient should never be a sudden loss. All healthcare professionals, Social workers and Non-Governmental Organisations must install the life after death of the person, who has struggled for every breath and assure that he/she shall rest in peace and shall smile seeing their near and dear ones living with dignity and pride in the society. Ultimately, the patient must have dignity in dying.

End-of-Life Decisions and Advanced Old Age

Directory of Open Access Journals (Sweden)

Stoyles

2014-07-01

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

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

Science.gov (United States)

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

2017-01-01

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

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

Science.gov (United States)

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

2018-01-11

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

Rezension zu: Sheila Jeffreys: The Industrial Vagina. The Political Economy of the Global Sex Trade. London: Routledge 2008.

Directory of Open Access Journals (Sweden)

Susanne Hofmann

2010-02-01

Full Text Available Sheila Jeffreys analysiert die Prozesse, die zu einer Industrialisierung und Globalisierung von Prostitution im späten 20. und 21. Jahrhundert geführt haben. Hauptverantwortlich für die gegenwärtige Diskursverschiebung um Prostitution ist für Jeffreys zum einen die sexuelle Revolution der 1970er Jahre und zum anderen die massive Finanzierung von Unterstützer/-innen der Sexarbeiterinnen zur HIV-Prävention in den 1980ern. Jeffreys legt wie in früheren Arbeiten ihre radikal-feministische Position dar und fordert eine Abschaffung der Prostitution. In ihrer Abrechnung mit dem liberalen feministischen Diskurs, für den eine Unterstützung von Sexarbeiterinnen prioritär ist, ignoriert sie die Widersprüchlichkeiten und Komplexitäten der gelebten Realitäten. An vielen Stellen ihres Buches bekräftigt Jeffreys stereotypische Männlichkeitsvorstellungen, was durch einen Blick über den Tellerrand des ihr vertrauten wissenschaftlichen Bezugsrahmens hätte vermieden werden können.

75 FR 32210 - United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...

Science.gov (United States)

2010-06-07

..., Jeffrey Hessing, Idaho Sports Medicine Institute, John Kloss, David Lamey, and Troy Watkins; Proposed... Sports Medicine Institute, John Kloss, David Lamey, and Troy Watkins, Civil Case No. 10-268. On May 28..., Jeffrey Hessing, Idaho Sports Medicine Institute, John Kloss, David Lamey, and Troy Watkins, Defendants...

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

Science.gov (United States)

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

2016-12-01

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

Life cycle thinking and assessment tools on environmentally-benign electronics: Convergent optimization of materials use, end-of-life strategy and environmental policies

Science.gov (United States)

Zhou, Xiaoying

The purpose of this study is to integrate the quantitative environmental performance assessment tools and the theory of multi-objective optimization within the boundary of electronic product systems to support the selection among design alternatives in terms of environmental impact, technical criteria, and economic feasibility. To meet with the requirements that result from emerging environmental legislation targeting electronics products, the research addresses an important analytical methodological approach to facilitate environmentally conscious design and end-of-life management with a life cycle viewpoint. A synthesis of diverse assessment tools is applied on a set of case studies: lead-free solder materials selection, cellular phone design, and desktop display technology assessment. In the first part of this work, an in-depth industrial survey of the status and concerns of the U.S. electronics industry on the elimination of lead (Pb) in solders is described. The results show that the trade-offs among environmental consequences, technology challenges, business risks, legislative compliance and stakeholders' preferences must be explicitly, simultaneously, and systematically addressed in the decision-making process used to guide multi-faceted planning of environmental solutions. In the second part of this work, the convergent optimization of the technical cycle, economic cycle and environmental cycle is addressed in a coherent and systematic way using the application of environmentally conscious design of cellular phones. The technical understanding of product structure, components analysis, and materials flow facilitates the development of "Design for Disassembly" guidelines. A bottom-up disassembly analysis on a "bill of materials" based structure at a micro-operational level is utilized to select optimal end-of-life strategies on the basis of economic feasibility. A macro-operational level life cycle model is used to investigate the environmental consequences

TU-D-201-02: Physicist’s Responsibility On “End-Of-Life for Brachytherapy Devices and Software

International Nuclear Information System (INIS)

Butler, W.

2015-01-01

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

Wind Turbine Blades: An End of Life Perspective

DEFF Research Database (Denmark)

Beauson, Justine; Brøndsted, Povl

2016-01-01

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

Extended irreversible thermodynamics and the Jeffreys type constitutive equations

International Nuclear Information System (INIS)

Serdyukov, S.I.

2003-01-01

A postulate of extended irreversible thermodynamics is considered, according to which the entropy density is a function of the internal energy, the specific volume, and their material time derivatives. On the basis of this postulate, entropy balance equations and phenomenological equations are obtained, which directly lead to the Jeffreys type constitutive equations

Correlation of advanced glycation end products to Alzheimer's disease

Directory of Open Access Journals (Sweden)

Zong-yan MA

2018-04-01

Full Text Available Alzheimer's disease (AD is a common retrograde neurodegenerative disease of the central nervous system, as well as the most common type of dementia in the aged, the main manifestations of AD are progressive decline of cognitive function and daily life ability. AD seriously affects the quality of life and physical and mental health of the aged, and increased the burden of family and society. The etiology and pathogenesis of AD remain unclear nowadays, and there is no objective and specific biological marker to help the early diagnosis and effective treatment. Advanced glycation end products (AGEs are stable end products formed by non enzymatic reaction between the free amino groups of proteins, lipids, nucleic acids macromolecules and the carbonyls of glucose or other reduced sugars. Recent years, more and more studies have focused on the correlation between AGEs and its receptors (RAGE in patients with cognitive impairment, however, the role played by AGEs in the pathogenesis of AD remains unclear. The present paper will give an overview from three aspects: the structure and characteristics of AGEs, the relationship between the occurrence and development of AD and AGEs and the relationship between AGEs and prognosis of cognitive impairment which we've known so far. DOI: 10.11855/j.issn.0577-7402.2018.01.16

On the Mathematics of the Jeffreys-Lindley Paradox

OpenAIRE

Villa, Cristiano; Walker, Stephen

2015-01-01

This paper is concerned with the well known Jeffreys-Lindley paradox. In a Bayesian set up, the so-called paradox arises when a point null hypothesis is tested and an objective prior is sought for the alternative hypothesis. In particular, the posterior for the null hypothesis tends to one when the uncertainty, i.e. the variance, for the parameter value goes to infinity. We argue that the appropriate way to deal with the paradox is to use simple mathematics, and that any philosophical argumen...

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

Science.gov (United States)

George, Linda K

2002-10-01

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

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

Science.gov (United States)

Boucomont, Aude

2016-02-01

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

High-end encroachment patterns of new products

NARCIS (Netherlands)

Rhee, van der B.; Schmidt, G.; Orden, van J.

2012-01-01

Previous research describes two key ways in which a new product may encroach on an existing market. In high-end encroachment, the new product first sells to high-end customers and then diffuses down-market; in low-end encroachment, the new product enters at the low end and encroaches up-market. This

Entropy generation in a mixed convection Poiseulle flow of molybdenum disulphide Jeffrey nanofluid

Science.gov (United States)

Gul, Aaiza; Khan, Ilyas; Makhanov, Stanislav S.

2018-06-01

Entropy analysis in a mixed convection Poiseulle flow of a Molybdenum Disulphide Jeffrey Nanofluid (MDJN) is presented. Mixed convection is caused due to buoyancy force and external pressure gradient. The problem is formulated in terms of a boundary value problem for a system of partial differential equations. An analytical solution for the velocity and the temperature is obtained using the perturbation technique. Entropy generation has been derived as a function of the velocity and temperature gradients. The solutions are displayed graphically and the relevant importance of the input parameters is discussed. A Jeffrey nanofluid (JN) has been compared with a second grade nanofluid (SGN) and Newtonian nanofluid (NN). It is found that the entropy generation decreases when the temperature increases whereas increasing the Brickman number increases entropy generation.

Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK.

Science.gov (United States)

Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina A; Da Silva Gane, Maria; Stoves, John; Warwick, Graham; Akhtar, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken

2014-09-01

South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

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

Science.gov (United States)

Tan, Reginald B H; Khoo, Hsien H

2005-02-01

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

A Critical Review of Research on Reuse of Mechanically Recycled FRP Production and End-of-Life Waste for Construction

Directory of Open Access Journals (Sweden)

Ardavan Yazdanbakhsh

2014-06-01

Full Text Available For the last three decades, fiber reinforced polymer (FRP composite materials have been widely used in major engineering industries. Managing FRP waste is becoming an important issue due to the growth in the production of FRP composite materials. In this article, the issue of FRP waste management is discussed and the commonly used methods for the handling of FRP waste are reviewed. One potentially viable use of FRP waste is in the partial replacement of fillers or aggregates in cementitious materials (particularly portland cement mortar and concrete. A number of important prior investigations performed on the use of FRP waste in concrete and mortar are reviewed. The results from most of those investigations suggest that FRP aggregates significantly reduce the strength of cementitious materials with little significant effect on durability. Recommendations for future research in this area are provided for producing stronger mortars and concretes incorporating FRP production and end-of-life waste.

End-of-life decision making in the ICU.

Science.gov (United States)

Siegel, Mark D

2009-03-01

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

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

Science.gov (United States)

Clark, Katherine; Phillips, Jane

2010-04-01

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

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

Science.gov (United States)

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

2012-11-01

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

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

Science.gov (United States)

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

2017-12-19

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

Bayesian Estimation of Two-Parameter Weibull Distribution Using Extension of Jeffreys' Prior Information with Three Loss Functions

Directory of Open Access Journals (Sweden)

Chris Bambey Guure

2012-01-01

Full Text Available The Weibull distribution has been observed as one of the most useful distribution, for modelling and analysing lifetime data in engineering, biology, and others. Studies have been done vigorously in the literature to determine the best method in estimating its parameters. Recently, much attention has been given to the Bayesian estimation approach for parameters estimation which is in contention with other estimation methods. In this paper, we examine the performance of maximum likelihood estimator and Bayesian estimator using extension of Jeffreys prior information with three loss functions, namely, the linear exponential loss, general entropy loss, and the square error loss function for estimating the two-parameter Weibull failure time distribution. These methods are compared using mean square error through simulation study with varying sample sizes. The results show that Bayesian estimator using extension of Jeffreys' prior under linear exponential loss function in most cases gives the smallest mean square error and absolute bias for both the scale parameter α and the shape parameter β for the given values of extension of Jeffreys' prior.

Total mesophilic counts underestimate in many cases the contamination levels of psychrotrophic lactic acid bacteria (LAB) in chilled-stored food products at the end of their shelf-life.

Science.gov (United States)

Pothakos, Vasileios; Samapundo, Simbarashe; Devlieghere, Frank

2012-12-01

The major objective of this study was to determine the role of psychrotrophic lactic acid bacteria (LAB) in spoilage-associated phenomena at the end of the shelf-life of 86 various packaged (air, vacuum, modified-atmosphere) chilled-stored retail food products. The current microbiological standards, which are largely based on the total viable mesophilic counts lack discriminatory capacity to detect psychrotrophic LAB. A comparison between the total viable counts on plates incubated at 30 °C (representing the mesophiles) and at 22 °C (indicating the psychrotrophs) for 86 food samples covering a wide range - ready-to-eat vegetable salads, fresh raw meat, cooked meat products and composite food - showed that a consistent underestimation of the microbial load occurs when the total aerobic mesophilic counts are used as a shelf-life parameter. In 38% of the samples, the psychrotrophic counts had significantly higher values (+0.5-3 log CFU/g) than the corresponding total aerobic mesophilic counts. A total of 154 lactic acid bacteria, which were unable to proliferate at 30 °C were isolated. In addition, a further 43 with a poor recovery at this temperature were also isolated. This study highlights the potential fallacy of the total aerobic mesophilic count as a reference shelf-life parameter for chilled food products as it can often underestimate the contamination levels at the end of the shelf-life. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

Anderson, Stacey L; Shreve, Scott T

2004-06-01

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

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

Science.gov (United States)

Ko, Eunjeong; Roh, Soonhee; Higgins, Doreen

2013-01-01

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

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

Science.gov (United States)

Dame, Linda; Hoebeke, Roberta

2016-12-01

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

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

Science.gov (United States)

Fink-Samnick, Ellen

2016-01-01

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

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

Science.gov (United States)

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

2013-07-01

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

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

Science.gov (United States)

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

2014-08-01

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

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

DEFF Research Database (Denmark)

Smink, Carla

2004-01-01

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

Doctors' learning experiences in end-of-life care

DEFF Research Database (Denmark)

Fosse, Anette; Ruths, Sabine; Malterud, Kirsti

2017-01-01

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

Environmental impact assessment of different end-of-life LCD management strategies.

Science.gov (United States)

Amato, Alessia; Rocchetti, Laura; Beolchini, Francesca

2017-01-01

The strong growth of the electrical and electronic equipment production combined with its short lifespan are causing the production of a significant amount of waste to treat. In particular, the present paper focuses on end-of-life liquid crystal displays (LCDs) for their significant content of valuable materials, like plastic, glass and metals that could be recovered after dismantling. In the recent literature, traditional LCD recycling processes are combined with innovative treatments, which allow to recover critical raw materials, such as indium. In this context, we have evaluated the environmental impact of four different strategies of end-of-life LCD management: the disposal in landfilling sites, the incineration, the traditional recycling treatment and an innovative process also addressed to the recovery of indium. The traditional recycling treatment resulted to be the best scenario for the environment. Indeed, a life cycle assessment study gave following environmental burdens (if negative they are credits): 18, 81, -68, -60kg CO 2 -equiv. and 0.08, 0.01, -0.25, -0.18mol H + -equiv., for the four scenarios in the categories of global warming and acidification, respectively. The limit of the variability of LCD composition was overcome including additional literature data in the study. In order to improve the innovative process sustainability, a system of water recirculation was optimized with a consequent impact decrease of 35% in the global warming category. Nevertheless, this action should be combined with an increase of indium concentration in the panel because the low metal content represents the bottleneck of the overall approach. In this regard, a sensitivity analysis showed that an increase of at least five times in indium concentration in the waste is needed to observe an advantage of the innovative vs the traditional recycling process, when the impact category of climate change is considered. As a whole, the life cycle assessment was confirmed as a key

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

Science.gov (United States)

Bonneval, Camille

2016-02-01

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

Life Cycle Assessment Of Hydrogen Production From Natural Gas Reforming Process

International Nuclear Information System (INIS)

Ozturk, M.

2010-01-01

Society has become concerned about the issues of natural resource depletion and environmental degradation. The environmental performance of products or processes has become a key issue, which is why ways to minimize the effects on the environment are investigated. The most effective tool for this purpose is called life cycle assessment (LCA). This concept considers the entire life cycle of product or process. The life cycle of a product begins with the extraction of raw materials from the earth to create the product and ends at the point when all materials are returned to the earth. LCA makes it possible to estimate the cumulative environmental impacts resulting from all stages in the product life cycle, often including impacts not considered in more traditional analyses. Therefore, LCA provides a comprehensive view of the environmental aspects of the product or process and a more accurate picture of the true environmental trade-offs in product selection. In the case of this study, life cycle assessments of hydrogen production via natural gas reforming process are investigated for environmental affect.

Current and emerging practice of end-of-life care in British prisons: findings from an online survey of prison nurses.

Science.gov (United States)

Papadopoulos, Irena; Lay, Margaret

2016-03-01

There are concerns about prisoners and detainees not having equal access to end-of-life care while in prison. There is a lack of existing literature about the standards of end-of-life care in UK prisons. The aim of this study was to investigate the views of current and former prison nurses with regard to the end-of-life care being provided in UK prisons. Prison nurses were invited to participate in an online survey and asked about their role in the prison, prisoners' access to healthcare facilities, and any barriers and good practices to end-of-life care. The survey included open-ended and closed questions. The closed questions were analysed using descriptive statistics. The open-ended responses were coded and grouped into themes. 31 (N=31) prison nurses responded to the survey. The reported barriers to end-of-life care included some prison regimes, lack of appropriate care and visiting facilities, lack of privacy and inadequate visiting hours. Respondents also reported examples of good practice, including having access to specialist palliative care and specialist equipment, and being able to receive visits from family and friends. The findings suggest that there is considerable variability in the end-of-life care provided to prisoners in the UK. Further research is needed in order to reduce the health inequalities and improve the quality of end-of-life care experienced by prisoners in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

Science.gov (United States)

Wilkie, Diana J; Ezenwa, Miriam O

2012-01-01

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

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

DEFF Research Database (Denmark)

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

2006-01-01

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

Development of an end-of-life vehicle recovery model using system dynamics and future research needs

Science.gov (United States)

Mohamad-Ali, N.; Ghazilla, R. A. R.; Abdul-Rashid, S. H.; Sakundarini, N.; Ahmad-Yazid, A.; Stephenie, L.

2017-06-01

The implementation of end-of-life vehicle (ELV) recovery policy in Malaysia has led vehicle manufacturers to look at different ways to improve design and development of vehicles. Nowadays, it is crucial to incorporate end-of-life (EOL) design strategies into the vehicle design in order to enhance the effectiveness of the ELV recovery network. Although recent studies have shown that product design has a significant effect on the product recovery rate, there is a lack of studies on how EOL design strategies affects the effectiveness of ELV recovery, particularly when there are dynamic changes in the behaviour of the product recovery network. Thus, in this study, we developed a preliminary model based on the system dynamics approach in order to predict the effectiveness of ELV recovery in response to dynamic changes of various factors (including EOL design strategies) in the business environment. We developed this model based on preliminary data that we had gathered from unstructured interviews with the key stakeholders of ELV management in Malaysia. We believe that our model will greatly benefit product designers in incorporating the appropriate EOL design strategies in order to boost ELV recovery effectiveness in Malaysia.

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

Science.gov (United States)

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

2017-03-01

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

Labelling of end-of-life decisions by physicians.

Science.gov (United States)

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

2014-07-01

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

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

Science.gov (United States)

Dobbins, Elizabeth H

2016-09-22

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

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

Science.gov (United States)

Mills, Katherine; Payne, Angela

2015-12-01

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

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

Science.gov (United States)

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

2013-08-01

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

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

Science.gov (United States)

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

2018-04-01

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

END-OF-LIFE DECISIONS IN DUTCH NEONATOLOGY

NARCIS (Netherlands)

Moratti, Sofia

2010-01-01

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

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

Science.gov (United States)

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

2014-05-01

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

Brominated flame retardants in end-of-life management not problematic regarding formation of brominated dioxins/furans (PBDD/F)

Energy Technology Data Exchange (ETDEWEB)

Drohmann, D. [Great Lakes Chemical, Bergisch Gladbach (Germany); Tange, L. [Eurobrom B.V., Rijswijk (Netherlands); Rothenbacher, K. [Bromine Science and Environmental Forum, Brussels (Belgium)

2004-09-15

Bromine is used as the building block for some of the most effective flame retarding agents available to the plastics industry today. They are used to protect against the risk of accidental fires in a wide range of products. Brominated flame retardants (BFRs), as all flame retardants, act to decrease the risk of fire by increasing the fire resistance of the materials in which they are applied. There is a perception that BFRs affect adversely the end-of-life management of plastics through formation of brominated dioxins and furans (PBDD/F). In fact, there exists a wide range of data and practical experience demonstrating that the end-of-life management of plastics containing BFRs are fully compliant with legislation setting the strictest limit values for PBDD/F and is fully compatible with an integrated waste management concept. Furthermore, all existing EU Risk Assessments on BFRs according to the European Existing Substance Regulations include an assessment of the potential formation of dioxins and furans. All assessments conclude that the risks along the life-cycle of the chemicals for human health and the environment associated with the potential formation of PBDD/F are negligible. Moreover, two recent Swedish studies found, that consumer products with BFRs emit less pollutants than the same products without any FRs. This paper summarises available studies and presents the latest results regarding potential formation of brominated dioxins and furans in end-of-life management of plastics containing brominated flame retardants. Additionally, before BFR products enter the market they are tested for PBDD/F according to the ''German Dioxin Ordinance''. Depending on the substitution pattern the limit values for PBDD/F are set at <1{mu}g/kg (ppb) respectively <5{mu}g/kg (ppb).

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

Science.gov (United States)

Ferrão, Paulo; Ribeiro, Paulo; Silva, Paulo

2008-01-01

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

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

Science.gov (United States)

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

2014-05-01

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

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

Science.gov (United States)

Mattes, Malcolm D; Sloane, Michelle A

2015-05-01

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

Effect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls.

Science.gov (United States)

Chitnis, X A; Georghiou, T; Steventon, A; Bardsley, M J

2013-12-01

To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death. Retrospective analysis using matched controls and administrative data. Community-based care in England. 29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history. Home-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care. Proportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care. Intervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, pnursing for longer. Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.

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

Science.gov (United States)

Baumann, Steven L; Todaro-Franceschi, Vidette

2017-07-01

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

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

NARCIS (Netherlands)

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

2006-01-01

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

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

NARCIS (Netherlands)

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

2006-01-01

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

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

Science.gov (United States)

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

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

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

NARCIS (Netherlands)

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

2012-01-01

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

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

Science.gov (United States)

Williams, Anna-Leila

2006-12-01

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

Culturally Diverse Communities and End-of-Life Care

Science.gov (United States)

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

Time-series product and substance flow analyses of end-of-life electrical and electronic equipment in China

International Nuclear Information System (INIS)

Habuer,; Nakatani, Jun; Moriguchi, Yuichi

2014-01-01

Highlights: • We estimate the possession and obsolescence of household appliances (HAs) in China. • Over 4.8–5.1 billion units of major HAs will be discarded in the next 20 years. • We calculate the amounts of substances contained in end-of-life (EoL) TV sets. • Less common metals will tend to decrease in content in generation of EoL TV sets. • Precious metals will tend to increase in content in EoL TV sets in 2015–2030. - Abstract: Given the amounts of end-of-life electrical and electronic equipment (EoL-EEE) being generated and their contents of both harmful and valuable materials, the EoL-EEE issue should be regarded not only as an emerging environmental problem but also as a resource management strategy in China. At present, in order to provide the basis for managing EoL-EEE at both product and substance levels in China, it is necessary to carry out a quantitative analysis on EoL-EEE and to determine how much of it will be generated and how much materials and substances it contains. In this study, the possession and obsolescence amounts of five types of household appliance (HA) including television (TV) sets and the amounts of substances contained in EoL TV sets were estimated using time-series product flow analysis (PFA) and substance flow analysis (SFA). The results of PFA indicated that the total possession amounts of those five types of HAs will exceed 3.1 billion units in 2030, which will be two times higher than those in 2010. In addition, it was estimated that cumulatively over 4.8–5.1 billion units of these five types of EoL HA would be obsoleted between 2010–2030. The results of SFA on TV sets indicated that the generated amounts of most of the less common metals and a part of common metals such as copper (Cu) would tend to decrease, whereas those of other common metals such as iron (Fe) as well as precious metals would tend to increase in EoL TV sets in 2015–2030. The results of this study provide a quantitative basis for helping

Time-series product and substance flow analyses of end-of-life electrical and electronic equipment in China

Energy Technology Data Exchange (ETDEWEB)

Habuer,, E-mail: habuer@env.t.u-tokyo.ac.jp; Nakatani, Jun; Moriguchi, Yuichi

2014-02-15

Highlights: • We estimate the possession and obsolescence of household appliances (HAs) in China. • Over 4.8–5.1 billion units of major HAs will be discarded in the next 20 years. • We calculate the amounts of substances contained in end-of-life (EoL) TV sets. • Less common metals will tend to decrease in content in generation of EoL TV sets. • Precious metals will tend to increase in content in EoL TV sets in 2015–2030. - Abstract: Given the amounts of end-of-life electrical and electronic equipment (EoL-EEE) being generated and their contents of both harmful and valuable materials, the EoL-EEE issue should be regarded not only as an emerging environmental problem but also as a resource management strategy in China. At present, in order to provide the basis for managing EoL-EEE at both product and substance levels in China, it is necessary to carry out a quantitative analysis on EoL-EEE and to determine how much of it will be generated and how much materials and substances it contains. In this study, the possession and obsolescence amounts of five types of household appliance (HA) including television (TV) sets and the amounts of substances contained in EoL TV sets were estimated using time-series product flow analysis (PFA) and substance flow analysis (SFA). The results of PFA indicated that the total possession amounts of those five types of HAs will exceed 3.1 billion units in 2030, which will be two times higher than those in 2010. In addition, it was estimated that cumulatively over 4.8–5.1 billion units of these five types of EoL HA would be obsoleted between 2010–2030. The results of SFA on TV sets indicated that the generated amounts of most of the less common metals and a part of common metals such as copper (Cu) would tend to decrease, whereas those of other common metals such as iron (Fe) as well as precious metals would tend to increase in EoL TV sets in 2015–2030. The results of this study provide a quantitative basis for helping

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

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Calvin, Amy Olivier

2004-06-01

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

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

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Codling, Mary; Knowles, Jane; Vevers, Ann

2014-04-01

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

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

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

2018-01-01

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

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

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

2016-12-01

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

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

Directory of Open Access Journals (Sweden)

Hammami MM

2016-05-01

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

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

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Germán Zurriaráin, Roberto

2017-01-01

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

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

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Paganini, Maria Cristina; Bousso, Regina Szylit

2015-11-01

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

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

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

2014-08-01

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

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

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

2016-11-01

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

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

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

Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

Science.gov (United States)

Wilson, Kimberley; Kortes-Miller, Katherine; Stinchcombe, Arne

2018-03-01

Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

Fighting for Dear Life: Christians and Aggressive End-of-Life Care.

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Shinall, Myrick C

2014-01-01

Patients or their family members sometimes give religious reasons for requesting life-sustaining technologies that have little hope of restoring health. This poses an ethical challenge for clinicians and a potential strain on limited health-care resources. Among Christians, one explanation for a preference for aggressive, life-prolonging care is the influence of the idea of martyrdom, which became the normative form of dying in early Christianity. The ancient discourse of martyrdom and the modern discourse of aggressive medical care both share a martial orientation and commend an ethos of combat. This paper examines ancient Christian martyrdom discourse to illuminate its affinity with the discourse of aggressive medical care. The ethos of martyrdom has shaped Christian attitudes toward death such that preference for aggressive medical care at the end of life is understandable.

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

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

2004-02-01

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

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

Science.gov (United States)

Bodemann, Christina

2014-03-01

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

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

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

2017-07-01

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

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

Directory of Open Access Journals (Sweden)

Bähler C

2018-03-01

Full Text Available Caroline Bähler,1 Andri Signorell,1 Eva Blozik,1,2 Oliver Reich1 1Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland; 2Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany Purpose: Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods: The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4% died of cancer. Intensity of treatment and health care utilization (including transitions at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results: In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion: Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity

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

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

2016-01-01

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

Life Course Stage and Social Support Mobilization for End-of-Life Caregivers.

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LaValley, Susan A; Gage-Bouchard, Elizabeth A

2018-04-01

Caregivers of terminally ill patients are at risk for anxiety, depression, and social isolation. Social support from friends, family members, neighbors, and health care professionals can potentially prevent or mitigate caregiver strain. While previous research documents the importance of social support in helping end-of-life caregivers cope with caregiving demands, little is known about differences in social support experiences among caregivers at different life course stages. Using life course theory, this study analyzes data from in-depth interviews with 50 caregivers of patients enrolled in hospice services to compare barriers to mobilizing social support among caregivers at two life course stages: midlife caregivers caring for parents and older adult caregivers caring for spouses/partners. Older adult caregivers reported different barriers to mobilizing social support compared with midlife caregivers. Findings enhance the understanding of how caregivers' life course stage affects their barriers to mobilization of social support resources.

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

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

2015-02-01

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

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

Science.gov (United States)

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

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

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

LENUS (Irish Health Repository)

Brien, Irene O

2012-02-01

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

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

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

2003-05-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Product differentiation among health maintenance organizations: causes and consequences of offering open-ended products.

Science.gov (United States)

Wholey, D R; Christianson, J B

1994-01-01

Open-ended products that allow an HMO enrollee to use providers who are not affiliated with the HMO have become an important component of the Clinton administration's health reform proposal, because these products maintain consumer freedom of choice of any provider. However, little is known about the consequences of offering an open-ended product from an organizational standpoint. This paper uses a theory of "spatial competition" to examine the decisions of health maintenance organizations to offer an open-ended product and the effect of offering an open-ended product on their enrollment.

Balancing dual roles in end-of-life research.

Science.gov (United States)

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

2007-01-01

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

Factors associated with end-of-life by home-visit nursing-care providers in Japan.

Science.gov (United States)

Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

2017-06-01

Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands.

Science.gov (United States)

Brouwer, Marije; Maeckelberghe, Els; DE Weerd, Willemien; Verhagen, Eduard

2018-07-01

In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is

END-OF-USE PRODUCTS IN REVERSE LOGISTICS

OpenAIRE

Marta Starostka-Patyk

2007-01-01

Reverse logistics is a very useful tool for enterprises which have to deal with end-of-use products. Forward logistics is not able to manage them, because they show up on the beginning of reverse supply chain. That is the reason for growing importance of reverse flows. Reverse logistics is quite new logistics system. This paper presents the idea of reverse logistics and end-of-use products problems.

A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

Science.gov (United States)

Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

2016-07-01

Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

Western dwarf mistletoe infects understory Jeffrey pine seedlings on Cleveland National Forest, California

Science.gov (United States)

Robert F. Scharpf; Detlev Vogler

1986-01-01

Many young, understory Jeffrey pines (Pinus jeffreyi Grev. & Balf.) were found to be infected by western dwarf mistletoe (Arceuthobium campylopodum Engelm.) on Laguna Mountain, Cleveland National Forest, in southern California. Under heavily infected overstory, about three-fourths of the young pines (about 15 years old on the...

Thermally radiative three-dimensional flow of Jeffrey nanofluid with internal heat generation and magnetic field

Energy Technology Data Exchange (ETDEWEB)

Shehzad, S.A., E-mail: ali_qau70@yahoo.com [Department of Mathematics, Comsats Institute of Information Technology, Sahiwal 57000 (Pakistan); Abdullah, Z. [Department of Mathematics, Comsats Institute of Information Technology, Sahiwal 57000 (Pakistan); Alsaedi, A. [Nonlinear Analysis and Applied Mathematics (NAAM) Research Group, Faculty of Science, King Abdulaziz University, P. O. Box 80257, Jeddah 21589 (Saudi Arabia); Abbasi, F.M. [Department of Mathematics, Comsats Institute of Information Technology, Islamabad 44000 (Pakistan); Hayat, T. [Nonlinear Analysis and Applied Mathematics (NAAM) Research Group, Faculty of Science, King Abdulaziz University, P. O. Box 80257, Jeddah 21589 (Saudi Arabia); Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000 (Pakistan)

2016-01-01

This research work addresses the three-dimensional hydromagnetic flow of Jeffrey fluid with nanoparticles. Flow is generated by a bidirectional stretching surface. The effects of thermal radiation and internal heat generation are encountered in energy expressions. More realistic convective boundary conditions at the surface are employed instead of constant surface temperature and mass species conditions. Boundary layer assumptions lead to the governing non-linear mathematical model. Resulting equations through momentum, energy and mass species are made dimensionless using suitable variables. The solution expressions of dimensionless velocities, temperature and nanoparticle concentration have been computed for the convergent series solutions. The impacts of interesting parameters on the dimensionless quantities are displayed and interpreted. The values of physical quantities are computed and analyzed. - Highlights: • Three-dimensional hydromagnetic flow of Jeffrey nanofluid is considered. • Brownian motion and thermophoresis effects are encountered. • Heat transfer analysis is performed with thermal radiation. • Results are plotted and visualized.

Pleurodesis for effusions in pediatric oncology patients at end of life

International Nuclear Information System (INIS)

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

2007-01-01

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

Pleurodesis for effusions in pediatric oncology patients at end of life

Energy Technology Data Exchange (ETDEWEB)

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

2007-03-15

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

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

Science.gov (United States)

Churchill, Larry R

2015-04-01

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

Education and training to enhance end-of-life care for nursing home staff: a systematic literature review.

Science.gov (United States)

Anstey, Sally; Powell, Tom; Coles, Bernadette; Hale, Rachel; Gould, Dinah

2016-09-01

The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

Science.gov (United States)

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

2006-09-01

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

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

African Journals Online (AJOL)

2017-12-01

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

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

Science.gov (United States)

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

2009-01-01

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

The end of life treatment of second generation mobile phone networks: Strategies to reduce the environmental impact

International Nuclear Information System (INIS)

Scharnhorst, Wolfram; Althaus, Hans-Joerg; Classen, Mischa; Jolliet, Olivier; Hilty, Lorenz M.

2005-01-01

A life cycle assessment was carried out based on a detailed life cycle inventory for a typical GSM 900 mobile phone network and related End of Life (EOL) treatment infrastructure. The environmental relevance of the three life cycle phases: production, use and EOL treatment was analysed using IMPACT2002+. The environmentally preferable EOL treatment alternative was identified on the basis of six previously developed EOL treatment scenarios. The results indicate that the environmental impacts attributable to the use phase dominate the environmental impacts incurred over the entire life cycle of the network. The impacts of the production phase are primarily attributable to the energy intensive manufacturing of printed wiring boards (PWB). The EOL phase dominates the impacts on ecosystem quality. In particular the long-term emissions of heavy metals have critical effects. Detailed analysis of the EOL phase shows that recycling of network materials in general leads to a two fold reduction of environmental impacts: in the EOL phase itself as well as by means of the avoided primary production of materials recovered in the EOL phase. An increase in the material quality of the secondary precious and rare materials leads to a significant reduction in the impacts on human health

Death ends a life, not a relationship

DEFF Research Database (Denmark)

Christensen, Dorthe Refslund; Sandvik, Kjetil

2014-01-01

In the final chapter, “Death Ends a Life, not a Relationship: objects as media on children’s graves”, Dorthe Refslund Christensen and Kjetil Sandvik investigate the relational affordances offered by objects as media in practices of death and commemoration on children’s graves. The authors argue t...... – mirrored in online memorial sites – that transform the dead child into a being with whom an altered relationship may be built, maintained and developed so that the bereaved can, eventually, integrate the dead into his or her ongoing life.......In the final chapter, “Death Ends a Life, not a Relationship: objects as media on children’s graves”, Dorthe Refslund Christensen and Kjetil Sandvik investigate the relational affordances offered by objects as media in practices of death and commemoration on children’s graves. The authors argue...... that when it comes to bereavement practices as they materialize on children’s graves, it is the accommodation and decoration of the grave itself that function as media with their variety of physical objects as ritual and relational tools for communication. The bereaved perform practices on children’s graves...

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

Science.gov (United States)

2011-06-16

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

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

NARCIS (Netherlands)

N.J.H. Raijmakers (Natasja)

2013-01-01

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

REUSE OF AUTOMOTIVE COMPONENTS FROM DISMANTLED END OF LIFE VEHICLES

Directory of Open Access Journals (Sweden)

Piotr NOWAKOWSKI

2013-12-01

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

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

Science.gov (United States)

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

2002-01-01

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

Activation Detection in fMRI Using Jeffrey Divergence

Science.gov (United States)

Seghouane, Abd-Krim

2009-12-01

A statistical test for detecting activated pixels in functional MRI (fMRI) data is proposed. For the derivation of this test, the fMRI time series measured at each voxel is modeled as the sum of a response signal which arises due to the experimentally controlled activation-baseline pattern, a nuisance component representing effects of no interest, and Gaussian white noise. The test is based on comparing the dimension of the voxels fMRI time series fitted data models with and without controlled activation-baseline pattern. The Jeffrey divergence is used for this comparison. The test has the advantage of not requiring a level of significance or a threshold to be provided.

United States Acculturation and Cancer Patients’ End-of-Life Care

Science.gov (United States)

Wright, Alexi A.; Stieglitz, Heather; Kupersztoch, Yankel M.; Paulk, M. Elizabeth; Kim, Yookyung; Katz, Ingrid T.; Munoz, Francisco; Jimenez, Rachel B.; Mutchler, Jan; Rivera, Lorna; Back, Anthony L.; Prigerson, Holly G.

2013-01-01

Background Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care. Methods and Findings In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, Punit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12). Conclusion The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more

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

Science.gov (United States)

Sander, Ruth

2012-11-30

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

[End-of-life decisions: results of the expert-validated questionnaire].

Science.gov (United States)

Ortiz-Gonçalves, Belén; Albarrán Juan, Elena; Labajo González, Elena; Santiago-Sáez, Andrés; Perea-Pérez, Bernardo

2018-02-02

To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

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

Science.gov (United States)

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

2011-01-01

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

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

Science.gov (United States)

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

2018-06-01

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

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

Science.gov (United States)

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

2015-12-01

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

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

Science.gov (United States)

Tait, Glendon R.; Hodges, Brian D.

2009-01-01

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

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

LENUS (Irish Health Repository)

Hayden, Deborah

2011-11-01

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

ORIGINAL ARTICLES Medical futility and end-of-life care

African Journals Online (AJOL)

2008-04-01

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

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

Science.gov (United States)

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

2011-11-01

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

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

Science.gov (United States)

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

2017-11-01

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

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

Science.gov (United States)

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

2018-06-11

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

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

Science.gov (United States)

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

2017-02-02

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

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

Science.gov (United States)

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

2015-06-01

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

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

Science.gov (United States)

Brown, Lawrence D

2012-10-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

2014-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Swiss doctors' attitudes towards end-of-life decisions and their determinants: a comparison of three language regions.

Science.gov (United States)

Fischer, Susanne; Bosshard, Georg; Faisst, Karin; Tschopp, Alois; Fischer, Johannes; Bär, Walter; Gutzwiller, Felix

2006-06-10

To investigate attitudes to end-of-life decisions, and the influence of cultural factors and of doctors' personal characteristics on these attitudes. As part of a European research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among doctors in the German-, French- and Italian-speaking areas of Switzerland. A written questionnaire was sent to a random sample of nine different types of specialist; it presented 14 statements on end-of-life decisions and doctors were asked whether they agreed or disagreed with them. The response rate was 64%. 1360 questionnaires were studied. The results show general agreement with statements on the alleviation of pain and other symptoms with possible life-shortening effect, as well as on non-treatment decisions. The language region was a strong determinant of agreement on some attitudes towards end-of-life decisions. Agreement on the use of lethal drugs and alleviation of pain and other symptoms with possible life-shortening effect was higher among French-speaking than among German- and Italian-speaking doctors. For nontreatment decisions, agreement was higher in the German-speaking region than in the French- and Italian-speaking regions of the country. Italian-speaking doctors were strongly opposed to any kind of end-of-life decision. Religious believers and those who attended a larger number of terminal patients tended to disagree more often with end-of-life decisions than the other doctors. In end-of-life decision-making, Switzerland represents "Europe in miniature". The impact on end-of-life decisions of cultural factors and the number of terminal patients attended needs further consideration.

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

NARCIS (Netherlands)

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

2012-01-01

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

Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.

Science.gov (United States)

Sprung, Charles L; Truog, Robert D; Curtis, J Randall; Joynt, Gavin M; Baras, Mario; Michalsen, Andrej; Briegel, Josef; Kesecioglu, Jozef; Efferen, Linda; De Robertis, Edoardo; Bulpa, Pierre; Metnitz, Philipp; Patil, Namrata; Hawryluck, Laura; Manthous, Constantine; Moreno, Rui; Leonard, Sara; Hill, Nicholas S; Wennberg, Elisabet; McDermid, Robert C; Mikstacki, Adam; Mularski, Richard A; Hartog, Christiane S; Avidan, Alexander

2014-10-15

Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

Analysis of heat transfer for unsteady MHD free convection flow of rotating Jeffrey nanofluid saturated in a porous medium

Directory of Open Access Journals (Sweden)

Nor Athirah Mohd Zin

Full Text Available In this article, the influence of thermal radiation on unsteady magnetohydrodynamics (MHD free convection flow of rotating Jeffrey nanofluid passing through a porous medium is studied. The silver nanoparticles (AgNPs are dispersed in the Kerosene Oil (KO which is chosen as conventional base fluid. Appropriate dimensionless variables are used and the system of equations is transformed into dimensionless form. The resulting problem is solved using the Laplace transform technique. The impact of pertinent parameters including volume fraction φ, material parameters of Jeffrey fluid λ1, λ, rotation parameter r, Hartmann number Ha, permeability parameter K, Grashof number Gr, Prandtl number Pr, radiation parameter Rd and dimensionless time t on velocity and temperature profiles are presented graphically with comprehensive discussions. It is observed that, the rotation parameter, due to the Coriolis force, tends to decrease the primary velocity but reverse effect is observed in the secondary velocity. It is also observed that, the Lorentz force retards the fluid flow for both primary and secondary velocities. The expressions for skin friction and Nusselt number are also evaluated for different values of emerging parameters. A comparative study with the existing published work is provided in order to verify the present results. An excellent agreement is found. Keywords: Jeffrey nanofluid, AgNPs, MHD and Porosity, Rotating flow, Laplace transform technique

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

Science.gov (United States)

Cookson, Richard

2013-12-01

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

The Tool Life of Ball Nose end Mill Depending on the Different Types of Ramping

Science.gov (United States)

Vopát, Tomáš; Peterka, Jozef; Kováč, Martin

2014-12-01

The article deals with the cutting tool wear measurement process and tool life of ball nose end mill depending on upward ramping and downward ramping. The aim was to determine and compare the wear (tool life) of ball nose end mill for different types of copy milling operations, as well as to specify particular steps of the measurement process. In addition, we examined and observed cutter contact areas of ball nose end mill with machined material. For tool life test, DMG DMU 85 monoBLOCK 5-axis CNC milling machine was used. In the experiment, cutting speed, feed rate, axial depth of cut and radial depth of cut were not changed. The cutting tool wear was measured on Zoller Genius 3s universal measuring machine. The results show different tool life of ball nose end mills depending on the copy milling strategy.

CORRELATION BETWEEN OZONE EXPOSURE AND VISIBLE FOLIAR INJURY IN PONDEROSA AND JEFFREY PINES. (R825433)

Science.gov (United States)

Ozone exposure was related to ozone-induced visible foliar injury in ponderosa and Jeffrey pines growing on the western slopes of the Sierra Nevada Mountains of California. Measurements of ozone exposure, chlorotic mottle and fascicle retention were collected during the years ...

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

Science.gov (United States)

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

2018-01-01

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

Evaluation end-of-life power generation of a satellite solar array

International Nuclear Information System (INIS)

Taherbaneh, Mohsen; Ghafooifard, H.; Rezaie, A.H.; Rahimi, K.

2011-01-01

Research highlights: → We present detailed design description and necessary considerations for solar panels utilized in a specific space mission. → All sources of losses and degradation of the solar panels are fully taken into account. → We introduce a comprehensive novel approach to investigate the electrical behavior of the solar panels. → We use a simple model to calculate the operating temperature range of the solar panels. → We also calculate Mission End-of-Life electrone fluence using SPENVIS. -- Abstract: Knowing the power generated by of solar arrays in a space missions shall satisfy mission requirements; prediction of the power generated by a solar array used in a space mission is very important and necessary. In this research, a detailed design description and necessary considerations for solar panels utilized in a specific space mission is presented. All sources of losses and degradation of solar panels are fully taken into account. This research emphasizes on investigation, analysis and verification of a manufactured solar assembly for a satellite before launch. Solar panels' generated power should be estimated at the end of the mission. For this purpose, radiation values and temperature operating range are specified for the mission. Panels' temperature operating rate is determined through considering a simple model and different spins for the satellite. Mission end-of-life 1 MeV equivalent dose is calculated by SPENVIS suite software. Finally, a comprehensive novel approach is introduced to investigate the electrical behavior of the solar panels. This approach can be implemented in MATLAB environment to obtain output power characteristics of the solar panels for each specific mission. The results are in full accordance with the mission requirements either in beginning-of-life or end-of-life. Therefore, the power prediction of the designed solar array for the mentioned satellite completely satisfies its mission requirements.

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

Science.gov (United States)

Marsh, Pauline; Spinaze, Anna

2016-05-01

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

Spiritual distress of military veterans at the end of life.

Science.gov (United States)

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

2015-06-01

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

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

DEFF Research Database (Denmark)

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

2014-01-01

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

End-of-Life Medical Spending In Last Twelve Months of Life is Lower than Previously Reported

DEFF Research Database (Denmark)

French, Eric; Aragon, Maria; Mccauley, Jeremy

2017-01-01

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiw...... but to spending on people with chronic conditions, which are associated with shorter life expectancies....

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

NARCIS (Netherlands)

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

2011-01-01

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

The Tool Life of Ball Nose end Mill Depending on the Different Types of Ramping

Directory of Open Access Journals (Sweden)

Vopát Tomáš

2014-12-01

Full Text Available The article deals with the cutting tool wear measurement process and tool life of ball nose end mill depending on upward ramping and downward ramping. The aim was to determine and compare the wear (tool life of ball nose end mill for different types of copy milling operations, as well as to specify particular steps of the measurement process. In addition, we examined and observed cutter contact areas of ball nose end mill with machined material. For tool life test, DMG DMU 85 monoBLOCK 5-axis CNC milling machine was used. In the experiment, cutting speed, feed rate, axial depth of cut and radial depth of cut were not changed. The cutting tool wear was measured on Zoller Genius 3s universal measuring machine. The results show different tool life of ball nose end mills depending on the copy milling strategy.

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

Science.gov (United States)

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

2017-08-24

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

What are the barriers to initiating end-of-life conversations with patients in the last year of life?

Science.gov (United States)

Travers, Alice; Taylor, Vanessa

2016-09-02

Improving end of life care is a national imperative. Unsatisfactory care persists particularly in acute hospitals, with shortcomings, variability in communication and advance care planning identified as fundamental issues. This review explored the literature to identify what is known about the barriers to initiating end-of-life conversations with patients from the perspective of doctors and nurses in the acute hospital setting. Six electronic databases were searched for potentially relevant records published between 2008 and 2015. Studies were included if the authors reported on barriers to discussing end of life with families or patients as described by doctors or nurses in hospital settings, excluding critical care. Of 1267 potentially relevant records, 12 were included in the review. Although there is limited high-quality evidence available, several barriers were identified. Recurrent themes within the literature related to a lack of education and training, difficulty in prognostication, cultural differences and perceived reluctance of the patient or family. This study illustrated that, in addressing barriers to communication, consideration needs to be extended to include how to embed good communication practice between patients and health professionals into the culture of this setting. Board level commitment is required to raise awareness of, and familiarity with, policies and protocols concerning communication and end-of-life care. Communication training should include practical skills and tools, opportunities to explore the personal beliefs of practitioners and managing their emotions, opportunities to analyse the local organisational (physical and social environment) and team barriers.

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

Directory of Open Access Journals (Sweden)

Anna E. van der Wath

2015-11-01

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

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

Science.gov (United States)

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

2016-09-01

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

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

OpenAIRE

Li, Li Bin

2013-01-01

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

Simultaneous effects of slip and MHD on peristaltic blood flow of Jeffrey fluid model through a porous medium

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M.M. Bhatti

2016-06-01

Full Text Available In this article, the simultaneous effects of slip and Magnetohydrodynamics (MHD on peristaltic blood flow of Jeffrey fluid model have been investigated in a non-uniform porous channel. The governing equation of blood flow for Jeffrey fluid model is solved with the help of long wavelength and creeping flow regime. The solution of the resulting differential equation is solved analytically and a closed form solution is presented. The impact of all the physical parameters is plotted for velocity profile and pressure rise. Nowadays, Magnetohydrodynamics is applicable in various magnetic drug targeting for cancer diseases and also very helpful to control the flow. The present analysis is also described for Newtonian fluid (λ1→0 as a special case of our study. It is observed that magnitude of the velocity is opposite near the walls due to slip effects whereas similar behavior has been observed for magnetic field.

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

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

2014-09-01

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

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

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

2007-12-01

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

A co-design process developing heuristics for practitioners providing end of life care for people with dementia.

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Davies, Nathan; Mathew, Rammya; Wilcock, Jane; Manthorpe, Jill; Sampson, Elizabeth L; Lamahewa, Kethakie; Iliffe, Steve

2016-08-02

The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice. Four broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing "routine care" at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering 'comfort feeding' only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer's wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting

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

NARCIS (Netherlands)

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

2014-01-01

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

The Meaning of Life-long Education for Contemporal' Industrial Production

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Janez Tušek

2001-12-01

Full Text Available The article shows the significance of and the need for permanent education of the people employed in industry who want to update production, implement novelties, monitor competition, and constantly increase productivity. Besides general needs and principles of life-long education there are some basic and general needs of education for modern industrial production. There is a special emphasis on education for overall quality, the significance of standardisation, protection of the environment, job satisfaction, safety at work, and dealing with customers. One chapter is dedicated to training for development and improvement of products, patent protection of new products, learning from competition, use of internet and other sources. At the end there are some cases of successful education in Slovenian industry.

Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

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Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

2016-11-01

End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

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

Directory of Open Access Journals (Sweden)

Anna Spathis

2008-03-01

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

End-of-life decision-making and terminal sedation among very old patients.

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De Gendt, Cindy; Bilsen, Johan; Mortier, Freddy; Vander Stichele, Robert; Deliens, Luc

2009-01-01

About half of the persons who die in developed countries are very old (aged 80 years or older) and this proportion is still rising. In general, there is little information available concerning the circumstances and quality of the end of life of this group. This study aims (1) to describe the incidence and characteristics of medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) and terminal sedation among very old patients who died nonsuddenly, (2) to describe the characteristics of the preceding decision-making process, and (3) to compare this with the deaths of younger patients. A sample of 5,005 death certificates was selected from all deaths in Flanders (Belgium) in the second half of 2001 (before euthanasia was legalized). Questionnaires were mailed to the certifying physicians. Response rate was 58.9%. An ELD was made for 53.6% very old (aged 80+) patients who died nonsuddenly (vs. 63.3% for the younger patients). Use of life-ending drugs occurred among 1.1% (six times less frequently than in younger patients), with no euthanasia cases, pain and symptom alleviation with a possible life-shortening effect among 27.3% (two times less frequently), and withholding or withdrawing life-prolonging treatments among 25.2% (slightly more frequently). Terminal sedation occurred among 6.9% of the cases, two times less frequently than for the younger patients. ELDs were not often discussed with very old patients. Among competent patients this was less than compared with younger patients. ELDs are less common for very old than for younger patients. Physicians seem to have a more reluctant attitude towards the use of lethal drugs, terminal sedation and participation in decision-making when dealing with very old patients. Advance care planning should increase the involvement of very old competent and noncompetent patients in end-of-life decision-making. (c) 2008 S. Karger AG, Basel.

Planning for Future Care and the End of Life: A Qualitative Analysis of Gay, Lesbian, and Heterosexual Couples.

Science.gov (United States)

Thomeer, Mieke Beth; Donnelly, Rachel; Reczek, Corinne; Umberson, Debra

2017-12-01

Two key components of end-of-life planning are (1) informal discussions about future care and other end-of-life preferences and (2) formal planning via living wills and other legal documents. We leverage previous work on the institutional aspects of marriage and on sexual-minority discrimination to theorize why and how heterosexual, gay, and lesbian married couples engage in informal and formal end-of-life planning. We analyze qualitative dyadic in-depth interviews with 45 midlife gay, lesbian, and heterosexual married couples ( N = 90 spouses). Findings suggest that same-sex spouses devote considerable attention to informal planning conversations and formal end-of-life plans, while heterosexual spouses report minimal formal or informal planning. The primary reasons same-sex spouses give for making end-of-life preparations are related to the absence of legal protections and concerns about discrimination from families. These findings raise questions about future end-of-life planning for same- and different-sex couples given a rapidly shifting legal and social landscape.

General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.

Science.gov (United States)

Giezendanner, Stéphanie; Jung, Corinna; Banderet, Hans-Ruedi; Otte, Ina Carola; Gudat, Heike; Haller, Dagmar M; Elger, Bernice S; Zemp, Elisabeth; Bally, Klaus

2017-01-01

Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in

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

Science.gov (United States)

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

2006-09-01

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

Standardizing an End-to-end Accounting Service

Science.gov (United States)

Greenberg, Edward; Kazz, Greg

2006-01-01

Currently there are no space system standards available for space agencies to accomplish end-to-end accounting. Such a standard does not exist for spacecraft operations nor for tracing the relationship between the mission planning activities, the command sequences designed to perform those activities, the commands formulated to initiate those activities and the mission data and specifically the mission data products created by those activities. In order for space agencies to cross-support one another for data accountability/data tracing and for inter agency spacecraft to interoperate with each other, an international CCSDS standard for end-to-end data accountability/tracing needs to be developed. We will first describe the end-to-end accounting service model and functionality that supports the service. This model will describe how science plans that are ultimately transformed into commands can be associated with the telemetry products generated as a result of their execution. Moreover, the interaction between end-to-end accounting and service management will be explored. Finally, we will show how the standard end-to-end accounting service can be applied to a real life flight project i.e., the Mars Reconnaissance Orbiter project.

Occupational Variation in End-of-Life Care Intensity.

Science.gov (United States)

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

2018-03-01

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

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

Science.gov (United States)

Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

2013-09-01

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

Back to the Future on Gender and Anti-School Boys: A Response to Jeffrey Smith

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Abraham, John

2008-01-01

This article examines recent claims by Jeffrey Smith that: (1) "hegemonic masculinity" is an expression of working class counter-school culture; (2) some teachers are "cultural accomplices" in constructing "hegemonic masculinities" of anti-school working class boys, thereby contributing to their underachievement; and (3) these "cultural…

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

DEFF Research Database (Denmark)

McGugan, Malcolm; McKirdy, Scott

2016-01-01

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

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

Science.gov (United States)

Chidwick, Paula; Sibbald, Robert

2011-01-01

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

Magnetic field and rotation effects on peristaltic transport of a Jeffrey fluid in an asymmetric channel

International Nuclear Information System (INIS)

Abd-Alla, A.M.; Abo-Dahab, S.M.

2015-01-01

In this paper, the peristaltic flow of a Jeffrey fluid in an asymmetric rotating channel is studied. Mathematical modeling is carried out by utilizing long wavelength and low Reynolds number assumptions. Closed form expressions for the pressure gradient, pressure rise, streamlines, axial velocity and shear stress on the channel walls have been computed numerically. Effects of Hartmann number, the ratio of relaxation to retardation times, time-mean flow, rotation and the phase angle on the pressure gradient, pressure rise, streamline, axial velocity and shear stress are discussed in detail and shown graphically. The results indicate that the effect of the Hartmann number, the ratio of relaxation to retardation times, time-mean flow, rotation and the phase angle are very pronounced in the phenomena. Comparison was made with the results obtained in the asymmetric channel and symmetric channel. - Highlights: • The peristaltic flow of a Jeffrey fluid in an asymmetric rotating channel with magnetic field. • Mathematical modeling for long wavelength and low Reynolds number assumptions. • Closed form expressions for the pressure gradient, pressure rise, stream function, axial velocity and shear stress

Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

Science.gov (United States)

Coyle, Nessa; Manna, Ruth; Shen, Megan; Banerjee, Smita C; Penn, Stacey; Pehrson, Cassandra; Krueger, Carol A; Maloney, Erin K; Zaider, Talia; Bylund, Carma L

2015-12-01

Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

Science.gov (United States)

Keim-Malpass, Jessica; Lindley, Lisa C

2017-08-01

Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

Forest rodents provide directed dispersal of Jeffrey pine seeds

Science.gov (United States)

Briggs, J.S.; Wall, S.B.V.; Jenkins, S.H.

2009-01-01

Some species of animals provide directed dispersal of plant seeds by transporting them nonrandomly to microsites where their chances of producing healthy seedlings are enhanced. We investigated whether this mutualistic interaction occurs between granivorous rodents and Jeffrey pine (Pinus jeffreyi) in the eastern Sierra Nevada by comparing the effectiveness of random abiotic seed dispersal with the dispersal performed by four species of rodents: deer mice (Peromyscus maniculatus), yellow-pine and long-eared chipmunks (Tamias amoenus and T. quadrimaculatus), and golden-mantled ground squirrels (Spermophilus lateralis). We conducted two caching studies using radio-labeled seeds, the first with individual animals in field enclosures and the second with a community of rodents in open forest. We used artificial caches to compare the fates of seeds placed at the range of microsites and depths used by animals with the fates of seeds dispersed abiotically. Finally, we examined the distribution and survival of naturally establishing seedlings over an eight-year period.Several lines of evidence suggested that this community of rodents provided directed dispersal. Animals preferred to cache seeds in microsites that were favorable for emergence or survival of seedlings and avoided caching in microsites in which seedlings fared worst. Seeds buried at depths typical of animal caches (5–25 mm) produced at least five times more seedlings than did seeds on the forest floor. The four species of rodents differed in the quality of dispersal they provided. Small, shallow caches made by deer mice most resembled seeds dispersed by abiotic processes, whereas many of the large caches made by ground squirrels were buried too deeply for successful emergence of seedlings. Chipmunks made the greatest number of caches within the range of depths and microsites favorable for establishment of pine seedlings. Directed dispersal is an important element of the population dynamics of Jeffrey pine, a

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

Science.gov (United States)

Maciejewski, Paul K.; Prigerson, Holly G.

2012-01-01

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

Third-year Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care.

Science.gov (United States)

Adesina, Oluwatomilayo; DeBellis, Anita; Zannettino, Lana

2014-08-01

Nurses have a vital role in providing end-of-life care to patients and their families, and it is important that nursing students are adequately prepared for this role. This article reports on qualitative findings from research that explored a cohort of third-year undergraduate Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care. The study used open-ended questions in a purpose-designed, self-administered questionnaire and thematic analysis of the responses. Five themes emerged from the analysis: the importance of the students' values and beliefs, the influence of experience, their views on what constitutes a good or bad death, their knowledge of ethics and legislation surrounding end-of-life care, and how they perceived their level of education and knowledge. The need for more education on end-of-life care has implications for curriculum development in undergraduate nursing programmes, which need to provide graduating nurses with the necessary knowledge and skills to deliver quality care to patients who are dying and their families.

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

Science.gov (United States)

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

2018-01-01

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

Questioning care at the end of life.

Science.gov (United States)

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

2005-06-01

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

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

Science.gov (United States)

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

2013-09-01

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

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

Science.gov (United States)

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

2013-03-01

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

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

Science.gov (United States)

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

2012-12-03

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

Environmental burdens in the management of end-of-life cathode ray tubes

International Nuclear Information System (INIS)

Rocchetti, Laura; Beolchini, Francesca

2014-01-01

Highlights: • The paper deals with different management options for end-of-life CRTs. • The environmental burdens for disposal and recycling are presented. • Recycling treatments allows to gain benefits for the environment. • Further treatments for fluorescent powders determine CO 2 credits. • More efforts should be directed towards recycling. - Abstract: We compared the environmental burdens in the management of end-of life cathode ray tubes (CRTs) within two frameworks according to the different technologies of the production of televisions/monitors. In the first case, CRT recycling is addressed to the recovery of the panel and funnel glass for the manufacturing of new CRT screens. In the second case, where flat screen technology has replaced that of CRT, the recycling is addressed to the recovery of the glass cullet and lead for other applications. The impacts were evaluated according to the problem-oriented methodology of the Institute of Environmental Sciences, Leiden University, Leiden, The Netherlands. Our data confirm that in both cases, the recycling treatment allows benefits to be gained for the environment through the recovery of the secondary raw materials. These benefits are higher for the “CRT technology” framework (1 kg CO 2 saved per CRT) than for the “flat screen technology” (0.9 kg CO 2 saved, per CRT, as the highest possible), mainly due to the high energy consumption for lead separation from the funnel glass. Furthermore, the recovery of yttrium from the fluorescent powders that are a residue of the recycling treatment would further improve the CO 2 credit for both the frameworks considered, which would provide a further saving of about 0.75 kg CO 2 per CRT, net of the energy and raw materials needed for the recovery. Overall, this study confirms that, even with a change in the destination of the recovered materials, the recycling processes provide a benefit for the environment: indeed the higher loads for the environment are

Environmental burdens in the management of end-of-life cathode ray tubes

Energy Technology Data Exchange (ETDEWEB)

Rocchetti, Laura; Beolchini, Francesca, E-mail: f.beolchini@univpm.it

2014-02-15

Highlights: • The paper deals with different management options for end-of-life CRTs. • The environmental burdens for disposal and recycling are presented. • Recycling treatments allows to gain benefits for the environment. • Further treatments for fluorescent powders determine CO{sub 2} credits. • More efforts should be directed towards recycling. - Abstract: We compared the environmental burdens in the management of end-of life cathode ray tubes (CRTs) within two frameworks according to the different technologies of the production of televisions/monitors. In the first case, CRT recycling is addressed to the recovery of the panel and funnel glass for the manufacturing of new CRT screens. In the second case, where flat screen technology has replaced that of CRT, the recycling is addressed to the recovery of the glass cullet and lead for other applications. The impacts were evaluated according to the problem-oriented methodology of the Institute of Environmental Sciences, Leiden University, Leiden, The Netherlands. Our data confirm that in both cases, the recycling treatment allows benefits to be gained for the environment through the recovery of the secondary raw materials. These benefits are higher for the “CRT technology” framework (1 kg CO{sub 2} saved per CRT) than for the “flat screen technology” (0.9 kg CO{sub 2} saved, per CRT, as the highest possible), mainly due to the high energy consumption for lead separation from the funnel glass. Furthermore, the recovery of yttrium from the fluorescent powders that are a residue of the recycling treatment would further improve the CO{sub 2} credit for both the frameworks considered, which would provide a further saving of about 0.75 kg CO{sub 2} per CRT, net of the energy and raw materials needed for the recovery. Overall, this study confirms that, even with a change in the destination of the recovered materials, the recycling processes provide a benefit for the environment: indeed the higher loads

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

NARCIS (Netherlands)

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

2013-01-01

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

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

NARCIS (Netherlands)

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

2010-01-01

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

Factors Influencing Consumers’ Intention to Return the End of Life Electronic Products through Reverse Supply Chain Management for Reuse, Repair and Recycling

Directory of Open Access Journals (Sweden)

Kamyar Kianpour

2017-09-01

Full Text Available Resource depletion, population growth and environmental problems force companies to collect their end of life (EOL products for reuse, recycle and refurbishment through reverse supply chain management (RSCM. Success in collecting the EOL products through RSCM depends on the customers’ participation intention. The objectives of this study are: (1 To examine the important factors influencing customers’ attitude to participate in RSCM; (2 To examine the important factors influencing customers’ subjective norm to participate in RSCM; (3 To examine the main factors influencing customers’ perceived behavioral control to participate in RSCM; (4 To examine the influence of attitude, subjective norms and perceived behavioral control on customers’ participation intention in RSCM. The Decomposed Theory of Planned Behaviour (DTPB has been chosen as the underpinning theory for this research. The research conducted employed the quantitative approach. Non-probability (convenience sampling method was used to determine the sample and data was collected using questionnaires. Partial Least Squares-Structural Equation Modeling (PLS-SEM technique was employed. A total of 800 questionnaires were distributed among customers of electronic products in Malaysia. Finally, the questionnaire was distributed among the customers in electronic retailer companies based on convenience sampling method. The empirical results confirm that consumers perception about the risk associated with EOL electronic products, consumers’ ecological knowledge and relative advantages associated with reuse, repair and recycling can influence the attitude of consumers to return the EOL products for reuse, repair and recycling to producer.

Improvement of succinate production by release of end-product inhibition in Corynebacterium glutamicum.

Science.gov (United States)

Chung, Soon-Chun; Park, Joon-Song; Yun, Jiae; Park, Jin Hwan

2017-03-01

Succinate is a renewable-based platform chemical that may be used to produce a wide range of chemicals including 1,4-butanediol, tetrahydrofurane, and γ-butyrolactone. However, industrial fermentation of organic acids is often subject to end-product inhibition, which significantly retards cell growth and limits metabolic activities and final productivity. In this study, we report the development of metabolically engineered Corynebacterium glutamicum for high production of succinate by release of end-product inhibition coupled with an increase of key metabolic flux. It was found that the rates of glucose consumption and succinate production were significantly reduced by extracellular succinate in an engineered strain, S003. To understand the mechanism underlying the inhibition by succinate, comparative transcriptome analysis was performed. Among the downregulated genes, overexpression of the NCgl0275 gene was found to suppress the inhibition of glucose consumption and succinate production, resulting in a 37.7% increase in succinate production up to 55.4g/L in fed-batch fermentation. Further improvement was achieved by increasing the metabolic flux from PEP to OAA. The final engineered strain was able to produce 152.2g/L succinate, the highest production reported to date, with a yield of 1.1g/g glucose under anaerobic condition. These results suggest that the release of end-product inhibition coupled with an increase in key metabolic flux is a promising strategy for enhancing production of succinate. Copyright © 2017. Published by Elsevier Inc.

Developing the science of end-of-life and palliative care research: National Institute of Nursing Research summit.

Science.gov (United States)

Csikai, Ellen L

2011-01-01

A rare opportunity to examine accomplishments and identify ways to advance research in end-of-life and palliative care was offered by the National Institute of Nursing Research (NINR) through a summit meeting held in August 2011. The Science of Compassion: Future Directions in End-of-Life and Palliative Care brought together nationally recognized leaders in end-of-life and palliative care research, including grantees of NINR, as well as more than 700 attendees from all disciplines. It was an exciting affirmation of the importance of moving forward in the field. Presented in this article is a summary of the summit and a call to action for end-of-life and palliative care social workers to engage in seeking funding to conduct needed research and to ensure our unique perspective is represented.

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

Science.gov (United States)

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

2017-02-01

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

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

NARCIS (Netherlands)

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

2012-01-01

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

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

Science.gov (United States)

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

2017-03-16

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

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

Science.gov (United States)

Rautureau, Pascal

2018-04-01

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

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

Science.gov (United States)

Li, Li Bin

2013-12-04

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

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

Science.gov (United States)

Sullivan, J; Monagle, P; Gillam, L

2014-03-01

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

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

Directory of Open Access Journals (Sweden)

Kovačević Aleksandra

2015-01-01

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

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

Science.gov (United States)

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

2018-06-01

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

Isozyme markers associated with O3 tolerance indicate shift in genetic structure of ponderosa and Jeffrey pine in Sequoia National Park, California

International Nuclear Information System (INIS)

Staszak, J.; Grulke, N.E.; Marrett, M.J.; Prus-Glowacki, W.

2007-01-01

Effects of canopy ozone (O 3 ) exposure and signatures of genetic structure using isozyme markers associated with O 3 tolerance were analyzed in ∼20-, ∼80-, and >200-yr-old ponderosa (Pinus ponderosa Dougl. ex Laws.) and Jeffrey pine (Pinus jeffreyi Grev. and Balf.) in Sequoia National Park, California. For both species, the number of alleles and genotypes per loci was higher in parental trees relative to saplings. In ponderosa pine, the heterozygosity value increased, and the fixation index indicated reduction of homozygosity with increasing tree age class. The opposite tendencies were observed for Jeffrey pine. Utilizing canopy attributes known to be responsive to O 3 exposure, ponderosa pine was more symptomatic than Jeffrey pine, and saplings were more symptomatic than old growth trees. We suggest that these trends are related to differing sensitivity of the two species to O 3 exposure, and to higher O 3 exposures and drought stress that younger trees may have experienced during germination and establishment. - Genetic variation in isozyme markers associated with ozone tolerance differed between parental trees and their progeny in two closely related species of yellow pine

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

LENUS (Irish Health Repository)

Coffey, Alice

2016-01-28

Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

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

Science.gov (United States)

2011-09-23

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

Life Cycle Assessment of Fiber-Reinforced Additive Manufacturing for Injection Molding Insert Production

DEFF Research Database (Denmark)

Hofstätter, Thomas; Stotz, Philippe Maurice; Bey, Niki

2017-01-01

Additively manufactured (AM) injection molding (IM) inserts have proved to be capable to substitute conventionally manufactured metal inserts with polymer-based insert enforced with short, virgin, unseized carbon fibers (CFs). It has been shown that the implementation of AM technology resulted......, this contribution provides a comparison of environmental performance of conventionally vs. additively manufactured inserts in a full life cycle perspective indicated in Figure 1, including materials, production, use and end-of-life (EoL) stages....

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

Science.gov (United States)

Wilson, F; Gott, M; Ingleton, C

2013-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Science.gov (United States)

Olsen, Molly L.; Swetz, Keith M.; Mueller, Paul S.

2010-01-01

Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. PMID:20805544

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

Science.gov (United States)

Parlos, Alexander G.; Toliyat, Hamid A.

2005-01-01

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

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

Science.gov (United States)

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

2016-05-01

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

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

Science.gov (United States)

Mendoza, Roger Lee

2017-09-01

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

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

Science.gov (United States)

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

2010-05-01

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

Product Life Design: Notes for course 41627

DEFF Research Database (Denmark)

McAloone, Timothy Charles; Andreasen, Mogens Myrup

2003-01-01

- and ecological specifications, life cycle-oriented quality, whole life costs. - Product life systems, "the meeting", relational properties, the role of the human operator. - Modelling of the product and the product life cycle, computer modelling. - The score model, Integrated Product Development, Life Cycle...... Engineering, Concurrent Engineering. - The importance of the product concept, explicit life phase concepts. - Modelling of meetings, "universal virtues", simulation. - Product modelling, Product Data Management, life cycle databases, design history, documentation. - The structure and the content of the DFX......The course in product life design is designed to give an understanding of the phenomena of life cycle and product life thinking, the role of product design in fitting to product life systems and thus achieving sound product life perspectives. The course aims at developing an ability in the student...

Metabolic engineering of Escherichia coli for production of mixed-acid fermentation end products

Directory of Open Access Journals (Sweden)

Andreas Hartmut Förster

2014-05-01

Full Text Available Mixed-acid fermentation end products have numerous applications in biotechnology. This is probably the main driving force for the development of multiple strains that are supposed to produce individual end products with high yields. The process of engineering Escherichia coli strains for applied production of ethanol, lactate, succinate, or acetate was initiated several decades ago and is still ongoing. This review follows the path of strain development from the general characteristics of aerobic versus anaerobic metabolism over the regulatory machinery that enables the different metabolic routes. Thereafter, major improvements for broadening the substrate spectrum of Escherichia coli towards cheap carbon sources like molasses or lignocellulose are highlighted before major routes of strain development for the production of ethanol, acetate, lactate and succinate are presented.

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

Science.gov (United States)

Wrigley, Anthony

2015-08-01

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

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

NARCIS (Netherlands)

Sizoo, E.M.; Pasman, H.R.W.; Dirven, L.; Marosi, C.; Grisold, W.; Stockhammer, G.; Egeter, J.; Grant, R.; Chang, S.; Heimans, J.J.; Deliens, L.; Reijneveld, J.C.; Taphoorn, M.J.B.

2014-01-01

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

[Is there any deontology of accompanying people at the end of life?].

Science.gov (United States)

Glorion, B

1999-01-01

The thought on ethics, enhances by accompanying patients or human-beings reaching end of life, belong to major themes which have for years been dealt with by philosophers and monks. The physicians, who by nature accompany and live with their patient this life period a sometimes close relationship, have conceived within deontology a wonderful expression of what ethics inspired them. Reading articles 37 and 38 of the Code of Ethics brings a clear, precise and qualified answer to the question raised by the title. We easily find out the main principles which would be the guideline to the doctor's behaviour coping with this situation: providing suitable and continue cares to maintain the quality of a life which comes to end, respecting dignity. Relieving suffers, morally assisting, comforting the family, knowing to limit the cares reasonably. The sensitive and human expression sums up pretty well the particularities essential to all (physicians, health professionals or volunteers) who have accepted this heavy task.

Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors' Experience.

Science.gov (United States)

Bahus, Marianne K; Førde, Reidun

2016-09-01

With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.

Science.gov (United States)

Eneanya, Nwamaka D; Goff, Sarah L; Martinez, Talaya; Gutierrez, Natalie; Klingensmith, Jamie; Griffith, John L; Garvey, Casey; Kitsen, Jenny; Germain, Michael J; Marr, Lisa; Berzoff, Joan; Unruh, Mark; Cohen, Lewis M

2015-06-12

End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions

End-of-life vehicle recycling : state of the art of resource recovery from shredder residue.

Energy Technology Data Exchange (ETDEWEB)

Jody, B. J.; Daniels, E. J.; Energy Systems

2007-03-21

Each year, more than 50 million vehicles reach the end of their service life throughout the world. More than 95% of these vehicles enter a comprehensive recycling infrastructure that includes auto parts recyclers/dismantlers, remanufacturers, and material recyclers (shredders). Today, about 75% of automotive materials are profitably recycled via (1) parts reuse and parts and components remanufacturing and (2) ultimately by the scrap processing (shredding) industry. The process by which the scrap processors recover metal scrap from automobiles involves shredding the obsolete automobiles, along with other obsolete metal-containing products (such as white goods, industrial scrap, and demolition debris), and recovering the metals from the shredded material. The single largest source of recycled ferrous scrap for the iron and steel industry is obsolete automobiles. The non-metallic fraction that remains after the metals are recovered from the shredded materials (about 25% of the weight of the vehicle)--commonly called shredder residue--is disposed of in landfills. Over the past 10 to 15 years, a significant amount of research and development has been undertaken to enhance the recycle rate of end-of-life vehicles (ELVs), including enhancing dismantling techniques and improving remanufacturing operations. However, most of the effort has focused on developing technology to recover materials, such as polymers, from shredder residue. To make future vehicles more energy efficient, more lighter-weight materials--primarily polymers and polymer composites--will be used in manufacturing these vehicles. These materials increase the percentage of shredder residue that must be disposed of, compared with the percentage of metals. Therefore, as the complexity of automotive materials and systems increases, new technologies will be required to sustain and maximize the ultimate recycling of these materials and systems at end-of-life. Argonne National Laboratory (Argonne), in cooperation

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

Science.gov (United States)

Belloc Rocasalbas, M; Girbes, A R J

2011-03-01

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

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

Science.gov (United States)

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

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

End-of-life care in the United States: policy issues and model programs of integrated care

Directory of Open Access Journals (Sweden)

Joshua M. Wiener

2003-05-01

Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

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

Science.gov (United States)

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

2013-01-01

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

Meetodist tulenev olukord. Bjaervika projekt, Oslo = Technique Driven Condition. Bjaervika project, Oslo / Danilo Dangubic, Gudjon Erlendsson, Jeffrey Turko

Index Scriptorium Estoniae

Dangubic, Danilo

2000-01-01

Oslo kesklinna sadamaala tavakohase üldplaneeringu asemel pakuvad Londoni arhitektuuribüroo Urban Office arhitektid Danilo Dangubic, Gudjon Erlendsson ja Jeffrey Turko alternatiivprojekti, mis keskendub linnakeskonnale ja meetodile selle uurimiseks. 9 ill

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

Science.gov (United States)

Grabow, Debra

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

Metabotypes with properly functioning mitochondria and anti-inflammation predict extended productive life span in dairy cows

Science.gov (United States)

Huber, K.; Dänicke, S.; Rehage, J.; Sauerwein, H.; Otto, W.; Rolle-Kampczyk, U.; von Bergen, M.

2016-01-01

The failure to adapt metabolism to the homeorhetic demands of lactation is considered as a main factor in reducing the productive life span of dairy cows. The so far defined markers of production performance and metabolic health in dairy cows do not predict the length of productive life span satisfyingly. This study aimed to identify novel pathways and biomarkers related to productive life in dairy cows by means of (targeted) metabolomics. In a longitudinal study from 42 days before up to 100 days after parturition, we identified metabolites such as long-chain acylcarnitines and biogenic amines associated with extended productive life spans. These metabolites are mainly secreted by the liver and depend on the functionality of hepatic mitochondria. The concentrations of biogenic amines and some acylcarnitines differed already before the onset of lactation thus indicating their predictive potential for continuation or early ending of productive life. PMID:27089826

Isozyme markers associated with O{sub 3} tolerance indicate shift in genetic structure of ponderosa and Jeffrey pine in Sequoia National Park, California

Energy Technology Data Exchange (ETDEWEB)

Staszak, J. [A Mickiewicz University, Genetics Department, ul. Umultowska 89, 61-614 Poznan (Poland); Grulke, N.E. [USDA Forest Service, 4955 Canyon Crest Drive, Riverside, CA 92507 (United States)], E-mail: ngrulke@fs.fed.us; Marrett, M.J. [5184 Tower Road, Riverside, CA 92506 (United States); Prus-Glowacki, W. [A Mickiewicz University, Genetics Department, ul. Umultowska 89, 61-614 Poznan (Poland)

2007-10-15

Effects of canopy ozone (O{sub 3}) exposure and signatures of genetic structure using isozyme markers associated with O{sub 3} tolerance were analyzed in {approx}20-, {approx}80-, and >200-yr-old ponderosa (Pinus ponderosa Dougl. ex Laws.) and Jeffrey pine (Pinus jeffreyi Grev. and Balf.) in Sequoia National Park, California. For both species, the number of alleles and genotypes per loci was higher in parental trees relative to saplings. In ponderosa pine, the heterozygosity value increased, and the fixation index indicated reduction of homozygosity with increasing tree age class. The opposite tendencies were observed for Jeffrey pine. Utilizing canopy attributes known to be responsive to O{sub 3} exposure, ponderosa pine was more symptomatic than Jeffrey pine, and saplings were more symptomatic than old growth trees. We suggest that these trends are related to differing sensitivity of the two species to O{sub 3} exposure, and to higher O{sub 3} exposures and drought stress that younger trees may have experienced during germination and establishment. - Genetic variation in isozyme markers associated with ozone tolerance differed between parental trees and their progeny in two closely related species of yellow pine.

Healthy End of Life Project (HELP): a progress report on implementing community guidance on public health palliative care initiatives in Australia.

Science.gov (United States)

Grindrod, Andrea; Rumbold, Bruce

2018-04-01

Contemporary end of life care policies propose increasing community capacity by developing sustainable skills, policies, structures, and resources to support members of a community in caring for each other at the end of life. Public health approaches to palliative care provide strategies to bring this about. Practical implementation can however be ineffective, principally due to failures to grasp the systemic nature of public health interventions, or to ensure that programs are managed and owned by community members, not the professionals who may have introduced them. This article outlines a comprehensive community development project that identifies local end of life needs and meets them through the efficient use of community resources. The project is the product of a three-phase enquiry. The first phase, carried out in a local community, examined carers' experiences of home-based dying, the networks that supported them during care, and broader community networks with the potential to extend care. Data were collected through in-depth research interviews, focus groups and consultation with a community research reference group. Findings were key issues to be targeted by a local community development strategy. In the second phase, these local findings were compared with other practice accounts to identify themes common to many contexts. A public health palliative care framework was then used to produce an evidence-informed community development model for end of life care. The third phase involves implementing and evaluating this model in different Australian contexts. A major theme emerging in phase one of the enquiry was the reluctance of carers to ask for, or even accept, offers of help from family, friends and community networks despite their evident need for support while providing end of life care at home. Others' willingness to provide support was thus hindered by uncertainty about what to offer, and concern about infringing on people's privacy. To develop

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments

Directory of Open Access Journals (Sweden)

Noortgate Nele

2009-12-01

Full Text Available Abstract Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses in Flanders (Belgium. The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%. While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%. More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments.

Science.gov (United States)

D'Haene, Ina; Vander Stichele, Robert H; Pasman, H Roeline W; Noortgate, Nele Van den; Bilsen, Johan; Mortier, Freddy; Deliens, Luc

2009-12-30

The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care

Hybrid life-cycle environmental and cost inventory of sewage sludge treatment and end-use scenarios: a case study from China.

Science.gov (United States)

Murray, Ashley; Horvath, Arpad; Nelson, Kara L

2008-05-01

Sewage sludge management poses environmental, economic, and political challenges for wastewater treatment plants and municipalities around the globe. To facilitate more informed and sustainable decision making, this study used life-cycle inventory (LCI) to expand upon previous process-based LCIs of sewage sludge treatmenttechnologies. Additionally, the study evaluated an array of productive end-use options for treated sewage sludge, such as fertilizer and as an input into construction materials, to determine how the sustainability of traditional manufacturing processes changes with sludge as a replacement for other raw inputs. The inclusion of the life-cycle of necessary inputs (such as lime) used in sludge treatment significantly impacts the sustainability profiles of different treatment and end-use schemes. Overall, anaerobic digestion is generally the optimal treatment technology whereas incineration, particularly if coal-fired, is the most environmentally and economically costly. With respect to sludge end use, offsets are greatest for the use of sludge as fertilizer, but all of the productive uses of sludge can improve the sustainability of conventional manufacturing practices. The results are intended to help inform and guide decisions about sludge handling for existing wastewater treatment plants and those that are still in the planning phase in cities around the world. Although additional factors must be considered when selecting a sludge treatment and end-use scheme, this study highlights how a systems approach to planning can contribute significantly to improving overall environmental sustainability.

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