WorldWideScience

Sample records for terminal care

  1. Settings for Terminal Care.

    Science.gov (United States)

    Corless, Inge B.

    1988-01-01

    Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…

  2. The Ethics of Terminal Care

    Science.gov (United States)

    Agich, George J.

    1978-01-01

    Need for a critical and analytical approach to ethics of terminal care is suggested by considering a series of unexamined questions regarding justification of terminal care. If terminal care is a moral and ethical enterprise, such considerations must be given a more prominent place in discussions of the hospice movement. (Author)

  3. ICU nurses' experiences in providing terminal care.

    Science.gov (United States)

    Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa

    2010-01-01

    At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

  4. Multidisciplinary care of the terminally ill patient.

    Science.gov (United States)

    O'Mahony, S; Coyle, N; Payne, R

    2000-04-01

    This article discusses sedation, the assessment and management of physical symptoms, and symptom-assessment scales for the terminally ill patient. The evaluation of the ability of the family or community to care for a terminally ill patient in pain also is discussed.

  5. The role of physiotherapy in terminal care

    National Research Council Canada - National Science Library

    Przewłocki Sławomir; Ronikier Aleksander

    2016-01-01

    Introduction: Terminal patients require proper care standards and professional team of doctors, physiotherapists, social workers, educators, psychologists and clergy directly involved in mitigating the suffering of a dying person...

  6. [Spiritual care model for terminal cancer patients].

    Science.gov (United States)

    Cheng, Ju-Fen; Lin, Ya-Ching; Huang, Pai-Ho; Wei, Chih-Hsin; Sun, Jia-Ling

    2014-12-01

    Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients.

  7. Evaluation of Care Provided to Terminally Ill Patients.

    Science.gov (United States)

    Loomis, Margaret T.; Williams, T. Franklin

    1983-01-01

    Studied the quality of terminal care in 40 patients in an acute care facility and a chronic care facility. Minimial difficulty was observed in making the transition from active to comfort care. An evaluation method and a model of terminal care emphasizing improved communication and emotional support are proposed. (Author/JAC)

  8. A Guide to Evaluation Research in Terminal Care Programs

    Science.gov (United States)

    Buckingham, Robert W., III; Foley, Susan H.

    1978-01-01

    Pressure for greater accountability is being exerted on programs for care of terminally ill and increasing demand for evaluation research. Components, implications, and limitations of evaluation systems are discussed, and their application in the terminal care setting addressed. Buckingham evaluation of hospice home care service is cited as a…

  9. [Terminal patient home care: the family caregivers perspective].

    Science.gov (United States)

    Oliveira, Stefanie Griebeler; Quintana, Alberto Manuel; Denardin-Budó, Maria de Lourdes; de Moraes, Natália de Andrade; Lüdtke, Manoela Fonseca; Cassel, Paula Argemi

    2012-09-01

    This study was aimed at getting to know the relationships built among patients, family caregivers and the health care team, during home care,from the perspective of the family caregiver It is a qualitative study with 11 family caregivers of terminal patients, registered on a home care service of a university hospital in the South of Brazil. Data collection was carried out through narrative interviews that were recorded transcribed and analyzed through content analysis. Three categories were built from data analysis: relationships among the family caregiver, the patient and the health care team; awareness of the patient's terminal condition. the caregiver's perspective; and situation in which patients are unaware of their terminal condition. They approach how the home care relationships are established among the caregivers, such as health care professionals and family caregivers, and the people who are taken care of such as the patients, highlighting the importance of communication in such care related context.

  10. [Palliative care of patients with terminal obstructive pulmonary disease].

    Science.gov (United States)

    von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E; Larsen, Shuruk Al-Halwai; Taudorf, Ebbe

    2011-10-17

    Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative phase of the disease. Furthermore we discuss the prognostic and ethical challenges for patients, their families and their caregivers. Finally, we summarize the current evidence for palliative treatment of dyspnoea and ways to evaluate response to treatment.

  11. Impact of combined hospice care on terminal cancer patients.

    Science.gov (United States)

    Loke, Song-Seng; Rau, Kung-Ming; Huang, Chih-Fang

    2011-06-01

    Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

  12. Concepts and definitions for "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care": a systematic review.

    Science.gov (United States)

    Hui, David; Nooruddin, Zohra; Didwaniya, Neha; Dev, Rony; De La Cruz, Maxine; Kim, Sun Hyun; Kwon, Jung Hye; Hutchins, Ronald; Liem, Christiana; Bruera, Eduardo

    2014-01-01

    The terms "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care" are commonly used but rarely and inconsistently defined. We conducted a systematic review to examine the concepts and definitions for these terms. We searched MEDLINE, PsycINFO, Embase, and CINAHL for published peer-reviewed articles from 1948 to 2012 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. We also searched 10 dictionaries, four palliative care textbooks, and 13 organization Web sites, including the U.S. Federal Code. One of 16, three of 134, three of 44, two of 93, and four of 17 articles defined or conceptualized actively dying, end of life, terminally ill, terminal care, and transition of care, respectively. Actively dying was defined as "hours or days of survival." We identified two key defining features for end of life, terminally ill, and terminal care: life-limiting disease with irreversible decline and expected survival in terms of months or less. Transition of care was discussed in relation to changes in 1) place of care (e.g., hospital to home), 2) level of professions providing the care (e.g., acute care to hospice), and 3) goals of care (e.g., curative to palliative). Definitions for these five terms were rarely found in dictionaries, textbooks, and organizational Web sites. However, when available, the definitions were generally consistent with the concepts discussed previously. We identified unifying concepts for five commonly used terms in palliative care and developed a preliminary conceptual framework toward building standardized definitions. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  13. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  14. Role of supportive care for terminal stage hepatocellular carcinoma.

    Science.gov (United States)

    Kumar, Manoj; Panda, Dipanjan

    2014-08-01

    Patients with end stage or terminal HCC are those presenting with tumors leading to a very poor Performance Status (ECOG 3-4) or Child-Pugh C patients with tumors beyond the transplantation threshold. Among HCC patients, 15-20% present with end stage or terminal stage HCC. Their median survival is less than 3-4 months. The management of end stage or terminal HCC is only symptomatic and no definitive tumor directed treatment is indicated. Patients with end stage or terminal HCC should receive palliative support including management of pain, nutrition and psychological support. In general, they should not be considered for participating in clinical trials. This review focuses on palliative care of terminal stage HCC.

  15. No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations.

    Science.gov (United States)

    Daly, Bobby; Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F; Hahn, Olwen M; Kline, Justin; Liu, Hongtao; Patel, Bhakti K; Verma, Anshu; Witt, Leah J; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D; Polite, Blase N

    2016-10-01

    Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. This was a retrospective case series of patients cared for in an academic medical center's ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient's electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care.

  16. [NURSING ACTION BEFORE THE TERMINAL PATIENT PHYSICAL CARE].

    Science.gov (United States)

    Delgado Sevilla, David; Juarez Vela, Raúl; Pellicer García, Begoña; Redondo Castán, Luis Carlos; Ramón Arbués, Enrique; López Martín, Inmaculada; De Blas Gómez, Irene; Alburquerque Medina, Eulalia

    2014-11-01

    Palliative care is a group of actions performed by nurses in order to increase the comfort and well-being of patients with terminal illnesses. The World Health Organization (WHO) defines this term as: An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual [1]. Cicely Mary Strode Saunders is considered as the precursor of the palliative care, who explained the need to change the Palliative Care Units in order to improve the quality of life of patients with terminal illnesses. Palliative care is necessary for patients with a terminal illness. In such cases, the life expectancy is less than six months. Human being is considered a biopsychosocial model. For this reason, the nurse must take into account all the requirements arising from these three dimensions of the human being. In this essay, we deal with palliative care in patients with terminal illnesses, considering the role of the nurse as an important reference when teaching palliative care to the main carer.

  17. [Medical care support intervention to the patient and family who has chosen a terminal care at home - an influence of satisfactory experience on the culture of terminal care].

    Science.gov (United States)

    Sugimoto, Kaoru; Ishikawa, Mariko; Kouketsu, Nobuko; Ozaki, Mitsuyo; Tomita, Ikue; Hong, Youngjae; Miura, Hisayuki; Nishikawa, Mitsunori; Yokoe, Yuriko; Nakashima, Kazumitsu

    2010-12-01

    The National Center for Geriatrics and Gerontology in Japan implemented a home medical care support system for aged patients in April 2009. In this study, we report a case of terminal care system where a medical care intervention was carried out by a close coordination of visiting nurses and other staffs with a "at-home terminal care" brochure on hand, and we discussed how this system was brought forward satisfactory and how it affected this culture.

  18. [Palliative care: communication as a strategy of care for the terminal patient].

    Science.gov (United States)

    de Andrade, Cristiani Garrido; da Costa, Solange Fátima Geraldo; Lopes, Maria Emília Limeira

    2013-09-01

    Palliative care involves an approach in the field of care for terminal patients and their families that seeks to assure them better quality of life by establishing good communication. The scope of this study was to verify how nurses use communication in the field of palliative care when assisting patients in the terminal phase. This is exploratory research of a qualitative nature in which 28 nurses working in wards of a hospital in the city of Joao Pessoa in the State of Paraíba participated in the period from August to October 2012. A form was used for data collection that was then analyzed using the content analysis technique. Three categories emerged from the analysis of the material: "palliative care and communication - interpersonal relationship between the nurse and the terminal patient"; "communication in palliative care as a strategy for strengthening the bond between the nurse and the terminal patient"; and "the importance of communication between the nurse and the family of the terminal patient under palliative care." The conclusion reached was that communication is seen to be an effective element of care for the patient in the terminal phase and it is extremely important for the promotion of palliative care.

  19. Spanish nurses' preparedness to care for hospitalised terminally ill patients and their daily approach to caring.

    Science.gov (United States)

    Arantzamendi, Maria; Addington-Hall, Julia; Saracibar, Maribel; Richardson, Alison

    2012-12-01

    To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives. Stage 2 was a regional survey (65% response rate) concerned with hospital nurses' opinions of caring for terminally ill patients and their perceived competence. The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided with an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. There is a need for an integrative approach in Spain that combines an educational programme with a supportive environment, focusing on developing nurses' competence to deliver emotional care and deal with their own feelings. Promoting a supportive environment might enable nurses to change their behaviour when caring for terminally ill patients and deal with patients' emotional as well as physical needs.

  20. Aspectos éticos de la fase terminal Ethical aspects of terminal phase care

    Directory of Open Access Journals (Sweden)

    Oscar Velásquez

    1993-02-01

    Full Text Available

    Partiendo de una definición de la ética en general, de la ética médica y de la bioética, el autor discute estos conceptos en cuanto se relacionan con la atención del paciente en fase terminal, así como los temas de la muerte, el sufrimiento y los sentimientos que despierta el saberse moribundo. Hace énfasis en las relaciones médico-paciente y médico-familla y en los valores éticos de la igualdad y la reciprocidad. Plantea cómo a menudo el médico carece de una actitud correcta frente al paciente terminal y propone guías para el trabajo médico en tales circunstancias. Destaca la necesidad de respetar en todo momento la autonomía y la dignidad del enfermo y de saber usar con sabiduría los recursos tecnológicos disponibles.

     

    The author starts with definitions of ethics, medical ethics and bioethics and discusses their relationship with terminal patient care; also discussed are the subjects of death, suffering and the feelings that appear with the selfawareness of being near-death. Emphasis Is given on both patient-physician and family-physician relationships and on the values of equality and reciprocity. Guidelines are proposed for the approach and medical care of terminal patients and their families; they deal mainly with the need to respect autonomy and dignity and with the wise use of technological advances presently available.

     

  1. Health Care Providers and Dying Patients: Critical Issues in Terminal Care.

    Science.gov (United States)

    Benoliel, Jeanne Quint

    1988-01-01

    Identifies three major areas of concern in relationship between health care providers and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…

  2. [Management of infections in palliative and terminal cancer care].

    Science.gov (United States)

    Sochor, M

    2013-01-01

    Patients with cancer are highly susceptible to infections. There is a lack of evidencebased guidelines or protocols for their management in palliative and endoflife care. To define an optimal dia-gnostic approach and therapeutic management of infections in patients with palliative and terminal cancer care. Along with thromboembolic disease and cancer progression, infections are the most frequent causes of death in oncology. Besides the impact on mortality, they are accompanied with a myriad of symptoms decreasing the quality of life. High incidence of infectons is due to a malignancy itself, the oncolgical therapy and host factors. There is a lack of evidencebased guidelines and protocols for the therapy of infections in palliative and terminal cancer care. Most of available studies are retrospective in nature, with diverse methods and cohorts. Incidence of infections in these patient oscillates between 16- 55% in specialized palliative units, and rises up to 83% in acute care hospitals. From the epidemiologic viewpoint, urinary (39- 42%) and respiratory infections (22- 36%) are the most frequent cases, followed by soft tissue and skin infections (6- 12%) and bacteremias (5- 14%). At present, the antibio-tic treatment does not seem to have a positive impact on the survival rate. Symptom control antibio-tic therapy as a means of symptom control still remains controversial, since it meets this purpose only in a few percents of studies. The most successful is the symtom control in urinary tract infections (60- 79%), in contrast to other sites of infection (30- 43%). In the last week of life there the symptom control is achieved only in 10% of patient. One should always consider the prognosis, actual preformance status and patients preferences when it comes to the management of dia-gnostics and therapy of infections. If the prognosis counts in weeks or months the dia-gnostics and therapy should not differ from the approach to any other oncological patient

  3. Palliative care for the terminal heart failure patient.

    Science.gov (United States)

    Beard, Walter L; Long, R Craig; Geraci, Stephen A

    2014-01-01

    Heart failure is a chronic disease afflicting millions of patients worldwide. Advances in treatment have allowed sufferers to enjoy overall prolonged survival and enhanced quality of life. Yet, a consequence of these therapeutic successes is that more patients survive to end-stage disease, with severe symptoms, poor quality of life, and no options available to prolong their survival reasonably. End-stage heart failure patients require a comprehensive palliative approach to care during their final months, with treatment goals focusing on symptom relief. Often, specific heart failure therapies can further this cause and should be administered when appropriate to alleviate specific symptoms, while other general palliative measures should also be considered as with other terminal patients. End-of-life palliative strategies must conform to accepted principles of ethical care. Constant communication with patients and families is essential to achieve best treatment goals for this growing segment of the population.

  4. Caring for families of the terminally ill in Malaysia from palliative care nurses' perspectives.

    Science.gov (United States)

    Namasivayam, Pathma; Lee, Susan; O'Connor, Margaret; Barnett, Tony

    2014-01-01

    To describe the process that nurses experienced in engaging with families in Malaysian palliative care settings and the challenges they faced. In palliative care settings, nurses and the terminally ill person's family members interact very closely with each other. It is important for nurses to work with families to ensure that the care of the terminally ill person is optimised. A qualitative design using grounded theory methods was used to describe how nurses engaged with families and the challenges they faced. Twenty-two nurses from home care and inpatient palliative care settings across Malaysia participated in this study. Data were collected through seven interviews and eight focus group discussions conducted between 2007-2009. The main problem identified by nurses was the different expectations to patient care with families. The participants used the core process of Engaging with families to resolve these differences and implemented strategies described as Preparing families for palliative care, Modifying care and Staying engaged to promote greater consistency and quality of care. When participants were able to resolve their different expectations with families, these resulted in positive outcomes, described as Harmony. However, negative outcomes of participants not being able to resolve their different expectations with families were Disharmony. This study highlights the importance of engaging and supporting families of the terminally ill as well as providing a guide that may be used by nurses and carers to better respond to families' needs and concerns. The study draws attention to the need for formal palliative care education, inclusive of family care, to enable nurses to provide the terminally ill person and their family effective and appropriate care. © 2013 John Wiley & Sons Ltd.

  5. Care to terminal patients. Perception of nurses from the intensive care unit of a hospital.

    Science.gov (United States)

    Mussolin Tamaki, Camila; Meneguin, Silmara; Aguiar Alencar, Rubia; Bronzatto Luppi, Claudia Helena

    2014-01-01

    To identify the perception of nurses with regard to the process of providing care to patients in the context of hospice care. Qualitative study using the methodological framework Collective Subject Discourse. A total of 18 nursing professionals of the adult intensive care unit of a public hospital in São Paulo, Brazil were interviewed between June and August 2012. The process of providing care to terminal patients is permeated by negative, conflictive and mixed feelings. As regards communication, while the participants acknowledge its importance as a therapeutic resource, they also admit a lack of professional qualification. The interviewees have difficulties to deal with care provided to terminal patients. The qualification of these professionals needs to be improved, starting in the undergraduate program.

  6. Attitudes about Death, Dying, and Terminal Care: Differences among Groups at a University Teaching Hospital.

    Science.gov (United States)

    Hatfield, C. B.; And Others

    1983-01-01

    Studied attitudes of eight hospital groups on several aspects of terminal care by means of a questionnaire. Responses of the groups, which included physicians, residents, nurses, aides, and orderlies, did not differ on general statements about terminal care. On more specific statements perception of personal involvement influenced responses.…

  7. Palliative care for terminally ill patients in the Netherlands: Dutch government policy.

    NARCIS (Netherlands)

    Francke, A.L.

    2003-01-01

    There is a broad range of palliative care available in the Netherlands. There are many options for obtaining palliative care at home. The care that terminally ill patients need can also be provided in nursing homes, care homes, hospitals and hospices. Government policy in this field is one of the

  8. Hospice offers more palliative care but costs less than usual care for terminal geriatric hepatocellular carcinoma patients: a nationwide study.

    Science.gov (United States)

    Hwang, Shinn-Jang; Chang, Hsiao-Ting; Hwang, I-Hsuan; Wu, Chen-Yi; Yang, Wang-Hsuan; Li, Chung-Pin

    2013-07-01

    Hospice care is important for patients with terminal hepatocellular carcinoma (HCC), especially in endemic areas of viral hepatitis. Differences between hospice care and usual care for geriatric HCC inpatients have not yet been explored in a nationwide survey. The study's purpose was to analyze differences between hospice care and usual care for geriatric HCC inpatients in a nationwide survey. This nationwide, population-based study used data obtained from the Taiwan National Health Insurance Database. Patients with terminal HCC who were ≥65 years old and received their end-of-life care in the hospital between January 2001 and December 2004 were recruited. The comparison group was selected by propensity score matching from patients receiving usual care in acute wards. We enrolled 729 terminal HCC patients receiving inpatient hospice care and 729 matched controls selected from 2482 HCC patients receiving usual care. Hospice care patients were treated mainly by family medicine doctors (36%) and oncologists (26%), while usual care patients were treated mainly by gastroenterologists (60.2%). The natural opium alkaloids were used more in the hospice care group than in the usual care group (72.7% versus 25.5%, Pcare group. HCC patients in hospice wards received more narcotic palliative care, underwent fewer aggressive procedures, and incurred lower costs than those in acute wards. Hospice care should be promoted as a viable option for terminally ill, elderly HCC patients.

  9. Pediatric Critical Care Transport as a Conduit to Terminal Extubation at Home: A Case Series.

    Science.gov (United States)

    Noje, Corina; Bernier, Meghan L; Costabile, Philomena M; Klein, Bruce L; Kudchadkar, Sapna R

    2017-01-01

    To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation. We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014. All cases were identified from our institutional pediatric transport database. Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes. Patients underwent palliative care transport home for terminal extubation. The rate of palliative care transports home for terminal extubation during the study period was 2.6 per 100 deaths. The patients were 7 months, 6 years, and 18 years old and had complex chronic conditions. The transfer process was protocolized. The families were approached by the PICU staff during multidisciplinary goals-of-care meetings. Parental expectations were clarified, and home hospice care was arranged pretransfer. All transports were performed by our pediatric critical care transport team, and all terminal extubations were performed by physicians. All patients had unstable medical conditions and urgent needs for transport to comply with the families' wishes for withdrawal of life support and death at home. As such, all three cases presented similar logistic challenges, including establishing do-not-resuscitate status pretransport, having limited time to organize the transport, and coordinating home palliative care services with available community resources. Although a relatively infrequent practice in pediatric critical care, transport home for terminal extubation represents a feasible alternative for families seeking out-of-hospital end-of-life care for their critically ill technology-dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports to include patient screening tools

  10. [Medical ethics in terminal stage viewed from emergency and critical care in Japan].

    Science.gov (United States)

    Aruga, Tohru

    2011-04-01

    In Japan, several types of the proposal for terminal care have been published by Medical Association, Ministry of Health, Labor and Welfare, etc. Among them, the guidelines proposed by Japanese Association for Acute Medicine (JAAM) are appreciated as most concretely expressed ethically as well as practically regarding the judgment of terminal stages, the medical ethics needed through the processes thereafter and the methods on withdrawal or withholding in terminal care. The author explained and considered the terminal care provided by medical professionals for the absolutely desperate including the brain dead following post-cardiac arrest syndrome for instance, according to the guidelines by JAAM. The best practice selected for the terminally ill ought to be reasonable and suitable from the aspects of both medical science and ethics.

  11. International Work Group in Death, Dying and Bereavement: Assumptions and Principles Underlying Standards for Terminal Care.

    Science.gov (United States)

    Essence: Issues in the Study of Ageing, Dying, and Death, 1979

    1979-01-01

    States the general assumptions and principles underlying standards for terminal care for those who have initiated or are planning programs for the terminally ill. These are urgently needed in view of the rapid development of the hospice movement. Patient-oriented, family-oriented, and staff-oriented standards are also enumerated. (BEF)

  12. Positive effects of experience in terminal care on nursing home staff in Japan.

    Science.gov (United States)

    Abe, Koji; Ohashi, Akira

    2011-09-01

    This study aimed to examine the psychological effects of terminal care experience on nursing home staff and analyze the differences between staff who are experienced and those who are inexperienced in providing terminal care. A mailed survey was conducted in 2007. A total of 37% (N = 72) of the participants had experience in terminal care in nursing homes. Analysis of variance (ANOVA) revealed that the professional efficacy (a subscale of the Maslach Burnout Inventory-General Survey [MBI-GS]) and tenure (duration of service) of the experienced staff were significantly higher than those of the inexperienced staff. The high professional efficacy noted among the experienced staff suggests that the provision of terminal care in nursing homes does not necessarily lead to burnout among caregivers and may in fact serve as an important motivational factor.

  13. What Proportion of Terminally Ill and Dying People Require Specialist Palliative Care Services?

    Directory of Open Access Journals (Sweden)

    Donna M. Wilson

    2014-01-01

    Full Text Available Currently, around 55 million people die each year worldwide. That number is expected to increase rapidly with accelerating population aging. Despite growth in the number of palliative care specialists and specialist services in most countries, the prospect of an increasing number of terminally ill and dying persons is daunting. This paper attempts to answer the question: what proportion of terminally ill and dying persons require specialist palliative care services? To address this question and highlight which persons require specialist palliative care, the current state of access to specialist palliative care services and specialists in Canada and other countries is highlighted, along with available evidence-based information on specialist services utilization and the care needs of terminally ill and dying persons. Current evidence and information gaps reveal that this question cannot be answered now, but it should be answered in advance of a crisis of unmet end-of-life care needs with the rising death toll.

  14. Knowledge and attitudes toward palliative terminal cancer care among Thai generalists.

    Science.gov (United States)

    Budkaew, Jiratha; Chumworathayi, Bandit

    2013-01-01

    Our objective was to determine the knowledge and attitudes of Thai generalists (general physicians) toward palliative terminal cancer care (PC) in a primary care setting. We performed a cross-sectional descriptive survey using a self-administered questionnaire. The total number of completed and returned questionnaires was 63, giving a 56% response rate. Data analysis was based on these (Cronbach's alpha=0.82) and percentages and mean values were assessed using the Fisher's exact test to determine the correlation of variables. Overall, attitude and knowledge levels were slightly satisfactory. Results indicated that general physicians had moderate scores in both attitudes (84.1%) and knowledge (55.7%) regarding palliative terminal cancer care. However, they had insufficient knowledge regarding truth telling, pain control and management with morphine, emergency management in terminal cancer care and treatment of fluid intake in terminal stages. Attitude and knowledge scores were statistically correlated (p=0.036). Knowledge scores were further positively associated with being taught palliative care in their medical curriculum (p=0.042). Formal education in palliative care and development of palliative care services are very much needed in Thailand to provide holistic care to terminally ill patients.

  15. Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study.

    Science.gov (United States)

    Yun, Young Ho; Lee, Myung Kyung; Kim, Seon Young; Lee, Woo Jin; Jung, Kyung Hae; Do, Young Rok; Kim, Samyong; Heo, Dae Seog; Choi, Jong Soo; Park, Sang Yoon; Jeong, Hyun Sik; Kang, Jung Hun; Kim, Si-Young; Ro, Jungsil; Lee, Jung Lim; Park, Sook Ryun; Park, Sohee

    2011-06-20

    We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosis and use of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise. In this prospective cohort study at 11 university hospitals and the National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollment and assessed how their survival was affected by the disclosure of terminal illness and administration of palliative care or nonuse of the ICU. In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months, and 17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05) and poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival. Patients' being aware that they are dying and entering a palliative care facility or ICU does not seem to influence patients' survival.

  16. Respiratory Therapists' Experiences and Attitudes Regarding Terminal Extubations and End-of-Life Care.

    Science.gov (United States)

    Grandhige, Anjali P; Timmer, Marjorie; O'Neill, Michael J; Binney, Zachary O; Quest, Tammie E

    2016-07-01

    Respiratory therapists (RTs) routinely care for patients with life-limiting illnesses and in some hospitals are responsible for terminal extubations. Data on how such experiences affect RTs are scarce. The objective of this work was to survey RTs at 2 academic medical centers about their experiences caring for patients with terminal extubations. An online survey was distributed to the hospitals' RTs. Survey data included demographics and experiences with end-of-life care and terminal extubations. The survey was derived from previously published questionnaires plus input from hospital RT leaders. Sixty-five of 173 RTs (37.6%) responded. Of these, 42.4% were ≥50 y old, and 62.7% were female. 20.3% had ≤5 y experience; 52.5% had ≥16 y. 93.8% self-reported being involved in at least one terminal extubation; of those, 36.1% reported performing ≥20. Nearly half (47.5%) wanted to be involved in family meetings discussing terminal extubations, but just 6.6% were frequently involved. Only 32.3% felt that they received adequate education regarding terminal illness in RT school; 32.3% reported gathering this knowledge while working. 60.0% wanted more formal education around terminal patient care. 27.9% reported sometimes being uncomfortable with performing a terminal extubation; most of these rarely felt that they had the option not to perform the extubation. RTs are rarely involved in end-of-life discussions despite a desire to be, and they experience situations that generate discomfort. There is demand for more formal RT training around care for terminal patients. Clinical protocols that involve RTs in meetings before ventilator withdrawal should be considered. Copyright © 2016 by Daedalus Enterprises.

  17. Aspectos éticos de la fase terminal Ethical aspects of terminal phase care

    OpenAIRE

    Oscar Velásquez

    1993-01-01

    Partiendo de una definición de la ética en general, de la ética médica y de la bioética, el autor discute estos conceptos en cuanto se relacionan con la atención del paciente en fase terminal, así como los temas de la muerte, el sufrimiento y los sentimientos que despierta el saberse moribundo. Hace énfasis en las relaciones médico-paciente y médico-familla y en los valores éticos de la igualdad y la reciprocida...

  18. Association between the duration of palliative care service and survival in terminal cancer patients.

    Science.gov (United States)

    Lee, Yong Joo; Yang, Jung-Hwa; Lee, Jung-Wook; Yoon, Johi; Nah, Jung-Ran; Choi, Whan-Seok; Kim, Chul-Min

    2015-04-01

    Preliminary studies of early palliative care showed improved quality of life, less medical cost, and better survival time. But, most terminal cancer patients tend to be referred to palliative care late. For the proper care of terminal cancer patients, it is necessary to refer to hospice and palliative care timely. The aim of this study is to analyze the effect of the duration of palliative care services on the survival in terminal cancer patients. We reviewed 609 patients who had died from terminal cancer between January 2010 and December 2012. We analyzed correlations of age, first Palliative Performance Scale (PPS) level, duration of palliative care service, and survival time. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Duration of palliative care services was significantly correlated with survival time. In univariate Cox regression analysis, age, and each group of duration of palliative care service showed significant associations with survival. Final multivariate Cox regression model retained four parameters as independent prognostic factors for survival (age HR = 0.99 (p = 0.002), 1∼10 days HR = 2.64 (p care services showed poor prognostic factor. Timely referral system from the end of chemotherapy is warranted.

  19. [Terminal care for elderly patients with dementia in two long-term care hospitals].

    Science.gov (United States)

    Hirakawa, Yoshihisa; Masuda, Yuichiro; Kimata, Takaya; Uemura, Kazumasa; Kuzuya, Masafumi; Iguchi, Akihisa

    2004-01-01

    A byproduct of the aging of the population has been a dramatic rise in patients with dementia. The aim of the present study is to clarify the use of aggressive and palliative treatments, artificial nutrition and sedation in long-term care hospitals in Japan. We assessed 123 deaths in people aged 65 and older who died in two long-term care hospitals in and around Nagoya from January 2001 to December 2002. All deceased were divided into two groups according to their diagnosis of dementia. Data on the particular characteristics of the deceased, diagnosis of dementia, aggressive treatments (including CPR, intubation, mechanical ventilation, the use of systemic antibiotics and blood transfusion), palliative treatments (including oxygen, narcotic and nonnarcotic pain medication) artificial nutrition (including hyperalimentation and tube feeding) and sedation during the last six months of their lives were collected from medical charts. The prevalence of aggressive and palliative interventions did not vary significantly with the diagnosis of dementia except for the use of vasopressors. Artificial nutrition was prevalent and few patients received sedatives in either group. Patients with and without dementia received similar treatments in the end-stage. A greater understanding of the course of dementia is needed to further discussions on the terminal care of people with dementia. A national consensus on how to treat end-stage demented patients is also needed.

  20. Dehydration in terminally ill patients. Is it appropriate palliative care?

    Science.gov (United States)

    Andrews, M; Bell, E R; Smith, S A; Tischler, J F; Veglia, J M

    1993-01-01

    Technological advances in artificial feeding and intravenous hydration play an important role in preserving life and facilitating patient recovery. In terminally ill patients, however, many hospice workers have observed that discontinuing artificial nutrition and hydration is more beneficial. This article presents three case reports from a hospice setting that demonstrate the palliative benefits of dehydration. The authors discuss possible physiologic explanations for observed dehydration-related phenomena and offer guidelines for determining when it is appropriate to decrease or discontinue nutritional support and hydration by artificial means.

  1. Integrated Care for the Terminally Ill: Variations in the Utilization of Formal Services.

    Science.gov (United States)

    Meyers, Allan R.; And Others

    1983-01-01

    A review of 85 patients who received home care for terminal illness showed that a small proportion of patients use a relatively high volume of both in-patient and home care services. Data suggest that there are two dimensions of service utilization: a medical dimension and a social dimension. (Author/RC)

  2. Care to the person in a terminal process in the perception of the nursing students

    Directory of Open Access Journals (Sweden)

    Rudval Souza da Silva

    2015-07-01

    Full Text Available Objective: to know the experiences of the nursing students regarding the care to the person in a terminal process. Methods: a qualitative study with data collected through semi-structured interviews held with ten nursing students. Results: from the data analysis, two theme categories emerged: Feelings expressed facing the first contact with the patients in a terminal process and care to the patient in a terminal process: dichotomy between theory and practice. When experiencing the care to the person in the dying process, students have shown that the feeling of helplessness was the most striking, among others such as sadness, anguish and insecurity. Conclusion: the practices of care of the nursing team disagree with the academic discussions, denying the discourse that the nurse should be present with the patient, regardless of his clinical condition.

  3. [Confirmation of intention by signature regarding terminal care treatment in elderly people].

    Science.gov (United States)

    Sato, Takeshi; Sato, Kazunori; Sato, Akira

    2011-01-01

    In Japan, it is rare for patients to confirm their intentions regarding terminal care treatment in hospital by signature. To maintain respect for the autonomy of elderly patients, we encouraged confirmation by signature regarding terminal care treatment in elderly patients, after repeated discussions. The purpose of this study was to clarify the status of confirmation of intention by signature. The subjects were 98 patients who signed documents signaling their intention regarding terminal care (signature group), and 165 patients who did not sign such documents (non-signature group), all of whom died in our hospital between April 2009 and March 2010. We surveyed and examined their backgrounds and treatment experiences based on the clinical records. Furthermore, we gave a questionnaire survey to these patients. A total of 31 (35.2%) patients from the signature group and 58 (35.2%) patients from the non-signature group responded. In the signature group 32 (32.7%) patients judged to be in a terminal state were discharged alive. Those in the signature group had a significantly higher age, higher ratio of dementia, lower activity level in their daily life and were hospitalized with respiratory illnesses. In addition, the frequency of the informed consent discussions was greater than that of the non-signature group. A total of 90% of the signature group was able to accept the confirmation of their intention regarding terminal care by signature. In both groups, the doctors' explanations were understood, and the patients' wishes were successfully conveyed. In Japan, confirmation of intention regarding terminal care by signature can be effective and useful as one of the methods to determine intention regarding terminal care treatment in elderly patients.

  4. Palliative and terminal care at home as portrayed in Dutch newspapers in 2009 compared to 2000.

    Science.gov (United States)

    Van den Berg, Rianne; Eliel, Miriam R; Meijman, Frans J

    2011-03-01

    Terminal care at home is receiving increased attention from the Dutch media, which is relevant for primary care providers. To explore the portrayal of terminal care at home in newspapers in the Netherlands in 2000 and in 2009. We performed a systematic analysis of documents retrieved from the LexisNexis Academic NL database. We compared data regarding the 'point of reference' (or 'frame') and the 'moral judgments' in articles appearing in the first six months of 2009 to the same period in 2000. In the year 2000, the framing of articles in regional newspapers appeared to be predominantly consumer-oriented (66%) and in national newspapers predominantly contextual (63%). The moral judgment in the regional articles was predominantly positive (66%), in the national newspapers predominantly negative (58%). In 2009, articles in regional and national newspapers were categorized mainly as consumer-oriented (73% and 55%, respectively), and new themes appeared, i.e. self care and medical topics. For moral judgment, again regional articles were mainly positive (76%) and national articles were mainly negative (39%) and neutral (31%). Regarding the theme 'terminal care at home' as published in Dutch newspapers in 2009 as compared to 2000, the diversity of the framing was more prominent and over all moral judgments were more positive, particularly in regional newspapers. Health care providers should realize that the portrayal of palliative and terminal care at home may differ depending on the type of newspaper--regional or national.

  5. Comparison of medical expenditure according to types of hospice care in patients with terminal cancer.

    Science.gov (United States)

    Lim, Taekyu; Nam, Seung-Hyun; Kim, Mi Sun; Yoon, Kyung Sook; Kim, Bong-Seog

    2013-02-01

    Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to nonhospice patients are difficult to make. Several studies demonstrated that palliative hospice care reduced medical expenditure in terminally ill patients compared with that of nonhospice care. Patients with terminal cancer who were registered in Hospice Care Program (HCP) by the written consent and died during same admission period in Seoul Veterans Hospital, Seoul, Korea, between January 2009 and December 2009 were included. We compared medical expenditure according to the ward type (hospice ward and general ward) in patients who received palliative hospice care in Seoul Veterans Hospital, Korea. The daily total average expenditure for each inpatient was 193 930 and 266 161 in the hospice and general ward, respectively (P = .001). Daily expenditure of parenteral nutrition and laboratory blood tests/X-ray was also significantly lower in hospice ward compared with general ward (P = .002 and P = .006), respectively; 12 (17%) of 72 patients had been admitted in the intensive care unit during hospice care period in general ward (P = .014); 1 (3%) of 32 patients received blood products in hospice ward, but 13 (18%) patients received blood products in general ward during palliative hospice care (P = .039). Hospice ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminally ill patients with cancer.

  6. Caring for terminal AIDS patients: The experiences of caregivers in ...

    African Journals Online (AJOL)

    Caregivers experienced caring for patients as fulfi lling and meaningful to them despite the sadness of death and dying. The participants face the death of their patients daily, from a disease that causes untold suffering to the patients, family members and to the caregivers themselves, who wish they could prevent the anguish ...

  7. Powerlessness in Terminal Care of Demented Patients: An Exploratory Study.

    Science.gov (United States)

    Akerlund, Britt Mari; Norberg, Astrid

    1990-01-01

    Interviewed five caregiving nursing staff members involved in dementia care concerning their ambivalent feelings toward spoon-feeding a severely demented patient. Although tube-feeding was regarded as an easier way to provide nourishment, spoon-feeding was preferred because it provided more human contact and love. (Author/NB)

  8. [A consideration of the support for terminal care at the private skilled nursing home].

    Science.gov (United States)

    Arao, Yuki; Sasabe, Mayako; Yamada, Yukari; Motoyama, Yuki; Morita, Katsuko; Kawazoe, Masahiro; Ono, Yoshiharu

    2009-12-01

    The increase in the number of residents in elderly care facilities has developed into a growing demand for home-based terminal care rather than treatments at medical institutions. Like many others, the Active Life Toyonaka (private skilled nursing home) has received more requests from its residents for adequate terminal care. It is unfortunate, however, that quite a few residents are obliged to be hospitalized for medical reasons that result in death. The purpose of our study is to determine what a terminal care should be like in a private skilled nursing home. The study has been conducted with the focuse on the successful case of a 90-year-old male resident diagnosed as having prostate cancer with bone metastasis. Our study has concluded that the crucial factors for a better terminal care should go as follows: (1) Having good coordination with medical institutions, (2) Reporting every change in residents' condition and administering an immediate treatment for alleviating pains of the residents, (3) Providing the residents with comfortable life of less restraint on activities in home-based care, (4) Sharing the same information among the staff of all divisions who is in charge of residents (doctors, nurses, caregivers, etc.) and (5) Establishing relationships of mutual trust with residents and their families. Nurses, especially, need to play important roles as coordinators among all the personnel concerned.

  9. The Palliative Care Information Act and Access to Palliative Care in Terminally ill Patients: A Retrospective Study.

    Science.gov (United States)

    Victoria, Kitty; Patel, Sarita

    2016-01-01

    Studies have shown that over 50% of end-of-life discussions take place for the first time in the hospital and that terminally ill patients often have unrealistic views regarding the possible scope of treatment. The Palliative Care information Act (PCIA) was passed in an attempt to address the lack of access for terminally ill patients to palliative care services. A multi-database systematic review was performed on published studies from 2010 to present, and there were none found measuring the effectiveness of the PCIA. We aimed to study the effect of the PCIA on access to palliative care services. We conducted a retrospective chart review of all terminally ill patients who died at Kingsbrook Jewish Medical Center from January 2010 to August 2013 in relation to passing of the PCIA. Prelaw (prior to the law passing), 12.3% of the terminal patients received palliative care consults, 25% during the transition period (time between passing of law and when it came into effect) and 37.7% postlaw (after coming into effect) (P access to palliative care services and can change the culture of a hospital to be more pro-palliative for the appropriate populations.

  10. Nurses' narratives on termination of primary nursing relationship with parents in neonatal intensive care.

    Science.gov (United States)

    Korhonen, Anne; Kangasniemi, Mari

    2014-12-01

    Primary nursing working model in the neonatal intensive care unit enables a long-lasting caring relationship with the infants and their parents. Terminating this kind of relationship is seldom discussed. The aim of the study was to describe nurses' experiences of terminating the primary nursing relationship with the parents in neonatal intensive care. Qualitative design using narrative method was used because there is a little knowledge relating to the topic. The data were collected with active interviews and analysed with narrative analysis. Seven nurses with experience of neonatal intensive care and primary nursing were recruited by convenience sampling. The approval was granted according to the hospital guidelines. The results gave rise to the three narratives that described the relationship between the primary nurse and the parents as the nursing relationship ends. All narratives shared a common plot, 'regulation of the closeness on nursing relationship', but it was manifested in different ways in each narrative. The plot in the narratives changed on a closeness-distance axis according to how the primary nurse regulated the nursing relationship and its termination. In the first narrative, the regulation of the relationship promoted distance, in the second connection and in the third closeness and connection. The long-lasting nature of the primary nursing working model may allow different caring relationships which will be revealed in terminating phase of care. This phenomenon is poorly recognised. It is important to study the caring relationship between the primary nurse and the parents of a hospitalised child, because the caring relationship is the core of nursing and needs to be considered in research and supported in practice. © 2013 Nordic College of Caring Science.

  11. Needs of labor and delivery nurses caring for women undergoing pregnancy termination.

    Science.gov (United States)

    Parker, Alyson; Swanson, Hilary; Frunchak, Valerie

    2014-01-01

    To explore the psychosocial, educational, and administrative support needs of labor and delivery (L&D) nurses who care for women undergoing pregnancy termination. A qualitative, descriptive design. This study was conducted on a L&D unit at a large, university-affiliated hospital in Quebec, Canada. A convenience sample of 10 L&D nurses participated in this study. Ages of participants ranged from 25 to 55 years, and experience on the unit ranged from 1 to 30 years. One-time, face-to-face interviews were conducted with each participant. Audio-recorded interviews were transcribed verbatim and analyzed using inductive content analysis. Participants valued interpersonal support from nurse colleagues and guidance from experienced nurses in managing the emotional aspect of this care. They raised concerns about the effect of nursing workload and patient-to-nurse ratios on patient care. Nurses noted a desire for knowledge and skill-building through access to evidence-based literature, continuing education sessions, and workshops. They also expressed a need for more information regarding the genetic counseling process and community resources available to women undergoing pregnancy termination. Ensuring continuity of care through knowledge sharing related to genetic counseling and community resources creates the context for holistic patient care. Increased attention to the particular needs of L&D nurses providing care to women undergoing termination may enhance the quality and safety of care for this unique population. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  12. Communicating a terminal prognosis in a palliative care setting: deficiencies in current communication training protocols.

    Science.gov (United States)

    Wittenberg-Lyles, Elaine M; Goldsmith, Joy; Sanchez-Reilly, Sandra; Ragan, Sandra L

    2008-06-01

    The goal of this study was to understand the use and effectiveness of current communication protocols in terminal prognosis disclosures. Data were gathered from an interdisciplinary palliative care consultation service team at a Veterans Hospital in Texas, USA. Medical communication guidelines, a consistent component in United States palliative care education, propose models for delivery of bad news. However, there is little empirical evidence that demonstrates the effectiveness of these guidelines in disclosures of a terminal prognosis. Based on ethnographic observations of terminal prognosis meetings with dying patients, palliative care team meetings, and semi-structured interviews with palliative care team practitioners, this study notes the contradictory conceptualizations of current bad news communication guidelines and highlights that communicating a terminal prognosis also includes (1) adaptive communication based on the patient's acceptability, (2) team based/family communication as opposed to physician-patient dyadic communication, and (3) diffusion of topic through repetition and definition as opposed to singularity of topic. We conclude that environmentally based revision to communication protocol and practice in medical school training is imperative.

  13. Terminal patients' awareness of impending death: the impact upon requesting adequate care.

    NARCIS (Netherlands)

    Francke, A.L.; Willems, D.L.

    2005-01-01

    In this qualitative study, 19 Dutch terminal patients and 23 relatives of deceased patients were interviewed. The interviews revealed that a timely request for care and anticipation of "what was going to happen" was determined by the degree to which patients and their relatives realize that the end

  14. Terminal patients' awareness of impending death: the impact upon requesting adequate care

    NARCIS (Netherlands)

    Francke, Anneke L.; Willems, Dick L.

    2005-01-01

    In this qualitative study, 19 Dutch terminal patients and 23 relatives of deceased patients were interviewed. The interviews revealed that a timely request for care and anticipation of "what was going to happen" was determined by the degree to which patients and their relatives realize that the end

  15. The Role of a Training Protocol in Formulating Patient Instructions as to Terminal Care Choices

    Science.gov (United States)

    Bursztajn, Harold

    1977-01-01

    The author proposes the training of physicians in the use of a protocol to help a patient draw up a Living Will. The successful use of such a training protocol could begin to meet the existing need for a more structured education in the care of the terminally ill and to minimize uncertainty by achieving standards of uniformity in this aspect of…

  16. Death Anxiety, Disclosure Behaviors, and Attitudes of Oncologists toward Terminal Care.

    Science.gov (United States)

    Cochrane, Joyce B.; And Others

    1991-01-01

    Examined relationships among death anxiety, disclosure behaviors, and attitudes toward terminal care of 99 oncologists. Found death anxiety scores lower for oncologists than typically reported for physicians. Short-term repeated exposure to dying patients resulted in comfort with dying patients whereas long-term repeated exposure resulted in…

  17. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

    OpenAIRE

    de Graaff Fuusje M; Francke Anneke L

    2009-01-01

    Abstract Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care for terminally ill Turkish and Moroccan migrants and their families in the Netherlands. Methods Questionnaires were sent to home care organizations and GPs working in areas where most of t...

  18. Palliative care services for Indian migrants in Australia: Experiences of the family of terminally Ill patients

    Directory of Open Access Journals (Sweden)

    Sujatha Shanmugasundaram

    2009-01-01

    Full Text Available Background: The way that health care systems in developing countries like India care for dying patients, has an impact on the expectations of such care for those who migrate to other countries faces. At the end of life, cultural issues may impact on the quality of life remaining and for that reason, it is important that particular cultural practices are understood. This paper describes a study that investigated the cultural issues of access to palliative care services for Indian migrants in Australia. Purpose of the Study: To investigate the experiences of the family members of terminally ill Indian migrants in Victoria, Australia. Objective of the Study: To explore the issues related to accessing palliative care services for Indian migrants; to identify the effectiveness of palliative care in supporting the patient and family and to recommend strategies for improving this care. Materials and Methods: A qualitative descriptive design was utilized. Up to 6 family members were selected for in-depth interviews in understanding cultural issues related to the palliative care services for a family member. Results: Analysis of the interviews revealed that families of Indian patients experience difficulties whilst receiving palliative care services, which fell into three main categories: Indian support systems, cultural issues, and caring experiences. Although each of these issues had a direct influence on the experience of terminal care that their family member received, cultural issues and support systems also influenced the caring experiences. Conclusion: Despite the successful implementation of palliative care services across Australia, there are still problems in accessing and receiving the services among minority and disadvantaged groups like various cultural groups.

  19. Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

    Science.gov (United States)

    Nakajima, Nobuhisa

    2017-06-01

    Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p oral intake groups, respectively ( p oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

  20. The ABCDE of good care: A thematic analysis on the art of caring for terminally ill patients in Malaysia

    Directory of Open Access Journals (Sweden)

    Tan Seng Beng

    2017-04-01

    Full Text Available The first and foremost requisite of caring is to treat patients as persons, not as diseases or bed-numbers. A qualitative study was conducted to explore the perception of good care from the point of view of 13 terminally ill patientsand 8 caregiving family members of the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The results were thematically analyzed. Five basic themes were generated: (1 Attitude, (2 Behaviour, (3 Communication, (4 Duty and (5 Environment—ABCDE. The results may provide useful insight into the art of caring.

  1. Terminal delirium misdiagnosed as major psychiatric disorder: Palliative care in a psychiatric inpatient unit.

    Science.gov (United States)

    Aligeti, Sabitha; Baig, Muhammad R; Barrera, Fernando F

    2016-06-01

    Delirium is a neuropsychiatric condition characterized by acute change in cognition and disturbance of consciousness. A similar state during the final days of life is termed "terminal delirium." We present three cases with end-stage chronic medical problems without any significant psychiatric history who were admitted to an inpatient psychiatric unit or a locked dementia unit for management of "depression," "dementia," or "psychosis." Early diagnosis of terminal delirium helps prevent patients, family members, and staff from undergoing severe emotional distress and facilitates appropriate end-of-life care.

  2. Health economics of a palliative care unit for terminal cancer patients: a retrospective cohort study.

    Science.gov (United States)

    Jung, Hyun-myung; Kim, Jinhyun; Heo, Dae Seog; Baek, Sun Kyung

    2012-01-01

    The objective of this study was to evaluate cost-reduction efficacy of a palliative care unit (PCU) by analyzing medical expenses of terminal cancer patients. Hospital bills and medical records of 656 patients who died of cancer from January to December 2007 at one university hospital in Seoul were analyzed. Of the total 656 patients, 126 died in the PCU. Compared to non-PCU patients, PCU patients were more likely to permit do-not-resuscitate (DNR), visit the emergency room (ER), and receive palliative chemotherapy (P care unit (ICU), used a ventilator, and received hemodialysis more often (P care could be realized.

  3. [Promotion of home shifts for terminal cancer patients through intervention of visitor palliative care team].

    Science.gov (United States)

    Shiraishi, Ko; Chigira, Mayumi; Tsuyuki, Naoko; Hozaki, Kyoko; Murotsu, Keizo; Umeki, Mikiko; Harada, Naohiro; Hirata, Satomi; Otsuka, Yuko; Hara, Hiroko

    2013-12-01

    It has been recommended that terminal cancer patients be shifted from the hospital to their homes. In our hospital, a visitor palliative care team was started for the purpose of the early introduction of palliative care, and home shifts were promoted. The results of home shifts by the visitor palliative care team from 2008 to 2012 were examined. Home shifts were possible for 27 cases out of 108 cases intervened. In 12 cases, there were at-home deaths, and the median at-home period was 55 days. In the group that could not be shifted, the at-home death rate and application rate of nursing care insurance were low. Additionally, the length of stay (median) for patients who died in hospitalization was 8 days for the group that could be shifted and 17 days for the group that could not be shifted. It was felt that effective communication with local health care facilities is important for a successful home shift. Early and adequate preparations for the treatment and care of terminal cancer patients undergoing home shift are important, and in this regard, a review of the current provisions of nursing care insurance is necessary.

  4. Nursing the dying: essential elements in the care of terminally ill patients.

    Science.gov (United States)

    de Araújo, M M T; da Silva, M J P; Francisco, M C P B

    2004-09-01

    To verify those aspects of care that nurses view as important when assisting patients beyond therapeutic possibilities and who are not under intensive care. (1) To find out how nurses cope with daily confrontation with the death and suffering of dying patients, (2) To identify whether nurses feel it is important to have communication skills in order to assist the terminally ill patient, (3) To estimate nurses' degree of work satisfaction, and (4) To explore the humane aspects of nursing assistance to the dying. Data were collected in January and February of 2002 by means of individual semistructured interviews with 14 nurses from the unit of haematology at a general hospital in the city of Sao Paulo, Brazil. Interviews were recorded, transcribed, and further analysed according to the qualitative method proposed by Bardin (1977). We found that Brazilian nurses caring for dying patients should be receiving psychological and emotional support. Results also highlighted different individual approaches in the endeavour to communicate with terminally ill patients, as well as the avoidance patterns developed by some nurses. The latter appeared to be as a result of personal difficulties in coping with the reality of human suffering and death. Finally, there is a need for better preparation in communication skills for nurses caring for terminally ill patients. Although the number of interviewed nurses in our study was small, the results corroborated the findings of other studies on the subject.

  5. [Applying hospice care concepts on a patient with terminal stage esophageal carcinoma: a nurse's experience].

    Science.gov (United States)

    Hsu, Hui-Kai; Lin, Mei-Chuan

    2010-04-01

    This report describes a nursing care experience with a patient diagnosed with terminal stage esophageal carcinoma. Nursing care was administered from November 8th to 30th, 2007. Patient data was collected and evaluated using direct caring, observation, medical reports and patient interviews covering the physical, psychological, social, and spiritual realms. Patient health problems included pain, ineffective airway clearance, anticipatory grieving and spiritual distress. In line with hospice care concepts, the author employed empathy, companionship, listening, and support to assist the patient to overcome fear and face death. Comfort care and pain control skills were also used to relieve the patient's physical suffering. As such, the author assisted patient to achieve the essence of "good death", i.e., peace of achieved in the physical, psychological, social and spiritual realms.

  6. [The perception by nurses of the significance of palliative care in patients with terminal cancer].

    Science.gov (United States)

    Fernandes, Maria Andréa; Evangelista, Carla Braz; Platel, Indiara Carvalho dos Santos; Agra, Glenda; Lopes, Marineide de Souza; Rodrigues, Francileide de Araújo

    2013-09-01

    This study sought to assess the perception of nurses with respect to cancer patients under palliative care. It is an exploratory study with a qualitative approach conducted with nurses from a hospital attending cancer patients under palliative care located in the city of João Pessoa, State of Paraíba. The study included nine nurses who worked in the hospital. The empirical material was collected using the technique of semi-structured interviews and analyzed using the content analysis technique. The interpretative analysis of the interviews led to the definition of three categories: Improving the quality of life through the alleviation of pain and suffering; Palliative Care: a multi-professional study of terminal patients and their families in the grieving process; Communication: a source of dignity in the terminal care process. The conclusion reached is that the study revealed that the nurses involved acknowledge the importance of the multidisciplinary team. It enables the nurses to reflect on the use of communication as an essential element of care for patient and family under palliative care. It is hoped that the data obtained may foster further research on the topic.

  7. [The adapting of a care plan after Kennedy terminal ulcer diagnosis].

    Science.gov (United States)

    Roca-Biosca, A; Rubio-Rico, L; Velasco-Guillen, M C; Anguera-Saperas, L

    A 69 year old man was admitted to the Intensive Care Unit (ICU) from the Emergency Department due to severe respiratory failure. Due to unsuccessful non-invasive mechanical ventilation, endotracheal intubation was performed. A category I ulcer in coccyx was detected 48h after admission. Eight hours later, a double erythema (the second one darker than the first one) with displacement between 30-45° over the bony prominence suggested there was a deep tissue injury. The lesion progressed rapidly during the next 24h. The shape and the rapid evolution of the injury lead us to diagnose a Kennedy terminal ulcer (KTU). At 72h after the admission, and once the causes of acute decompensation were ruled out, limitation of life-sustaining treatment was decided. An individualised plan of care was drawn up with the aim of identifying problems in a patient with KTU evolving from a critical to a terminal situation. Our overall objectives (NOC) were to adapt the care plan based on a realistic approach. Nursing interventions (NIC) included actions such as pain management, conservative treatment of the injury, agony care and support to help the family to make decisions. The diagnosis of KTU helped the health care team in the decision-making process when they considered limiting the life support, as well as in the adapting of the care plan to the actual situation. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  8. Caring for terminal AIDS patients: The experiences of caregivers in a palliative care institution

    Directory of Open Access Journals (Sweden)

    Essie Ricks

    2009-04-01

    ervaar as gevolg van hul betrokkenheid by die dood en afsterwe van hul pasiënte aan VIGS. Die inligting wat deur hierdie deelnemers gedeel word, vorm die basis van die ontwikkeling van breë riglyne om die versorgers te ondersteun.

    How to cite this article:
    Van Rooyen, D., Williams, M. & Ricks, E., 2009, 'Caring for terminal AIDS patients: The experiences of caregivers in a palliative care institution', Health SA Gesondheid 14(1, Art. #440, 11 pages. DOI: 10.4102/hsag.v14i1.440

  9. Quality of life changes and intensive care preferences in terminal cancer patients.

    Science.gov (United States)

    Hwang, In Cheol; Keam, Bhumsuk; Yun, Young Ho; Ahn, Hong Yup; Kim, Young-Ae

    2015-10-01

    There is scarce research on the short-term fluctuations in end-of-life (EoL) care planning for seriously ill patients. The aim of our study was to investigate the stability of preferences regarding treatment in an intensive care unit (ICU) and identify the factors associated with changes in preferences in terms of quality of life (QoL). A prospective examination on preference changes for ICU care in 141 terminal cancer patients was conducted. Patients were categorized according to their change in preference during the final two months of their lives into four categories: (1) the keep-accept group, (2) the keep-reject group, (3) the change to accept group, and (4) the change to reject group. Using multiple logistic analyses, we explored the association between patient demographics, health-related QoL, and changes in ICU preference. The overall stability of ICU preferences near the end of life was 66.7% (κ = 0.33, p care [adjusted odds ratio (aOR) toward accept 12.35, p = 0.021; aOR toward reject 10.56, p = 0.020] than unmarried patients. Patients with stable physical function tended to accept ICU care (aOR = 5.05, p = 0.023), whereas those with poor performance (aOR = 5.32, p = 0.018), worsened QoL (aOR = 8.34, p = 0.007), or non-aggravated fatigue (aOR = 8.36, p = 0.006) were more likely to not accept ICU care. The attitudes of terminally ill cancer patients regarding ICU care at the end of life were not stable over time, and changes in their QoL were associated with a tendency to change their preferences about ICU care. Attention should thus be paid to patients' QoL changes to improve medical decision making with regard to EoL care.

  10. Development, implementation and evaluation of a terminal and hospice care educational online module for preclinical students.

    Science.gov (United States)

    Tse, Chung Sang; Ellman, Matthew S

    2017-03-01

    To explore the application of an online learning tool to teach preclinical medical students terminal and hospice care in a blended curricula. We created and evaluated a 30 min interactive online module at the Yale School of Medicine. Second-year medical students were randomly assigned to complete the online module or not (control group) prior to attending a required half-day hospice clinical experience. We assessed the students' knowledge and attitudes with a 23-item survey. 152 students (response rate 51%) participated in this study from 2012 to 2014. 56% (n=85) completed the online module, 37% (n=56) did not and 7% (n=11) did not indicate whether they had completed the module or not. Students who completed the online module prior to the hospice experience scored higher (phospice and palliative care, but their attitudes were similar to those who did not complete the online module. Overall, the students felt somewhat uncomfortable caring for dying patients although they regarded it as a physician's duty and felt that palliative/hospice care education is important in medical school. When combined with a mentored clinical hospice experience, an online module appears to enhance the teaching of the dying process and terminal care for preclinical medical students. This online module may prove useful for other institutions. 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/.

  11. Care of terminally-ill patients: an opinion survey among critical care ...

    African Journals Online (AJOL)

    EB

    Background: Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma ..... Withholding therapy is more acceptable among physicians as doctors in general withhold information about interventions judged too futile to offer. They thus keep greater ...

  12. The existence of nursing in caring for terminally ills’life: a phenomenological study

    Directory of Open Access Journals (Sweden)

    Carla Simone Leite de Almeida

    2014-02-01

    Full Text Available By taking care of cancer patients in their process of end of life, nursing experience situations of suffering before the anguish of others. This study aimed to understand the meaning and significance attributed by the nurses from the palliative care cancer hospital. This is a phenomenological research, grounded in Heidegger’s thinking, performed with 13 nurses, who work at Oncology hospitalward, through semi-structured interviews, which were analyzed according to the steps recommended by Josgrilberg. From understanding the statementsof the subjects, two ontological themesemerged: Feeling satisfaction and love in the care offered and Feeling anger and inabilitytowards terminally ill patients.We inferred that working in Oncology Ward is something rewarding for these professionals, but it entails physical and mental suffering, from feeling helpless before the death-dying process. Thus, we showedthat nursing professionals need to be recognized as human beings and as such, also deserving of care.

  13. Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care.

    Science.gov (United States)

    Santalahti, P; Hemminki, E; Aro, A R; Helenius, H; Ryynänen, M

    1999-01-01

    The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals' data, only 13% of pregnancies with a serious fetal disorder detected were continued. All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they

  14. Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language?

    Science.gov (United States)

    Kim, Sang Hyuck; Shin, Dong Wook; Kim, So Young; Yang, Hyung Kook; Nam, Eunjoo; Jho, Hyun Jung; Ahn, Eunmi; Cho, Be Long; Park, Keeho; Park, Jong-Hyock

    2016-04-01

    Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients' cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don't know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. Only 411 respondents (20.6%) chose "advanced," while most respondents (74.5%) chose "terminal stage" as the stage of the hypothetical patient, and a small proportion of respondents chose "early stage" (0.7%) or "don't know" (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.

  15. Care of terminally-ill patients: an opinion survey among critical care ...

    African Journals Online (AJOL)

    EB

    Conclusion: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of ... Patient's age, diagnosis, ICU stay and religious factors have been identified as factors ..... medical and nursing care for patients labeled no code. Intensivists practicing in the ...

  16. The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill.

    Science.gov (United States)

    Mok, Esther; Wong, Frances; Wong, Daniel

    2010-02-01

    This paper is a report of a study conducted to explore the phenomenon of spirituality and spiritual care among terminally ill Chinese patients. Meeting a patient's spiritual needs is a fundamental part of holistic nursing care. In the Western literature, spirituality is related to connectedness, faith, and hope. Contemporary scholars in the West suggest that spirituality is a broader term than religion. Phenomenological interviews were conducted with a convenience sample of 15 terminally ill Chinese patients in 2007. Participants found the term spirituality an abstract concept and described it as a unique personal belief which gives strength and relates to meaning of life. Spirituality is integrated with the body and mind and is a multidimensional concept. The acceptance of death as a process in life and 'letting go' leads to serenity and peace of mind. Other important themes include how the meaning of life is derived through relationships and connectedness, self-reflection of responsibilities, and obligations fulfilled. Inner spiritual well-being is attained from having faith and knowing possibilities in life and after death. Participants did not expect nurses to provide spiritual care, but when quality interpersonal care was given it gave them strength and spiritually supportive. If healthcare professionals can provide a compassionate and loving environment that facilitates acceptance and hope, the spiritual life of patients is enhanced. For dying individuals to experience love and for them to be understood as valuable even when no longer economically productive are both experiences of healing.

  17. Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death.

    Science.gov (United States)

    Wenrich, M D; Curtis, J R; Shannon, S E; Carline, J D; Ambrozy, D M; Ramsey, P G

    2001-03-26

    Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care. Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed. The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope. Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.

  18. Impact of palliative care consultative service on disease awareness for patients with terminal cancer.

    Science.gov (United States)

    Chou, Wen-Chi; Hung, Yu-Shin; Kao, Chen-Yi; Su, Po-Jung; Hsieh, Chia-Hsun; Chen, Jen-Shi; Liau, Chi-Ting; Lin, Yung-Chang; Liaw, Chuang-Chi; Wang, Hung-Ming

    2013-07-01

    Awareness of the status of disease among terminally ill cancer patients is an important part of the end-of-life care. We have evaluated how palliative care consultative service (PCCS) affects patient disease awareness and determined who may benefit from such services in Taiwan. In total, 2,887 terminally ill cancer patients consecutively received PCCS between January 2006 and December 2010 at a single medical center in Taiwan, after which they were evaluated for disease awareness. At the beginning of PCCS, 31 % of patients (n = 895) were unaware of their disease status. The characteristics of these 895 patients were analyzed retrospectively to determine variables pertinent to patient disease awareness after PCCS. In total, 485 (50 %) of the 895 patients became aware of their disease at the end of PCCS. Factors significantly associated with higher disease awareness included a longer interval between the date of hospital admission and that of PCCS referral (>4 weeks versus ≤2 weeks), a longer duration of PCCS (>14 days versus ≤7 days), the male gender, divorced marital status (versus married), and family awareness (versus lack of family awareness). Lower disease awareness was associated with older age (age > 75 years versus age = 18-65 years), referral from non-oncology departments, and primary cancer localization (lung, colon-rectum, or urological versus liver). Disease awareness is affected by multiple factors related to the patients, their families, and the clinicians. The promotion of PCCS increased disease awareness among terminally ill cancer patients in Taiwan.

  19. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

    NARCIS (Netherlands)

    de Graaff, F.M.; Francke, A.L.

    2009-01-01

    Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care

  20. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey.

    NARCIS (Netherlands)

    Graaff, F.M. de; Francke, A.L.

    2009-01-01

    BACKGROUND: Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care

  1. PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede

    that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care......) The primary sector needs easy access to specialist advise, supervision and empowerment. 4) Better and easier communication pathways are important, both within the primary sector and across the sectors to improve accessibility.CONCLUSION. Our study shows a need for improvements in palliative home care...... and provides important knowledge about how these improvements are achieved.The GPs want closer supervision and improved shared care. They want to be key persons in palliative home care, but to fill this role it is vital that they take or are given the responsibility in a very transparent way, i.e.: A way...

  2. The experience of family caregivers caring for a terminal patient at home: A research review.

    Science.gov (United States)

    Martín, J Martín; Olano-Lizarraga, M; Saracíbar-Razquin, M

    2016-12-01

    One of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people's lives, it is necessary to comprehend their personal experience in a holistic way. To reveal the experience of family caregivers who are caring for a terminal patient in their home. A qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them. The analysis permitted the caregivers' experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment. This review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family

  3. Differences in Terminal Hospitalization Care Between U.S. Men and Women.

    Science.gov (United States)

    Just, Erica; Casarett, David J; Asch, David A; Dai, Dingwei; Feudtner, Chris

    2016-08-01

    In many settings, men and women receive different care. We sought to determine whether men and women receive different care during terminal hospitalizations. We analyzed data of 98,314 adult patients who died while hospitalized in 458 acute care hospitals in the U.S. during 2011. We examined sex-based differences in lengths of stay (LOS), resuscitation status, and intensive interventions and processes of care, adjusting for patient- and hospital-level characteristics. Women represented half of the sample (48,509; 49.34%), were older than men (73.8 vs. 70.6 years, P care in an intensive care unit (OR 0.95; 95% CI 0.93, 0.98), cardiopulmonary resuscitation (OR 0.83; 95% CI 0.80, 0.86), mechanical ventilation (OR 0.94; 95% CI 0.91, 0.97), hemodialysis (adjusted OR 0.81; 95% CI 0.78, 0.86), or surgical procedures (OR 0.88; 95% CI 0.84, 0.93). Men who die in hospitals receive more aggressive care than women. Further research should examine potential causes of this overall pattern. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

    DEFF Research Database (Denmark)

    Santalahti, P; Hemminki, E; Aro, A R

    1999-01-01

    that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound......, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation...... in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive more attention in future studies....

  5. The infusion of opioids during terminal withdrawal of mechanical ventilation in the medical intensive care unit.

    Science.gov (United States)

    Mazer, Mark A; Alligood, Chad M; Wu, Qiang

    2011-07-01

    Most deaths in intensive care units occur after limitation or withdrawal of life-sustaining therapies. Often these patients require opioids to assuage suffering; yet, little has been documented concerning their use in the medical intensive care unit. To determine the dose and factors influencing the use of opioids in patients undergoing terminal withdrawal of mechanical ventilation in this setting. Data were prospectively collected from 74 consecutive patients expected to die soon after extubation. The doses of morphine, effect on time to death, and relation of dose to diagnostic categories were analyzed. The mean (±standard deviation) dose of morphine given to patients during the last hour of mechanical ventilation was 5.3mg/hour. Patients dying after extubation received 10.6 mg/hour just before death. Immediately before extubation, the dose correlated directly with chronic medical opioid use and sepsis with respiratory failure and inversely with coma after cardiopulmonary resuscitation or a primary neurological event. After terminal extubation, the final morphine dose correlated directly with the presence of sepsis with respiratory failure and chronic pulmonary disease. The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses. After extubation, each 1mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes (P = 0.011). Premorbid conditions may influence the dose of morphine given to patients undergoing terminal withdrawal of mechanical ventilation. Higher doses of morphine are associated with a longer time to death. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  6. Determinants of complicated grief in caregivers who cared for terminal cancer patients.

    Science.gov (United States)

    Chiu, Yu-Wen; Huang, Chia-Tsuan; Yin, Shao-Min; Huang, Yung-Cheng; Chien, Ching-Hsin; Chuang, Hung-Yi

    2010-10-01

    There is little research on determinants and the grief that caregivers experience after their relatives die of cancer. This study evaluated factors which influence complicated grief among caregivers who cared for patients who died of cancer in Taiwan. This prospective study recruited 668 caregivers who cared for terminally ill cancer patients in the hospice ward or who received shared-care consultation. Caregivers were interviewed on the telephone an average 8.9 months after the cancer patients passed away. The Inventory of Complicated Grief (ICG), modified for use in a Chinese population, was used to assess the grief status of caregivers. ICG >25 was defined as complicated grief. Our study found that female gender (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.75-2.82), spouse relationship (OR, 1.20; 1.01-1.40), parents-children relationship (OR, 1.70; 1.11-2.31), lack of religious belief (OR, 1.47; 1.19-1.75), unavailable family support (OR, 1.42; 1.03-1.83), and history of mood co-morbidity (OR, 1.41; 1.02-1.83) were risk factors that would predispose towards complicated grief; whereas, longer duration of caring (months, OR, 0.79; 0.69-0.91), medical disease history in the carer (OR, 0.77; 0.57-0.99), and patients being cared for on the hospice ward (OR, 0.60; 0.44-0.77) were factors that would mitigate against complicated grief. These results suggest that clinical professionals who care for terminal cancer patients and their caregivers should pay particular attention to caregivers with these predisposing factors.

  7. Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter?

    Science.gov (United States)

    Faull, Christina; Windridge, Kate; Ockleford, Elizabeth; Hudson, Michael

    2013-03-01

    The prompt availability of medications to manage symptoms is key to high quality end-of-life care and anticipatory prescribing of these drugs is thought good practice. This study explored the challenges encountered by primary and community health professionals in Leicestershire and Rutland related to anticipatory prescribing when caring for terminally ill patients who wish to remain at home to die. A qualitative study was conducted using eight focus groups (54 participants) and nine individual interviews with a purposively sampled range of health professionals providing care for people who wished to die at home. Themes were identified iteratively via constant comparison. Challenges fell into four categories: resourcing concerns, professional expertise/experience, professionals' relationships with patients, and professionals' relationships with other professionals. The latter included the most serious perceived challenges. Links between community and hospital care providers and between 'usual' hours and 'out-of-hours' care providers were seen as particularly unstable. These findings suggest that building and maintaining trusting, responsive, personal links between professionals, both within and between teams, is essential when implementing good practice guidelines about anticipatory end-of-life prescribing in the community. The need for good communication and relationships between patients and professionals and maintaining expertise and confidence in end-of-life care are also key factors in the effective use of anticipatory prescribing for symptom management for dying patients.

  8. Art therapy for terminal cancer patients in a hospice palliative care unit in Taiwan.

    Science.gov (United States)

    Lin, Ming-Hwai; Moh, Shwu-Lan; Kuo, Yu-Cheng; Wu, Pin-Yuan; Lin, Chiung-Ling; Tsai, Mei-Hui; Chen, Tzeng-Ji; Hwang, Shinn-Jang

    2012-03-01

    Even though terminal cancer patients receive help from a hospice palliative care team, they have to suffer the pressure of death with deteriorating conditions. This study aims to evaluate the effect of art therapy for these terminal cancer patients. The patients involved were terminal cancer patients who were under the care of team members, which included physicians, nurses, social workers, clergy, art therapists, and volunteers in a hospice palliative care unit in Taiwan. The art therapy in our study took the form of visual fine art appreciation and hands-on painting. The effects of the art therapy were evaluated according to patients' feelings, cognitions, and behaviors. There were 177 patients (105 males and 72 females; mean age: 65.4 ±15.8 years) in the study. Each patient received a mean of 2.9 ± 2.0 sessions of the art therapy and produced a mean of 1.8 ± 2.6 pieces of art. During the therapy, most patients described their feelings well, and created art works attentively. Patients expressed these feelings through image appreciation and hands-on painting, among which the landscape was the most common scene in their art. After the therapy, the mean score of patients' artistic expressions (one point to each category: perception of beauty, art appreciation, creativity, hands-on artwork, and the engagement of creating artwork regularly) was 4.0 ± 0.7, significantly higher than the score before therapy (2.2 ± 1.4, p art therapy through visual art appreciation and hands-on creative artwork.

  9. Prognosis terminal: truth-telling in the context of end-of-life care.

    Science.gov (United States)

    Rich, Ben A

    2014-04-01

    Recent contributions to the medical literature have raised yet again the issue of whether the term "terminal" is an intelligible one and whether there is a consensus view of its meaning that is sufficient to justify or even require its use in discussing end-of-life care and treatment options with patients. Following a review of the history and development of informed consent, persistent problems with the communication of prognosis and the breaking of bad news are analyzed. The author argues that candid but compassionate communication between physicians and patients about prognosis is essential to informed decisions about both disease-directed (curative) and palliative therapies.

  10. [Leadership in the promotion of inter-professional collaboration in terminal cancer care].

    Science.gov (United States)

    Ogiwara, Miyoko; Ishikawa, Mitsuko; Yamaoka, Keita; Matsumoto, Ayumi; Fujimaki, Yoko; Watanabe, Mutsuko; Kushida, Kazuki

    2014-12-01

    Home care requires indispensable inter-professional/inter-organizational collaboration. However, due to differences in specialization, the language used, and work structure, medical professionals may be confronted with a gap between the ideal and reality of collaboration. In the present case, a 50-year-old female with terminal cancer wished to receive home care and was consequently transferred to her home. The patient has been receiving a 24-h continuous drip infusion via a central venous route and using a patient-controlled analgesia pump for pain management. She has chronic respiratory failure in addition to cancer-related pain. Furthermore, she has been injecting herself with insulin 4 times per day because she has type 2 diabetes. The patient requires almost full assistance in daily life. This type of home care is equivalent to inpatient care that requires inter-professional and inter-organizational collaboration by 12 professionals. The leadership of a care manager with knowledge of a patient's life and family background is essential in such cases.

  11. Validation of the prognosis in palliative care study predictor models in terminal cancer patients.

    Science.gov (United States)

    Kim, Eun-Shin; Lee, Jung-Kwon; Kim, Mi-Hyun; Noh, Hye-Mi; Jin, Yeong-Hyeon

    2014-11-01

    Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. This study included 202 advanced cancer patients who were admitted to the cancer hospital's palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor's survival estimates in inpatients. The median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor's estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'days' showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'weeks' showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B 'months' group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The 'weeks' and 'months' groups showed significantly prolonged survival rates than 'days' group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method. The PiPS predictor models effectively predicted the survival ≥14 days in terminal cancer patients, and were superior to doctor's estimates.

  12. Pain and hospice care in nursing home residents with dementia and terminal cancer.

    Science.gov (United States)

    Monroe, Todd B; Carter, Michael A; Feldt, Karen S; Dietrich, Mary S; Cowan, Ronald L

    2013-10-01

    One condition associated with severe end-of-life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. A total of 45% of residents were in hospice at the end-of-life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1-14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1-0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end-of-life palliative care for nursing home residents with terminal cancer and severe dementia. © 2013 Japan Geriatrics Society.

  13. Factors Associated With Caregivers' Resilience in a Terminal Cancer Care Setting.

    Science.gov (United States)

    Hwang, In Cheol; Kim, Young Sung; Lee, Yong Joo; Choi, Youn Seon; Hwang, Sun Wook; Kim, Hyo Min; Koh, Su-Jin

    2017-01-01

    Resilience implies characteristics such as self-efficacy, adaptability to change, optimism, and the ability to recover from traumatic stress. Studies on resilience in family caregivers (FCs) of patients with terminal cancer are rare. This study aims to examine the factors associated with FCs' resilience in a terminal cancer care setting. This is a cross-sectional study of 273 FCs from 7 hospice and palliative care units in Korea. Resilience was categorized as high and low, and factors associated with resilience were grouped or categorized into subscales. A multivariate logistic regression analysis was used to examine relevant factors. High FCs' resilience was significantly associated with FCs' health status, depression, and social support. In a multivariate regression model, FCs' perception of good health (adjusted odds ratio [aOR] = 2.26, 95% confidence interval [CI] = 1.16-4.40), positive social support (aOR = 3.70, 95% CI = 1.07-12.87), and absence of depression (aOR = 3.12, 95% CI = 1.59-6.13) remained significantly associated with high FCs' resilience. Lack of family support is associated with and may be a cause of diminished resilience. And more concern should be paid to FCs to improve FCs' health and emotional status. Education programs might be effective for improving caregivers' resilience. Further research with supportive interventions is indicated.

  14. What Happens and What Matters : A study on Palliative and Terminal care in the Hospital (PalTeC-H)

    NARCIS (Netherlands)

    F.E. Witkamp (Frederika)

    2015-01-01

    markdownabstract__Abstract__ Palliative and terminal care. In 2002 the World Health Organization redefined palliative care as “an approach that improves the quality of life of patients and their family facing the problems associated with life-threatening illness, through the prevention and

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

    Science.gov (United States)

    Viney, Linda L.; And Others

    1994-01-01

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

  16. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development

    NARCIS (Netherlands)

    Steen, J.T. van der; Dekker, N.; Gijsberts, M.H.E.; Vermeulen, L.H.; Mahler, M.M.; The, B.A.

    2017-01-01

    BACKGROUND: When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of

  17. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

    Directory of Open Access Journals (Sweden)

    de Graaff Fuusje M

    2009-01-01

    Full Text Available Abstract Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care for terminally ill Turkish and Moroccan migrants and their families in the Netherlands. Methods Questionnaires were sent to home care organizations and GPs working in areas where most of these migrants are living. 93 nurses and 78 GPs provided information about their experiences and opinions regarding home care for this group of patients. The data were analyzed by descriptive statistics. Results GPs refer relatively few patients from these migrant groups to home care. They often find it difficult to assess the needs of these patients and their families. In 40% of the GPs' cases in which terminally ill Turkish and Moroccan migrants were not referred to home care, the GP regretted this afterwards: the patients had not received sufficient qualified care, and their informal carers had often become overburdened. In addition, home care nurses often express dissatisfaction with the home care given to terminally ill Turkish or Moroccan patients, because of communication problems, the patients' lack of knowledge of the disease, or difficulties in making suitable appointments with the patient or with the family. Conclusion Nurses and GPs cite chiefly similar factors influencing access to and use of home care as family members did in a previous study. However, according to GPs and nurses, the main barrier to the use of home care concerns communication problems, while relatives cited the preference for family care as the main reason for abstaining from the use of home care.

  18. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey.

    Science.gov (United States)

    de Graaff, Fuusje M; Francke, Anneke L

    2009-01-26

    Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care for terminally ill Turkish and Moroccan migrants and their families in the Netherlands. Questionnaires were sent to home care organizations and GPs working in areas where most of these migrants are living. 93 nurses and 78 GPs provided information about their experiences and opinions regarding home care for this group of patients. The data were analyzed by descriptive statistics. GPs refer relatively few patients from these migrant groups to home care. They often find it difficult to assess the needs of these patients and their families. In 40% of the GPs' cases in which terminally ill Turkish and Moroccan migrants were not referred to home care, the GP regretted this afterwards: the patients had not received sufficient qualified care, and their informal carers had often become overburdened.In addition, home care nurses often express dissatisfaction with the home care given to terminally ill Turkish or Moroccan patients, because of communication problems, the patients' lack of knowledge of the disease, or difficulties in making suitable appointments with the patient or with the family. Nurses and GPs cite chiefly similar factors influencing access to and use of home care as family members did in a previous study. However, according to GPs and nurses, the main barrier to the use of home care concerns communication problems, while relatives cited the preference for family care as the main reason for abstaining from the use of home care.

  19. Struggling to adapt: caring for older persons while under threat of organizational change and termination notice.

    Science.gov (United States)

    Fläckman, Birgitta; Hansebo, Görel; Kihlgren, Annica

    2009-03-01

    Organizational changes are common in elder care today. Such changes affect caregivers, who are essential to providing good quality care. The aim of the present study was to illuminate caregivers' experiences of working in elder care while under threat of organizational change and termination notice. Qualitative content analysis was used to examine interview data from 11 caregivers. Interviews were conducted at three occasions during a two-year period. The findings show a transition in their experiences from 'having a professional identity and self-confidence', to 'being a professional in a threatening situation caused by someone else' and to 'struggling to adapt to a changed working environment as a person and a professional'. The caregivers experienced a loss of pride and satisfaction. Previous literature indicates that this may have consequences for the quality of care and that employees may be at risk of negative health effects. However, the caregivers continued to struggle, doing their best to complete their duties. The study has implications for high-level decision-makers, managers and caregivers in similar work-life situations in that it deals with factors that facilitate or impede similar transitions.

  20. Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

    Directory of Open Access Journals (Sweden)

    Filipe Pereira

    2016-01-01

    Full Text Available This work is developed in the context of Ambient Assisted Living (AAL and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and LabVIEW platforms, respectively. The proposed solution has, as main feature, its adaptability to the patient needs. One of the MCT functionalities is the remote access to the patient data through the web. The caregiver may request help from a specialist who sends back information in real time to perform first aid assistance. This device has a flexible configuration allowing a fast and cheap reconfiguration according the specific needs of the patient. The proposed mechatronic system intends to meet the needs of bedridden patients improving their quality of life, health, safety, and comfort, while enabling the remote monitoring of the patients.

  1. Caring for women undergoing second-trimester medical termination of pregnancy.

    Science.gov (United States)

    Andersson, Inga-Maj; Gemzell-Danielsson, Kristina; Christensson, Kyllike

    2014-05-01

    The objective was to explore the experiences and perceptions of nurses/midwives caring for women undergoing second-trimester medical termination of pregnancy (MTOP). The study had a qualitative design using semistructured interviews. It took place in three wards at one gynecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second-trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes. The analysis revealed two themes: "The professional self," with six subthemes describing the experiences and perceptions described in terms of professional behavior, and "The personal self," with four subthemes containing the experiences and perceptions described in terms of personal values. Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP. The findings of this study support the need for training, mentoring and support by experienced colleagues to help nurses/midwives feel secure in their professional role in difficult situations and feel confident in their personal life situation. Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge and empathy. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in

  2. Terminal withdrawal of mechanical ventilation at a long-term acute care hospital: comparison with a medical ICU.

    Science.gov (United States)

    White, Alexander C; Joseph, Bernard; Gireesh, Arvind; Shantilal, Priya; Garpestad, Erik; Hill, Nicholas S; O'Connor, Heidi H

    2009-08-01

    Failure to wean from prolonged mechanical ventilation (MV) is common in long-term acute care hospitals (LTACHs), but the process of terminal withdrawal of MV in LTACHs is not well described. We compared terminal withdrawal of MV at an LTACH with that in a medical ICU (MICU). A retrospective medical chart review was done of all patients undergoing terminal withdrawal of MV in an LTACH (n = 30) and in a MICU (n = 74) over a 2-year period. The decision to withdraw MV was more likely initiated by patient or family in the LTACH and by medical staff in the MICU (p care, and hospital administration were more likely to participate in the withdrawal process at the LTACH compared with the MICU (p Terminal withdrawal of MV in the LTACH differs from that in the MICU with regard to decision making, benzodiazepine use, and cause of death.

  3. Nurses experiences in palliative care of terminally-ill HIV patients in a level 1 district hospital.

    Science.gov (United States)

    Bam, Nokwanda E; Naidoo, Joanne R

    2014-07-30

    Whilst the discourse of palliative care in HIV management is largely documented and regarded as being an essential component, various authors have further argued that within the context of HIV care in sub-Saharan Africa, palliative care and exploration of the dimensions thereof is largely lacking. This article presents the lived experiences of nurses involved in palliative care, thus providing the perspective of nurses and the multi-faceted dimensions of the nature of caring inherent. This study explored the respondents' understanding of the concepts 'caring' and 'terminal patient' and described the experiences of nurses caring for terminally-ill patients with HIV and how these experiences influence the nature of care rendered. Qualitative research using Husserl's approach of phenomenology design underpinned the study and Giorgi's steps of analysis were used to make meaning of the data. The concept 'caring' was experienced by the nurses as transforming the patients' quality of life through supportive care and hope for life. Palliative care made the nurses conscious of their own mortality, enabling them to be more sensitive, compassionate and dedicated to caring for their patients. The findings described the social networking that enabled nurses to collaborate with colleagues in the interdisciplinary teams and shared knowledge, skills and support within the palliative care team in order to optimise patient outcomes. Nurses with prolonged involvement in caring for terminally-ill patients with HIV experienced helplessness and emotional stress. Recommendations based on the results are that training in psychological and holistic care of the patient, professional counselling and stress management services are needed to support the nurse in this context.

  4. [Home palliative care for a terminal stage cancer patient--a view point of autonomy support].

    Science.gov (United States)

    Oiwa, Takashi

    2008-12-01

    To recuperate from terminal stage cancer at one's dear old home is like a patient spending his time all day long with the family. Therefore, it is necessary for a patient to know his state of well being, and to comprehend how to cope with the expected change in cancer stages. In other words, the patient has to make his own decision as to what he wants to be cared for in the homecare environment, and he should provide information to the family and to caregivers. The author expresses such kind of a relationship as autonomy support, and it is an important viewpoint of home palliative care. Moreover, the idea of autonomy support was effective as well as relieving a severe pain of the disease from the patient. In our case for example, we experienced not only the amount of narcotic usage to control pain has decreased but the increase in narcotic amount at the near death period has also declined. In addition, we compared a home palliative care to a home recuperation of the senior citizen. As a result, the followings were emphasized: 1) In order to improve in the quality of home palliative care, it is important to catch the difference in subtle changes between the cancer patient and the senior citizen. 2) To note the problem of the sense of loss related to the welfare tools introduction. In this article, the problem of the cancer end stage caring was compared with the senior citizen homecare, and found that an autonomous support is clearly important.

  5. Effect of Terminal Patient Care Training on the Nurses' Attitudes Toward Death in an Oncology Hospital in Turkey.

    Science.gov (United States)

    Göriş, Songül; Taşcı, Sultan; Özkan, Birgül; Ceyhan, Özlem; Kartın, Pınar Tekinsoy; Çeliksoy, Aliye; Elmalı, Ferhan; Eser, Bülent

    2017-03-01

    This is an experimental research aiming at identifying the effect of terminal patient care training on the nurses' attitudes toward death. The sample of this study (n = 41) involves 20 nurses in the training group and 21 nurses in the control group. Nurses were offered terminal patient care training and their attitudes toward death were assessed before and after the intervention. The Death Attitude Profile-Revised (DAP-R) subscale mean scores for fear of death (3.9-4.6, p  .05) in any of the five DAP-R subscales. In accordance with these findings, this study suggests that terminal patient care training should be implemented in the nursing curriculum more extensively and should be frequently repeated as part of the nurses' in-service education.

  6. A new hospice consulting system for terminal cancer patients in transferring to post-acute care options in Taiwan.

    Science.gov (United States)

    Chang, P M-H; Liu, Y-Y L; Chao, T-C; Lin, H-L; Chen, M-B; Chen, P-M; Chiou, T-J

    2010-03-01

    The terminal cancer patients increase needs for hospice care day by day. A new hospice consulting system has been developed in Taiwan to provide options for terminal cancer patients in choosing a suitable post-acute hospice care while a combined hospice care system is also given by the consulting team in the acute wards. Hereinafter is our report. From March 2005 to January 2006, 313 terminal cancer patients were analysed. These patients had signed consent forms for palliative treatment and had received consultations from the new hospice consulting system. Multivariate analysis showed that the home care patients had better performance status (P = 0.012), less shortness of breath (P = 0.006), less limbs swelling (P = 0.043), less flatulency (P = 0.000) and less constipation (P = 0.018). Among the 162 patients with regular follow-up, the symptoms/signs were significantly improved after intervention of consulting team in pain (P = 0.000), shortness of breath (P = 0.000), difficulty in sleeping (P = 0.002), nausea (P = 0.004), constipation (P = 0.008), changes in skin (P = 0.024) and adoption (P = 0.000). This new system had significant improvement in the terminal cancer patients' symptoms/signs control in acute wards and could contribute to the care quality of home care patients.

  7. Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model.

    Science.gov (United States)

    Koh, Su Jin; Kim, Shinmi; Kim, Jinshil

    2016-02-01

    In Korea, patients with terminal cancer are often caught out of the loop in end-of-life (EoL) care discussions. Healthcare professionals also have difficulty engaging in such communication in a variety of healthcare contexts. Therefore, the objective of our study was to develop a communication model for EoL care decision making compatible with the clinical environment in Korea. Using focus-group interview methodology, participants included eight doctors and five nurses who provide EoL care for terminal cancer patients in acute hospital settings or hospice care facilities in various provinces of Korea. Five themes emerged regarding EoL care discussion, which included: (1) timing, (2) responsible professionals, (3) disclosure of bad news, (4) content areas of EoL care discussion, and (5) implementing strategies for EoL care discussions. These themes were based on development of a communication algorithm for EoL discussion among patients with terminal cancer. A structural communication step for delivery of a terminal prognosis was specified at the phase of disclosure of bad news: beginning with determination of a patient's decision-making capability, followed by a patient's perception of his/her condition, a patient's wish to know, family dynamics, and a patient's and/or family's readiness for EoL discussions. The proposed context-oriented communication algorithm could provide a helpful guideline for EoL communication and, accordingly, facilitate meaningful improvements in EoL care in Korean clinical practice. The feasibility of this algorithm has not yet been determined, and its validation in a larger sample of patients with terminal cancers, using a quantitative research methodology, is a priority of research.

  8. Caring for terminal AIDS patients: The experiences of caregivers in a palliative care institution

    Directory of Open Access Journals (Sweden)

    Magdalena (Dalena van Rooyen

    2009-06-01

    Full Text Available This research focused on the lived experiences of caregivers working with AIDS patients, particularly patients who die from this disease whilst resident in a formal institution. A qualitative, exploratory, descriptive, and contextual research design with a phenomenological approach to inquiry was utilised. Thirteen unstructured interviews, which were audio-taped, were conducted with caregivers working full-time in a formal institution caring for patients who are dying from AIDS. The transcribed interviews were analysed using Tesch’s method of descriptive analysis (in Creswell 1994:115. One central theme emerged, namely that in their daily duty (at their place of work, caregivers experienced various challenges as a result of having to deal with the death of their patients suffering from AIDS, and five sub-themes were formulated from further analysis. The five subthemes were: • Caregivers experienced emotional challenges in caring for patients dying of AIDS; • Caregivers experienced a difference in death and dying of adults as apposed to children; • Caregivers experienced the rationalisation of death and dying differently; • Caregivers experienced that faith in God give them strength to cope with death and dying; • Caregivers experienced caring for patients as fulfilling and meaningful to them despite the sadness of death and dying. The participants face the death of their patients daily, from a disease that causes untold suffering to the patients, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. They described their emotional experiences, which included the various challenges that they face as a result of having to deal with the death and dying of their patients suffering from AIDS. The information shared by these participants formed the foundation of the broad guidelines that

  9. Palliative care versus euthanasia. The German position: the German General Medical Council's principles for medical care of the terminally ill.

    Science.gov (United States)

    Sahm, S W

    2000-04-01

    In September 1998 the Bundesärztekammer, i.e., the German Medical Association, published new principles concerning terminal medical care. Even before publication, a draft of these principles was very controversial, and prompted intense public debate in the mass media. Despite some of the critics' suspicions that the principles prepared the way for liberalization of active euthanasia, euthanasia is unequivocally rejected in the principles. Physician-assisted suicide is considered to violate professional medical rules. In leaving aside some of the notions customarily used in the euthanasia debate, e.g., passive euthanasia, the principles emphasize the obligation of physicians to offer and the right of patients to receive palliative care. The principles explicitly list modalities of basic treatment that are indispensable in all cases, such as the obligation to satisfy hunger and thirst. This statement is meant to resolve the dispute on nutrition and hydration at the end of life, as it shifts the focus of care from maintaining physiological parameters to satisfying subjective needs. For patients in a persistent vegetative state, artificial feeding is held to be obligatory. Yet, the principles make reference to recent German jurisdiction which permit the stopping of artificial feeding if it is in accordance with the patient's presumed will. Additionally, the wording concerning this issue is found to remain unclear. Patients' autonomy is strengthened by explicitly welcoming advance directives as a means to ascertain patients' wills. The principles mark some changes compared to earlier documents. They deserve careful analysis and should be considered in the international debate on issues concerning the end of life.

  10. Nurses experiences in palliative care of terminally-ill HIV patients in a level 1 district hospital

    Directory of Open Access Journals (Sweden)

    Nokwanda E. Bam

    2014-07-01

    Full Text Available Background: Whilst the discourse of palliative care in HIV management is largely documented and regarded as being an essential component, various authors have further argued that within the context of HIV care in sub-Saharan Africa, palliative care and exploration of the dimensions thereof is largely lacking. This article presents the lived experiences of nurses involved in palliative care, thus providing the perspective of nurses and the multi-faceted dimensions of the nature of caring inherent. Objectives: This study explored the respondents’ understanding of the concepts ‘caring’ and ‘terminal patient’ and described the experiences of nurses caring for terminally-ill patients with HIV and how these experiences influence the nature of care rendered. Methods: Qualitative research using Husserl’s approach of phenomenology design underpinned the study and Giorgi’s steps of analysis were used to make meaning of the data. Results: The concept ‘caring’ was experienced by the nurses as transforming the patients’ quality of life through supportive care and hope for life. Palliative care made the nurses conscious of their own mortality, enabling them to be more sensitive, compassionate and dedicated to caring for their patients. The findings described the social networking that enabled nurses to collaborate with colleagues in the interdisciplinary teams and shared knowledge, skills and support within the palliative care team in order to optimise patient outcomes. Conclusion: Nurses with prolonged involvement in caring for terminally-ill patients with HIV experienced helplessness and emotional stress. Recommendations based on the results are that training in psychological and holistic care of the patient, professional counselling and stress management services are needed to support the nurse in this context.

  11. Trajectories of Terminally Ill Patients' Cardiovascular Response to Receptive Music Therapy in Palliative Care.

    Science.gov (United States)

    Warth, Marco; Kessler, Jens; Hillecke, Thomas K; Bardenheuer, Hubert J

    2016-08-01

    Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms. The present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise. Eighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants' gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors. Both VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals' trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow. Higher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients' physiological response and need to be taken into account in clinical practice and future theory building. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Low socioeconomic status is associated with more aggressive end-of-life care for working-age terminal cancer patients.

    Science.gov (United States)

    Chang, Chun-Ming; Wu, Chin-Chia; Yin, Wen-Yao; Juang, Shiun-Yang; Yu, Chia-Hui; Lee, Ching-Chih

    2014-12-01

    The relationship between low socioeconomic status (SES) and aggressiveness of end-of-life (EOL) care in cancer patients of working age (older than 18 years and younger than 65 years) is not clear. We assessed the association between aggressiveness of EOL care and differences in SES among working-age terminal cancer patients from Taiwan between 2009 and 2011. A total of 32,800 cancer deaths were identified from the Taiwan National Health Insurance Research Database. The indicators of aggressive EOL care (chemotherapy, more than one emergency room [ER] visit or hospital admission, more than 14 days of hospitalization, intensive care unit [ICU] admission, and death in an acute care hospital) in the last month of life were examined. The associations between SES and the indicators were explored. Up to 81% of the cancer deaths presented at least one indicator of aggressive EOL care. Those who were aged 35-44 years and male, had low SES, had metastatic malignant disease, lived in urban areas, or were in hospitals with more abundant health care resources were more likely to receive aggressive EOL care. In multilevel logistic regression analyses, high-SES cancer deaths had less chemotherapy (p terminal cancer patients in Taiwan received aggressive EOL care. EOL cancer care was even more aggressive in those with low SES. Public health strategies should continue to focus on low-SES patients to provide them with better EOL cancer care. ©AlphaMed Press.

  13. How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study.

    Science.gov (United States)

    Wang, Jack P; Wu, Chen-Yi; Hwang, I-Hsuan; Kao, Chien-Hui; Hung, Yi-Ping; Hwang, Shinn-Jang; Li, Chung-Pin

    2016-01-08

    Inpatient palliative care is important for patients with terminal pancreatic cancer. However, the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer have not been explored in a population-based study. This population-based nationwide study was conducted using data from the Taiwan National Health Insurance database to analyze the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer. We identified 854 patients with terminal pancreatic cancer, who had received in-hospital end-of-life care between January 2003 and December 2006. These patients were then sub-divided and matched 1:1 (using propensity score matching) according to whether they received inpatient palliative care (n = 276) or acute hospital care (n = 276). These groups were subsequently compared to evaluate any differences in the use of aggressive procedures, prescribed medications, and medical costs. Inpatient palliative care was typically provided by family physicians (39%) and oncologists (25%), while acute hospital care was typically provided by oncologists (29%) and gastroenterologists (24%). The inpatient palliative care group used natural opium alkaloids significantly more frequently than the acute hospital care group (84.4% vs. 56.5%, respectively; P care group also had shorter hospital stays (10.6 ± 11.1 days vs. 20.6 ± 16.3 days, respectively; P care units received more frequent pain control treatments, underwent fewer aggressive procedures, and incurred lower medical costs. Therefore, inpatient palliative care should be considered a viable option for patients with terminal pancreatic cancer.

  14. [Home care for terminal cancer patients from the family and caregiver perspective].

    Science.gov (United States)

    Ishikawa, Mitsuko; Ogiwara, Miyoko; Yamaoka, Keita; Matsumoto, Ayumi; Fujimaki, Yoko; Watanabe, Mutsuko; Kushida, Kazuki

    2014-12-01

    The progression of home care provision is associated with an increased burden on the family, as patients tend to progressively become more dependent on medicine. In the present case, a family supported a patient by performing medical activities such as taking blood sugar measurements, administering insulin injections, exchanging fluids, managing each tube, handling medical devices, conducting status observations, and attending to emergency calls. Thus, the family caregiver undertakes duties that were previously performed by a nurse and interacts with the various professionals who visit the patient's home daily. Therefore, the caregiver undergoes a considerable amount of stress. Family caregivers with no medical knowledge or nursing experience require plenty of support, in order to fulfill a patient's requirements. The first step is the establishment of trust between the medical professionals and the caregiver. In the present case, because the trust had been established, interprofessional collaboration ensured that the patient received support until the end. Thus, we reported on the perspectives of the family and caregiver on home care for terminal cancer patients.

  15. When Terminal Illness Is Worse Than Death: A Multicenter Study of Health-Care Providers' Resuscitation Desires.

    Science.gov (United States)

    Chavez, Luis O; Einav, Sharon; Varon, Joseph

    2017-11-01

    To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ2 test for the presence of associations ( P code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness. A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired "definitely full code" (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired "definitely no code" or "partial support," and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness ( P code status and terminal illness code preference among physicians ( P = .290) and nurses ( P = .316), whereupon other hospital workers were more consistent ( P < .01, Cramer V = .291). Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.

  16. Prospective Study on Music Therapy in Terminally Ill Cancer Patients during Specialized Inpatient Palliative Care.

    Science.gov (United States)

    Kordovan, Sarah; Preissler, Pia; Kamphausen, Anne; Bokemeyer, Carsten; Oechsle, Karin

    2016-04-01

    This study was a prospective evaluation of feasibility, acceptance, and potential beneficial effects of music therapy in terminally ill cancer patients on a specialized palliative care inpatient ward. Intervention had to consist of at least two sessions, but frequency and duration was left to the patients` decision. Different music therapy methods were offered to the patient at the beginning of every session. Patients rated their subjective benefit. Disease-related and sociodemographic factors were considered as potentially influencing factors. A total of 166 music therapy sessions were performed with 41 patients (average, 4; range, 2-10). Average session duration was 41 minutes (range, 20-70). Most favored methods were therapeutic conversation in 84% of sessions; listening to relaxing music, 39%; playing an instrument, 31%; and music-lead imagination, 11%. Receptive music therapy was applied in 45%, active forms in 25%, a combination of both in 7%, and therapeutic conversation only in 23%. Music therapy was rated to be "helpful" in 68%. Positive effects were significantly associated with frequency (p = 0.009) and duration (p = 0.040), living in a partnership (p = 0.017), having children (p = 0.035), psycho-oncologic therapy (p = 0.043), experience with music therapy (p = 0.007), role of music in life (p = 0.035), playing an instrument (p = 0.021), and singing regularly (p = 0.003). Music therapy techniques, especially receptive methods, are feasible and well accepted in terminally ill cancer patients. Therapeutic conversation seems to play an important role. Frequency and duration of music therapy, previous experience with music and music therapy, as well as sociodemographic factors influence positive effects of music therapy.

  17. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development.

    Science.gov (United States)

    van der Steen, Jenny T; Lemos Dekker, Natashe; Gijsberts, Marie-José H E; Vermeulen, Laura H; Mahler, Margje M; The, B Anne-Mei

    2017-04-28

    When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of a small evidence base. In 2015-2016, we performed a mixed-methods qualitative study in which we (1) analysed the domains and recommendations from the European Association for Palliative Care (EAPC) dementia white paper and identified those with particular relevance for the terminal phase; (2) performed a series of focus group discussions with Dutch family caregivers of people with dementia in variable stages; (3) conducted interviews with experts involved in 15 special forms of terminal care for people with dementia in five countries. The terminal phase was defined as dying but because of the difficulty predicting it, we included advanced dementia. We initially analysed the three parts separately, followed by an integrated analysis of (1)-(3) to inform service development. (1) The EAPC domain of "avoiding overly aggressive, burdensome, or futile treatment" was regarded of particular relevance in the terminal phase, along with a number of recommendations that refer to providing of comfort. (2) Families preferred continuity in care and living arrangements. Despite a recognition that this was a time when they had complex support needs, they found it difficult to accept involvement of a large team of unfamiliar (professional) caregivers. Mostly, terminal care was preferred at the place of residence. (3) The expert interviews identified preferred, successful models in which a representative of a well-trained team has the time, authority and necessary expertise to provide care and education of staff and family to where people are and which ensure continuity of relationships with and around the patient. A mobile team that specializes in palliative care in dementia and supports professional

  18. [The anxiety and influence factors of care managers who provide a home palliative care for terminal cancer patients--a comparison between nursing staffs and others].

    Science.gov (United States)

    Furumoto, Naoko; Hirose, Kyoko; Shobatake, Tadataka; Yano, Hidemi; Okazaki, Noriko

    2010-12-01

    In home palliative care, care managers play an important part. But we suspect that care managers, who don't have a medical license, may feel an anxiety. So, we investigated if these care managers felt an anxiety, and would like to report a role of nursing staffs in home palliative care. We surveyed care managers who were working in the western part of Hiroshima. The number of care managers was 199. And 129 of them(86.9%)filled out the questionnaire. We used c 2 -test and analyzed the difference of an anxiety between nursing staffs and the others. The care managers felt an anxiety about the patient's condition and the therapy rather than nursing staffs. Nursing staffs play an important role by doing a therapeutic management for terminal cancer patients, an explanation for the family of patients, and a cooperation with other staffs.

  19. Impact of individual and market factors on the timing of initiation of hospice terminal care.

    Science.gov (United States)

    Christakis, N A; Iwashyna, T J

    2000-05-01

    Hospice terminal care is now used by 10% to 15% of elderly Americans at variable points before their deaths. By examining the duration of patient survival after enrollment in hospice care, we sought to identify individual and market factors associated with the timing of hospice use. We linked Medicare claims, census information, and Area Resource File data to form a national cohort of 151,410 hospice patients admitted in 1993 and followed up until late 1996. We examined this cohort with Cox regression and other means. The primary outcome measure was survival after hospice enrollment. The patients had a mean +/- SD age of 79.0 +/- 7.4 years; 10.2% were nonwhite; 51.4% were female; and 71.3% had cancer. Median survival after hospice enrollment was 30 days (interquartile range, 10-86 days). After adjustment for measured patient, provider, and market factors, several variables were associated with relatively earlier hospice enrollment, farther from death. Compared with complementary groups, nonwhites were enrolled in hospice 4 days earlier; women, 5 days earlier; older people, 1 day earlier; and those with substance abuse, psychiatric disease, or dementia, each 3 days earlier. After adjustment, income and education were not associated with the timing of enrollment. Patients residing in markets with more hospital beds, greater hospice capacity, or a higher proportion of generalists were enrolled earlier. Even after adjustment for certain clinical attributes, individual social factors and local market factors were associated with survival after hospice enrollment. Certain socially disadvantaged groups were enrolled earlier, as were those residing in areas with more medical institutions. The decision to enroll patients in hospice may depend on both nonclinical and clinical factors.

  20. The person from Porlock. Ethical issues in terminal care: the Dutch perspective.

    Science.gov (United States)

    Blijham, G H

    1995-01-01

    In the Netherlands medical decisions concerning end of life (MDEL) play a role in 38% of all deaths. Euthanasia, defined as an intentional termination of life by somebody else at an individual's request, is done in 1.8% of deaths. Only 4% of Dutch physicians would never perform or refer for euthanasia, and over 50% have performed euthanasia. Around 25,000 Dutch patients per year bring up euthanasia as a possibility in case suffering becomes unbearable; around 10% will finally have euthanasia performed. On the basis of these opinions and data the Dutch legislation has recently been reformed. Euthanasia remains a crime and each case will be reviewed by the district attorney. Court decisions, however, have confirmed the view that in some cases of euthanasia the physician may be confronted with conflicting obligations and therefore will not be punished. As a consequence, cases fulfilling a number of requirements will not be prosecuted. In conclusion, MDEL including euthanasia are considered ethically justifiable and legally permissible if they are part of an open, honest and careful approach to patients with unbearable suffering, in particular in the case of cancer.

  1. Initial Efficacy Testing of an Autobiographical Memory Intervention on Advance Care Planning for Patients With Terminal Cancer.

    Science.gov (United States)

    Brohard, Cheryl

    2017-11-01

    To test the efficacy of a novel intervention to facilitate advance care planning.
. Exploratory, quasiexperimental pilot study with two independent groups.
. A large hospice located in the southwestern United States. 
. A convenience sample of 50 participants with terminal cancer enrolled in hospice.
. An autobiographical memory (ABM) intervention used the participants' experiences with cancer and end of life for the purpose of directing advance care planning.
. Two domains of advance care planning, decision making and communication, were measured in relation to 11 variables. The ABM intervention was nonthreatening, short in duration, and easily completed with participants as they recalled, without hesitation, specific personal memories of family and friends who had died and their advance care plans. The Mann-Whitney nonparametric test revealed that participants in the experimental group had a higher average rank than those in the control group for communicating the decision about antibiotics, as well as exhibited a trend toward significance for five other advance care planning variables.
. Findings showed that directive ABMs may be effective in influencing the decision making and communication of advance care planning for terminally ill patients with cancer.
. The current level of understanding about using the ABM intervention suggests that nurses can initiate an advance care planning conversation using this approach.

  2. [Examination of clinical presentation in terminal-phase lung cancer patients at a single palliative care unit].

    Science.gov (United States)

    Kambayashi, Takatoyo; Nakatsukasa, Hironobu; Kawashima, Ichiro

    2013-10-01

    To study the clinical presentation of lung cancer patients at our palliative care unit (PCU). We examined the clinical presentation of lung cancer patients at our PCU and compared it with the clinical presentation of patients with malignant tumors besides those indicative of lung cancer. The PCU occupancy ratio of lung cancer patients to inpatients was 24%, which was dependent on the type of carcinoma. Lung cancer patients in need of oxygen inhalation and/or terminal sedation were more in number than those with other types of malignant tumors. On the other hand, few patients needed treatment. Dyspnea is the major reason for the terminal sedation of lung cancer patients. Severe dyspnea appeared to be the typical clinical presentation of terminal-phase lung cancer patients.

  3. Providing Informal Care in Terminal Illness: An Analysis of Preferences for Support Using a Discrete Choice Experiment.

    Science.gov (United States)

    Hall, Jane; Kenny, Patricia; Hossain, Ishrat; Street, Deborah J; Knox, Stephanie A

    2014-08-01

    The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services. This cross-sectional study used 2 discrete choice experiments to ascertain the preferences of carers supporting patients with different levels of care need, determined by the assistance needed with personal care and labeled High Care (HC) and Low Care (LC). The sample included 168 informal carers of people receiving palliative care at home from 2 palliative care services in Sydney, Australia. Data were collected in face-to-face interviews; carers chose between 2 hypothetical plans of support services and their current services. Data were analyzed with generalized multinomial logit models that were used to calculate the impact of each attribute on the probability of a carer choosing a service plan. Preferred support included nursing services; the probability of choosing a plan increased significantly if it included nurse home visits and phone advice (P situation. The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers. © The Author(s) 2013.

  4. Concepts and Definitions for “Actively Dying,” “End of Life,” “Terminally Ill,” “Terminal Care,” and “Transition of Care”: A Systematic Review

    Science.gov (United States)

    Hui, David; Nooruddin, Zohra; Didwaniya, Neha; Dev, Rony; De La Cruz, Maxine; Kim, Sun Hyun; Kwon, Jung Hye; Hutchins, Ronald; Liem, Christiana; Bruera, Eduardo

    2013-01-01

    Context The terms “actively dying,” “end of life,” “terminally ill,” “terminal care,” and “transition of care” are commonly used but rarely and inconsistently defined. Objectives We conducted a systematic review to examine the concepts and definitions for these terms. Methods We searched MEDLINE, PsycINFO, Embase, and CINAHL for published peer-reviewed articles from 1948 to 2012 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. We also searched 10 dictionaries, four palliative care textbooks, and 13 organization Web sites, including the U.S. Federal Code. Results One of 16, three of 134, three of 44, two of 93, and four of 17 articles defined or conceptualized actively dying, end of life, terminally ill, terminal care, and transition of care, respectively. Actively dying was defined as “hours or days of survival.” We identified two key defining features for end of life, terminally ill, and terminal care: life-limiting disease with irreversible decline and expected survival in terms of months or less. Transition of care was discussed in relation to changes in 1) place of care (e.g., hospital to home), 2) level of professions providing the care (e.g., acute care to hospice), and 3) goals of care (e.g., curative to palliative). Definitions for these five terms were rarely found in dictionaries, textbooks, and organizational Web sites. However, when available, the definitions were generally consistent with the concepts discussed previously. Conclusion We identified unifying concepts for five commonly used terms in palliative care and developed a preliminary conceptual framework toward building standardized definitions. PMID:23796586

  5. Impact of hospital case volume on quality of end-of-life care in terminal cancer patients.

    Science.gov (United States)

    Morishima, Toshitaka; Lee, Jason; Otsubo, Tetsuya; Ikai, Hiroshi; Imanaka, Yuichi

    2013-02-01

    Quality of end-of-life (EOL) care is gaining increasing attention. However, the relationship between hospital case volume and performance of benchmark quality indicators is not well characterized. The aim of this study was to determine whether hospital case volume affects EOL care for terminal cancer patients. We conducted a retrospective cross-sectional study using claims data of patients who died of cancer at acute-care hospitals in Kyoto prefecture, Japan, between March 2009 and May 2010. Hospitals were grouped into tertiles based on the number of terminal cancer cases. We used multilevel logistic regression models to examine the association of the following quality indicators with the tertiles: opioid use during the last 2 months of life (indicating good quality of care), provision of intensive care unit (ICU) service or life-sustaining treatments during the last month of life (poor quality), and chemotherapy during the last month of life (poor quality). The final sample for analysis consisted of 3294 decedents from 88 hospitals. Significant associations between hospital case volume and quality of EOL care were identified after adjusting for patient and hospital characteristics. Small- and medium-volume hospitals were found to be less likely to administer opioids, and medium-volume hospitals were more likely to provide ICU service or life-sustaining treatments when compared with large-volume hospitals. No significant association between chemotherapy use and case volume was observed. The results showed that the case volume of terminally ill cancer patients was associated with several aspects of quality of EOL care.

  6. Pregabalin prescription for terminally ill cancer patients receiving specialist palliative care in an acute hospital.

    Science.gov (United States)

    Yajima, Ryo; Matsumoto, Kazuaki; Ise, Yuya; Suzuki, Norihito; Yokoyama, Yuta; Kizu, Junko; Katayama, Shiro

    2016-01-01

    Pregabalin is recommended as an adjuvant analgesic for neuropathic cancer-related pain, and may be taken at all steps of the World Health Organization analgesic ladder. However, unlike opioids, pregabalin treatments are limited to an oral administration route. If patients have oral feeding difficulties, it is not possible to administer any drug as an adjuvant analgesic for neuropathic cancer-related pain. Therefore, the aim of the present study was to clarify the problems of pain control after pregabalin discontinuation in terminally ill cancer patients. Our subjects comprised cancer patients who died during their hospital stay and were referred between April 2013 and October 2015 to the palliative care team of the 899-bed Cancer Hospital at the Nippon Medical School Hospital in Japan. The medical records of each patient were retrospectively reviewed, and patient characteristics were recorded. We obtained data on 183 patients during the study period. Thirty-eight (20.8 %) patients were treated with pregabalin. Thirty-three (86.8 %) out of 38 patients were prescribed pregabalin for neuropathic cancer-related pain. The incidence of bony metastases was significantly higher in patients administered pregabalin than in those not taking the drug (non-pregabalin group 32.4 % vs pregabalin group 57.9 %). Pregabalin was ultimately discontinued in all patients, with the main reason being oral feeding difficulties (81.6 %). After the discontinuation of pregabalin, the amount of opioid drugs administered was increased in 56.5 % of patients with oral feeding difficulties. Our results demonstrated that the amount of opioid drugs administered was increased in more than 50 % of patients following the discontinuation of pregabalin, and was repeatedly increased for some patients. A new administration route is required for cancer patients unable to take oral medication. UMIN000022507. May 28, 2016 retrospectively registered.

  7. A semiparametric joint model for terminal trend of quality of life and survival in palliative care research.

    Science.gov (United States)

    Li, Zhigang; Frost, H R; Tosteson, Tor D; Zhao, Lihui; Liu, Lei; Lyons, Kathleen; Chen, Huaihou; Cole, Bernard; Currow, David; Bakitas, Marie

    2017-12-20

    Palliative medicine is an interdisciplinary specialty focusing on improving quality of life (QOL) for patients with serious illness and their families. Palliative care programs are available or under development at over 80% of large US hospitals (300+ beds). Palliative care clinical trials present unique analytic challenges relative to evaluating the palliative care treatment efficacy which is to improve patients' diminishing QOL as disease progresses towards end of life (EOL). A unique feature of palliative care clinical trials is that patients will experience decreasing QOL during the trial despite potentially beneficial treatment. Often longitudinal QOL and survival data are highly correlated which, in the face of censoring, makes it challenging to properly analyze and interpret terminal QOL trend. To address these issues, we propose a novel semiparametric statistical approach to jointly model the terminal trend of QOL and survival data. There are two sub-models in our approach: a semiparametric mixed effects model for longitudinal QOL and a Cox model for survival. We use regression splines method to estimate the nonparametric curves and AIC to select knots. We assess the model performance through simulation to establish a novel modeling approach that could be used in future palliative care research trials. Application of our approach in a recently completed palliative care clinical trial is also presented. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients.

    Science.gov (United States)

    Prizer, Lindsay P; Gay, Jennifer L; Perkins, Molly M; Wilson, Mark G; Emerson, Kerstin G; Glass, Anne P; Miyasaki, Janis M

    2017-10-01

    A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices. A cross-sectional survey study of neurologists. A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database. Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p care referral. Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

  9. [A Study on problems associated with a patient's death during home care, based on the duration of home care and patient's age-why terminal home care is difficult for a patient's family].

    Science.gov (United States)

    Ohara, Hiroo; Okabe, Hiromi; Tsuchiya, Kumiko; Kikuchi, Kana

    2012-12-01

    When a patient receives home care, an important factor is how the family accepts the patient's death. In this study, we observed that the number of long-term in-home terminal care cases increased, as well as the number of short-term in-home care cases. Moreover, the number of cancer cases among the young population is also increasing. Consequently, how to acceptance of a patient's death varies among their family. When tending to patients, suitable support from the medical staff is required. Additionally, various options need to be provided for terminal care.

  10. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD

    Directory of Open Access Journals (Sweden)

    Maite Rivera Gorrin

    2015-03-01

    Full Text Available Terminal-stage patients on peritoneal dialysis (PD are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a short-term life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis.

  11. Internação domiciliar do paciente terminal: o olhar do cuidador familiar Internación domiciliaria del paciente terminal: la visión del cuidador familiar Terminal patient home care: the family caregiver's perspective

    Directory of Open Access Journals (Sweden)

    Stefanie Griebeler Oliveira

    2012-09-01

    seres cuidados (los pacientes, explicitando cómo la comunicación es importante en el contexto del cuidar.This study was aimed at getting to know the relationships built among patients, family caregivers and the health care team, during home care, from the perspective of the family caregiver. It is a qualitative study with 11 family caregivers of terminal patients, registered on a home care service of a university hospital in the South of Brazil. Data collection was carried out through narrative interviews that were recorded, transcribed and analyzed through content analysis. Three categories were built from data analysis: Relationships among the family caregiver, the patient and the health care team; Awareness of the Patient's Terminal Condition: the Caregiver's Perspective; and Situation in which Patients are Unaware of their Terminal Condition . They approach how the home care relationships are established, among the caregivers, such as health care professionals and family caregivers, and the people who are taken care of, such as the patients, highlighting the importance of communication in such care related context.

  12. Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care.

    Science.gov (United States)

    Ubogagu, Edith; Harris, Dylan G

    2012-12-01

    Terminal haemorrhage is a rare and distressing emergency in palliative oncology. We present an algorithm for the management of terminal haemorrhage in patients likely to receive end-of-life care at home, based on a literature review of the management of terminal haemorrhage for patients with advanced cancer, where a DNAR (do not attempt resuscitation) order is in place and the patient wishes to die at home. A literature review was conducted to identify literature on the management of terminal haemorrhage in patients with advanced cancer who are no longer amenable to active interventional/invasive procedures. Electronic databases, the grey literature, local guidelines from hospitals and hospices, and online web portals were all searched systematically. The literature review was used to formulate a management algorithm. The evidence base is very limited. A three-step practical algorithm is suggested: preparing for the event, managing the event ('ABC') and 'aftercare'. Step 1 involves the identification and optimisation of risk factors. Step 2 (the event) consists of A (assure and re-assure the patient), B (be there - above all stay with the patient) and C (comfort, calm, consider dark towels and anxiolytics if possible). Step 3 (the aftercare) involves the provision of practical and psychological support to those involved including relatives and professionals. Terminal haemorrhage is a rare yet highly feared complication of advanced cancer, for which there is a limited evidence base to guide management. The suggested three-step approach to managing this situation gives professionals a logical framework within which to work.

  13. [Characteristics of the population hospitalized for advanced and terminal heart failure and experiences in palliative caring in the Intensive Care Unit of cardiology].

    Science.gov (United States)

    Bedet, A; Garçon, P; Boulogne, M; Richard, J F; Opatowski, L; Moubarak, G; Rejasse, G; Cador, R

    2015-09-01

    Advanced heart failure incidence is in progression. Palliative care access remains difficult due to its unpredictable course. The aim of this study was to describe the characteristics of patients admitted in Cardiology Intensive Care Unit for advanced heart failure who received palliative care and compare them to the whole population of acute heart failure hospitalized in the same period. The patients hospitalized for acute heart failure were retrospectively included from 2009 to 2013. We identified among them those who received palliative care. Specific caring was decided in pluridisciplinary meeting. On 940 patients included, 42 patients (4.5%) receive palliative care. Ischemic heart disease was the main etiology (n=19; 45.2%). Right ventricular dysfunction (n=34; 80.9%) was associated with supra-ventricular arrhythmia (n=28; 66.7%). Twenty-eight patients (57.1%) have died in hospital, 9 (21.4%) were referred to a palliative care unit and 8 (19.1%) was discharged or referred to a rehabilitation center. Time between inclusion and death was 6 days on average. Intra-hospital mortality in control group was 6.8%. Palliative care in cardiology is uncommon and has often been too late because of its poor adaptability to advanced heart failure. It is, as consequence, necessary to identify the prognostic factors of these patients in order to propose a personalized care and to adjust the intensity of care ahead of the terminal evolution of heart failure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

    Science.gov (United States)

    Kato, Koki; Fukuda, Haruhisa

    2017-11-01

    To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

  15. The cost of home-based terminal care for people with AIDS in South ...

    African Journals Online (AJOL)

    Objectives. To describe the costs of establishing and operating a home-based care (HBC) project providing palliative care for people with AIDS CPWA), and to project the full costs to the health care system of extending this care model. Design. Data were collected from seven sites participating in the Hospice Association of ...

  16. [Medroxyprogesterone Acetate as Part of Palliative Care for Terminal-Stage Breast Cancer Patients--A Report of Two Cases].

    Science.gov (United States)

    Okamoto, Akiko; Ueno, Hiroshi; Yamashiro, Akiko; Okada, Megumi; Nakasone, Arisa; Hatano, Takahiko; Harada, Akiho; Taniguchi, Ayano; Onishi, Keiko; Kwon, Chul; Fukazawa, Keita; Taguchi, Tetsuya; Amaya, Fumimasa; Hosokawa, Toyoshi

    2016-03-01

    Various effective strategies have recently been described in the treatment of breast cancer, including endocrine therapy, chemotherapy, and molecular-targeted therapy, providing long-term survival benefits even after cancer recurrence. However, terminal-stage patients experience side effects and worse quality of life (QOL), in addition to deterioration of their general condition caused by the progression of the disease itself. When providing the best supportive care, use of anti-cancer drugs is not taboo and can represent a good option as long as physical, social, psychological, and spiritual supports are provided to both the patients and their families. Medroxyprogesterone acetate (MPA) is an endocrine therapeutic drug. In Japan, MPA is used only as a late-line endocrine therapy for breast cancer recurrence because many other endocrine therapy drugs are much more effective and MPA increases the risk of thrombosis and obesity. Here, we report 2 patients with breast cancer who reached terminal stage more than 10 years after the first diagnosis. MPA was administered as the final-line treatment. During that time, their appetite and QOL improved and the patients became more active than when they had been undergoing aggressive anticancer treatment. Both patients spent quality time with their families until their death. MPA may be a good option as part of palliative care of breast cancer patients in terminal stage.

  17. Factors that affect quality of dying and death in terminal cancer patients on inpatient palliative care units: perspectives of bereaved family caregivers.

    Science.gov (United States)

    Choi, Jin Young; Chang, Yoon Jung; Song, Hye Young; Jho, Hyun Jung; Lee, Myung Kyung

    2013-04-01

    There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dying and death in PCUs. The aim of this study was to identify factors associated with the quality of dying and death for terminally ill cancer patients in PCUs. Data were collected from 570 bereaved family caregivers of terminally ill cancer patients. All patients were registered and died in one of the 40 inpatient PCUs designated by the Korean Ministry of Health and Welfare. We assessed the perceived timing of referral to a PCU; the quality of end-of-life cancer care with the Care Evaluation Scale; and the quality of dying and death with the Good Death Inventory. The perception of appropriate timing of referral, use of a community-based PCU, and higher quality of cancer care as assessed by the Care Evaluation Scale were associated with good dying and death in all domains of the Good Death Inventory. The good quality of end-of-life care in a PCU improves the quality of dying in terminally ill cancer patients. The data have the potential to guide the development of interventions aimed at achieving a good quality of dying for patients with terminal cancer. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  18. Palliative care consultation versus palliative care unit: which is associated with shorter terminal hospitalization length of stay among patients with cancer?

    Science.gov (United States)

    Alsirafy, Samy A; Abou-Alia, Ahmad M; Ghanem, Hafez M

    2015-05-01

    Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [±9.4] vs 17.8 [±19.7] days, respectively; P terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service. © The Author(s) 2013.

  19. The evaluation of the relationship between the level of disclosure of cancer in terminally ill patients with cancer and the quality of terminal care in these patients and their families using the Support Team Assessment Schedule.

    Science.gov (United States)

    Nakajima, Nobuhisa; Hata, Yoshinobu; Onishi, Hideki; Ishida, Mayumi

    2013-06-01

    To examine the relationship between informing patients of cancer and the quality of terminal care. This was a study of 87 consecutive terminally ill cancer patients who died during the last 27-month period. Notification of cancer was classified into 4 groups (A, B, C, and D, respectively): "nondisclosure," "disclosure of cancer diagnosis," "disclosure of life threatening," and "disclosure of poor prognosis." We evaluated the quality of palliative care using Support Team Assessment Schedule-Japanese (STAS-J). A, B, C, and D groups included 8, 22, 37, and 20 cases, respectively. Regarding physical symptoms, no marked difference was noted. Anxiety was significantly reduced, and the recognition of disease conditions and the level of communication were significantly higher in the groups that received specific information (P terminal care.

  20. Vulnerability to Foster Care Drift after the Termination of Parental Rights

    Science.gov (United States)

    Cushing, Gretta; Greenblatt, Sarah B.

    2009-01-01

    Objectives: After the termination of parental rights (TPR), there is no guarantee that youth will achieve legal permanence through adoption either quickly or at all. This study identifies obstacles in reaching adoption after TPR. Methods: Data are extracted via brief case reviews of 640 children and in-depth case reviews of 145 children to…

  1. Projected Image and Observed Behavior of Physicians in Terminal Cancer Care.

    Science.gov (United States)

    Family, Gilla

    1993-01-01

    Reports on abandoned study examining potential benefits of psychotherapy to terminal cancer patients. Preliminary feasibility study found physicians' attitudes toward their dying patients as reformed and progressive. Interest shown by physicians did not translate into tangible research effort in spite of active pursuit by investigator over period…

  2. Outcomes of Palliative Care Team Consultation for Ventilator Withdrawal from Terminally Ill Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Wen-Hao Su

    2016-09-01

    Conclusion: In our study, ventilator withdrawal is more acceptable for intensive-care physicians when cardiac arrest had happened previously, and late referral for palliative care is frequently in the ICU. The survival time after ventilator removal was not shorter for those with do not resuscitate status. For the purpose of better end-of-life care, the promotion of education for palliative care is necessary.

  3. The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues.

    Science.gov (United States)

    Lee, June Koo; Yun, Young Ho; An, Ah Reum; Heo, Dae Seog; Park, Byeong-Woo; Cho, Chi-Heum; Kim, Sung; Lee, Dae Ho; Lee, Soon Nam; Lee, Eun Sook; Kang, Jung Hun; Kim, Si-Young; Lee, Jung Lim; Lee, Chang Geol; Lim, Yeun Keun; Kim, Samyong; Choi, Jong Soo; Jeong, Hyun Sik; Chun, Mison

    2014-08-01

    Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent). The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care. © The Author(s) 2013.

  4. Does Disclosure of Terminal Prognosis Mean Losing Hope? Insights from Exploring Patient Perspectives on Their Experience of Palliative Care Consultations.

    Science.gov (United States)

    Coulourides Kogan, Alexis; Penido, Marcia; Enguidanos, Susan

    2015-12-01

    A primary barrier to physician disclosure of terminal prognosis is concern that patients will lose hope. Inpatient palliative care (IPC) teams are especially posed to mediate this barrier, but little is known about patient perceptions and experience of IPC. This study aimed to elicit seriously ill patients' perspective and experience of an IPC consultation, and to explore patient attitudes toward information derived from the consultation. An exploratory, qualitative study was conducted at a large nonprofit community hospital in the Los Angeles area. An established IPC team conducted individualized consults with patients and families within 24 hours of referral. Eligible participants were English-speaking adults, aged 18 or over, who had received an IPC consultation within the previous week during their hospitalization. Purposive recruitment of patients was conducted by the IPC social worker. Interviews were conducted at bedside using a semistructured interview protocol employing open-ended questions. Twelve seriously ill patients were interviewed. Four themes were identified from the interview transcripts: (1) holistic care approach, (2) knowledge/information gained, (3) hope and enlightenment, and (4) patient readiness. Results suggest that disclosure of a terminal prognosis does not mean loss of patient hope. Instead, hope was redefined on a goal other than cure. Presenting patients with information and increasing their knowledge about care options and resources may facilitate patients in identifying meaningful goals that are better aligned with their prognosis.

  5. Can a good death and quality of life be achieved for patients with terminal cancer in a palliative care unit?

    Science.gov (United States)

    Leung, Kai-Kuen; Tsai, Jaw-Shiun; Cheng, Shao-Yi; Liu, Wen-Jing; Chiu, Tai-Yuan; Wu, Chih-Hsun; Chen, Ching-Yu

    2010-12-01

    Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. This study was designed to evaluate the change of quality of life and quality of death over time and between patients of long and short survival in a palliative care unit. Patient demography, cancer sites, Eastern Cooperative Oncology Group (ECOG) status were collected at admission. Quality of life, including physical and psychological symptoms, social support, and spirituality was assessed daily after admission. Quality of death was assessed by a Good Death Scale (GDS) at admission and retrospectively for 2 days before death. A total of 281 patients (52% women) were admitted and died in the study period. One hundred forty-five patients (51.6%) died within 3 weeks. Although those with short survival (quality of life dimensions at admission, at 1 week, and at 2 days before death between survival groups. Physical conditions deteriorated with time but other dimensions continued to improve until death. GDS and subdimensions continued to improve until death. Although those with long survival (≥3 weeks) have better scores for awareness, acceptance, timeliness, comfort, and GDS at admission, there was no difference between the two groups at 2 days before death. Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.

  6. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD).

    Science.gov (United States)

    Gorrin, Maite Rivera; Teruel-Briones, José Luis; Vion, Victor Burguera; Rexach, Lourdes; Quereda, Carlos

    2015-01-01

    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis. Copyright © 2015. Published by Elsevier España, S.L.U.

  7. [Home care service at the division of general medicine in Jichi Medical University Hospital--the terminal stage cancer patient's care in the past 3 years].

    Science.gov (United States)

    Tsuruoka, Yuko; Tsuruoka, Koki; Amagai, Yoko; Kajii, Eiji

    2007-12-01

    We have provided a home care service for the past 20 years as a part of our community medical program at the Division of General Medicine in Jichi Medical University Hospital (JMUH). We reflected our activities of the past 3 years since 2004, and considered our meanings of home care service at the University Hospital. Especially, we reported on terminal stage cancer patients who died in the past 3 years. We normally visit about 10 homes of our patients who live near the University Hospital. There has been a decreasing trend toward a regular home visit by doctor, but an emergency visit has been increasing. Further more, we visited many elderly cerebral vascular patients in the past. However, many terminal stage cancer patients have now been requesting us to visit their homes. A total of 17 patients died in the past 3 years: 10 of 17 patients died at their homes, and 6 of them were terminal stage cancer patients who died at their homes.

  8. [Euthanasia in history and the present - in the spectrum between euthanasia and terminal care].

    Science.gov (United States)

    von Engelhardt, Dietrich

    2010-01-01

    Euthanasia signifies in antiquity an easy and happy death and not at all an active termination of life, which was forbidden in the Hippocratic oath, but justified by philosophers. In the Christian middle ages active euthanasia and abortion are explicitly refused. At the beginnings of modern times MORE (1516) and BACON (1623) plead for euthanasia and differentiate for the first time between "euthanasia interior" as a mental preparation and "euthanasia exterior" as a physical and direct termination of life. Around 1900 a change takes place--in medicine as well as in the humanities and arts. The lawyer Karl BINDING and the psychiatrist Alfred HOCHE (1920) support active euthanasia in the case of mental deficiency; similar views are taken by the population. Under the "Third Reich" euthanasia unlawfully is carried out as termination of life without or even against consent. Today oaths, declarations and laws are intended to prevent such a "medicine without humanity" (MITSCHERLICH and MIELKE 1947). Active voluntary euthanasia is under certain conditions allowed by the legislation in some countries (Netherlands, Belgium, Luxembourg). Essential seem the consideration of different types of euthanasia and above all a psychical-mental assistance in the process of dying. The height of culture is measured by dealing with death and dying.

  9. [Current situation of available back-up beds for terminal home care patients].

    Science.gov (United States)

    Kato, Toshihiko; Takahashi, Osamu; Shimizu, Kazuko; Chiba, Yasuko

    2014-12-01

    The Palliative Care Unit at Heiwa Hospital has 16 beds, and offers inpatient support in general wards, as well as back-up beds in emergencies in collaboration with local home care support clinics. For two years from January 2012 to December 2013, there were 1,213 cases where patients were seen for initial outpatient visits at the Department of Palliative Care. At the time of the initial visit, visiting medical care had been introduced for 25% of the cases. Although 59% of the patients who visited our department are hospitalized, 20% of inpatients have been hospitalized at the request of their home care physician. The availability of back-upbeds offers patients and their families, as well as related medical institutions, a sense of security, and enables home care to continue. The significance of back-upbeds will become even more important in the future.

  10. The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography.

    Science.gov (United States)

    Offen, John

    2015-03-01

    To explore the role of UK district nurses in providing care for adult patients with a terminal diagnosis by reviewing qualitative research. Meta-ethnography was used to conduct the synthesis. CINAHL, MEDLINE and British Nursing Index (BNI) were searched comprehensively for primary research relating to the role of UK district nurses in palliative care. The abstracts and titles of 700 papers were screened against inclusion criteria, of these 97 full papers were appraised. Some 24 studies reported in 25 papers were selected for inclusion in the synthesis. In total, five key themes were identified: valuing the role; practical role; relationships with patients and families; providing psychological support; and role uncertainty. Further synthesis yielded two 'lines of argument'. The concept of the 'expert friend' argues that the atypical relationship district nurses cultivate with patients underpins district nurses' provision of palliative care and profoundly influences the nature of psychological support given. Secondly, the concept of 'threat and opportunity' encapsulates the threat district nurses can feel to their traditional role in palliative care through changing health and social policy, while recognising the benefits that access to specialist knowledge and better training can bring. The findings have implications for understanding the motivators and barriers experienced by district nurses delivering palliative care in a time of unprecedented change to community health services.

  11. Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients

    DEFF Research Database (Denmark)

    Skorstengaard, Marianne H.; Neergaard, Mette A.; Andreassen, Pernille

    2017-01-01

    Objectives: The dual aim of this study is, first, to describe preferred place of care (PPOC) and preferred place of death (PPOD) in terminally ill patients with lung and heart diseases compared with cancer patients and second, to describe differences in level of anxiety among patients...... to be cared for and to die at home. Patients with cancer and heart diseases chose hospice as their second most common preference for both PPOC and PPOD, whereas patients with lung diseases chose nursing home and hospice equally frequent as their second most common preference. Regardless of their diagnosis......-sectional study. Setting: Eligible patients from the recruiting departments filled in questionnaires regarding sociodemographics, PPOC and PPOD, and level of anxiety. Results: Of the 354 eligible patients, 167 patients agreed to participate in the study. Regardless of their diagnosis, most patients wished...

  12. End-of-life issues in caring for patients with dementia: the case for palliative care in management of terminal dementia.

    Science.gov (United States)

    Coleman, Albert M E

    2012-02-01

    The number of people suffering with dementia is increasing in the general population and the trend is projected to continue as people live longer, especially in countries with developed economies. The most common cause of dementia (among the many other causes) is Alzheimer's dementia, which is considered a terminal illness. The disease could eventually lead to death, or death could occur as a consequence of co-morbid physical complications. The problem of end of life (EOL) care for patients suffering from dementia though spoken of and written about, does not get the attention and system support as for example patients suffering from cancer receive. Many reasons have been advanced for the current state of affairs where EOL issues for patients suffering from dementia are concerned. This article attempts to revisit the issues, and the reasons, that may contribute to this. Some guidelines on palliative management in cases of patients suffering from severe dementia exist; the evidence base for these guidelines though is relatively weak. The ethical and legal issues that may influence or impact on the decision to initiate the palliative care pathway in the management of EOL issues for dementia patients in the terminal or end stage of the illness is highlighted. Initiatives by the department of health in England and Wales, and other bodies with interest in dementia issues and palliative care in the United Kingdom to ensure good and acceptable EOL pathways for patients with dementia are mentioned.

  13. [Terminal care education and consultation activities in advance of the critical stage of disease by attending physicians at a rehabilitation unit].

    Science.gov (United States)

    Sato, Takeshi; Makigami, Kuniko

    2008-07-01

    We aimed to examine the effectiveness of information provided by a physician to patients and their family in a geriatric rehabilitation unit for facilitating terminal care decision-making process. The subjects were 338 patients who entered our rehabilitation unit between July 2005 and June 2007. Of the 338 patients, we provided terminal care consultation for 224 upon admission. We surveyed the 224 patients who received consultation as well as the 114 patients who did not, and examined the effect of the consultations on decision-making regarding terminal care. In both the intervention and non-intervention groups, approximately half of the patients' families had an opportunity to discuss terminal care prior to entering the hospital. The intervention group, however, had a significantly higher ratio (42.0%) of having the opportunity to discuss terminal care among their family members after leaving the hospital. In the non-intervention group, 31.4% had the knowledge of an artificial respirator and 37.1% tube feeding. This was low compared to the intervention group, among 60% understood both. Among the intervention group, there were many who desired these consultations to be provided far in advance of the critical stage of disease to allow more time to make end-of-life decisions. Furthermore, 60% of the intervention group indicated that the terminal care consultations were effective and useful. In light of these results, physicians should provide terminal care consultations before death is imminent. Since this will encourage self decision-making and help clarify the family's intentions, these kinds of consultations should be more actively implemented.

  14. End of life care for terminally ill-patients in North West of Iran

    Directory of Open Access Journals (Sweden)

    Hossein Jabbari

    2014-11-01

    Full Text Available Introduction: Nowadays chronic disease and number of elderly population climb in low and middle-income countries and need for high-quality hospice care services for them. The aim of this study was to review the experience of hospitalized end of life (EOL patients and their family’s regarding hospice care. Methods: In this qualitative study with the phenomenological approach, 20 patients and their families were chosen using purposive sampling to achieve data saturation from the Tabriz University of Medical Sciences Hospitals, Iran. The required data were collected using in deep semi-structured interviews and analyzed using Diekelmann method. Results: Patients and their family’s experiences included 7 main themes: lack of special education for healthcare providers, preferences, financial problems, health care quality, lack of providing information to patients and their families, limitation in life due to disease, burdens to EOL care for family. Conclusion: Due to the lack of experience in hospice care in Iran, patients, families and health care provider not have adequate knowledge about hospice. The cost of this service is high, and qualities of these services are low. Furthermore provide educational courses for patients, families and health care provider and decrease of cost and improve of quality are necessary.

  15. The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients.

    Science.gov (United States)

    Ahn, Eunmi; Shin, Dong Wook; Choi, Jin Young; Kang, Jina; Kim, Dae Kyun; Kim, Hyesuk; Lee, Eunil; Hwang, Kwan Ok; Oh, Bumjo; Cho, BeLong

    2013-12-01

    We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Experiences of truth disclosure in terminally ill cancer patients in palliative home care.

    Science.gov (United States)

    Friedrichsen, Maria; Lindholm, Ann; Milberg, Anna

    2011-06-01

    The aim of this study was to explore the experiences and preferences of terminally ill cancer patients regarding truth telling in the communication of poor prognoses. We recorded and transcribed interviews with 45 patients who knew their cancer was terminal, and analyzed their responses hermeneutically. Patients identified three different modes of truth: (1) the absolute objective truth that they are dying; (2) the partial truth about their condition including some facts but not all of the details; and (3) the desired truth, originating in the patient's own beliefs about a healthy or better life. Coping strategies were related to patients' preferred mode of truth: (1) facing the truth in order to take action; (2) facing some parts of the truth in order to maintain hope; and (3) hovering between facing and avoiding the truth. In their struggle for existential survival, patients used different coping strategies, changing from one to another depending upon the circumstances. Varying use of different coping strategies impacts on patient preferences concerning communication about bad news with their doctors. Truth-telling entails more than merely providing information related to the forthcoming death. It also concerns how physicians or other healthcare staff can support the patient's existential survival by fine-tuning the communication of "truth" according to the individuals' preferences.

  17. Values important to terminally ill African American older adults in receiving hospice care.

    Science.gov (United States)

    Noh, Hyunjin

    2014-01-01

    While racial disparity in the use of hospice care by older African Americans is widely acknowledged, little is known about the values that they consider as important in receiving health care services along with direct experiences with having these values respected by hospice care providers. Using individual, face-to-face interviews, data were collected directly from 28 African American hospice patients about their experiences in hospice care. Content analysis was used to identify and categorize themes from multiple readings of the qualitative data. Resulting themes included: dying at home, open communications, independent decision-making, autonomy in daily life, unwillingness to be a burden, and relationships. Through the initial assessment, value preferences can be explored and then shared with hospice team members to ensure that services are provided in such a way that their values and preferences are respected.

  18. [The Home Care Doctor Today is "STRIKE" - Considering Care of Terminal Stage Patients with Cancer through a Case Report].

    Science.gov (United States)

    Ogihara, Miyoko; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-12-01

    Although many patients wish to remain in their familiar home environment while undergoing cancer treatment, many obstacles prevent a patient from receiving cancer care at home. With early-stage cancer, the patients may better accept the diagnosis and have a greater will to fight the illness. However as time proceeds, progression or recurrence of cancer may occur, and eventually, proactive treatments will not be available. This progression results in great physical and mental strain on the patients and their family. At all stages of such progression, opportunities exist for a care provider to assist with overcoming potential obstacles by openly communicating with the patients, talking through the patients' experiences, and understanding their feelings. However, on diagnosis, cancer patients must often face the reality that they have very little time left to live. When transiting medical care from their long-trusted hospital to a home care base, a new physician must be selected and other decisions related to their care must be quickly made. Transferring responsibility to a good home care provider can greatly influence a patient's emotional state. This paper reports one such case in which the patients died in their homes with the best comfort and possible outcome.

  19. Dying at home: nursing of the critically and terminally ill in private care in Germany around 1900.

    Science.gov (United States)

    Nolte, Karen

    2009-06-01

    Over the last twenty years, 'palliative care' has evolved as a special nursing field in Germany. Its historic roots are seen in the hospices of the Middle Ages or in the hospice movement of the twentieth century. Actually, there are numerous everyday sources to be found about this subject from the nineteenth century. The article at hand deals with the history of nursing the terminally ill and dying in domestic care in the nineteenth century. Taking care of and nursing the dying was part of everyday routine in the nursing care as practiced by the deaconesses and sisters in those days. Mit der Seelenpflege bei den unheilbar Kranken und Sterbenden schufen die Kaiserswerther Diakonissen sich einen von Arzten unabhängigen Kompetenzbereich. Meine Analysen zur Privatpflege zeigen jedoch darüber hinaus, dass die in ihrer Aufmerksamkeit auf das Mutterhaus ausgerichteten Diakonissen auch in Leibespflege sehr viel unabhängiger von den Arzten zu agieren schienen als die freien Krankenschwestern. The article takes a look not only at the actual nursing activities but also at the relationship between the sisters and their patients and their relatives and the family doctor. On the basis of the recorded letters which the nurses wrote to the deaconess motherhouse in Kaiserswerth, it is also possible to analyze how the deaconesses communicated and reflected their actions at the deathbed.

  20. Narratives of 'terminal sedation', and the importance of the intention-foresight distinction in palliative care practice.

    Science.gov (United States)

    Douglas, Charles D; Kerridge, Ian H; Ankeny, Rachel A

    2013-01-01

    The moral importance of the 'intention-foresight' distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating 'slow euthanasia'. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some 'mental gymnastics,' the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of 'terminal' sedation--cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. © 2011 Blackwell Publishing Ltd.

  1. Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study.

    Science.gov (United States)

    Tardy, B; Picard, S; Guirimand, F; Chapelle, C; Danel Delerue, M; Celarier, T; Ciais, J-F; Vassal, P; Salas, S; Filbet, M; Gomas, J-M; Guillot, A; Gaultier, J-B; Merah, A; Richard, A; Laporte, S; Bertoletti, L

    2017-03-01

    Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors. Background The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown. Objectives Our primary aim was to assess the bleeding risk of patients in a real-world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding. Patients/Methods In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non-major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis. Results The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3-11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2-1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months. Conclusions Decisions regarding the use of thromboprophylaxis in palliative

  2. Evaluation of inpatient multidisciplinary palliative care unit on terminally ill cancer patients from providers' perspectives: a propensity score analysis.

    Science.gov (United States)

    Cheng, Shao-Yi; Dy, Sydney; Fang, Pai-Han; Chen, Ching-Yu; Chiu, Tai-Yuan

    2013-02-01

    The effectiveness of inpatient palliative care units, a complex intervention, is challenging to evaluate due to methodological and practical difficulties. We conducted a study to evaluate providers' perceived effectiveness of one such unit. A non-concurrent, prospective, controlled study using the Audit Scale for good death services as an indicator of process of care and the Good Death Scale as the outcome of provider assessment of quality of dying was conducted. Eighty of 212 terminally ill cancer patients were matched from a tertiary medical center in Taiwan. Patients in the unit served as the intervention group and patients in the oncology ward served as controls. Multiple logistic regression was applied to estimate the propensity of choosing the unit for each patient, and linear regression analysis was conducted to identify predictive factors for mean change scores of the Good Death Scale. Male gender (P < 0.001, 95% confidence interval = 0.73-2.43) was associated with better quality of dying while having hepatocellular carcinoma (P < 0.004, 95% confidence interval = -2.22 to -0.44) was associated with worse quality. For those in the unit, higher total Audit Scale scores were positively related to the outcome of quality of dying. The unit (P < 0.001, 95% confidence interval = 8.67-12.97) and higher Good Death Scale at admission (P < 0.001, 95% confidence interval = 0.44-1.13) were predictors of Audit Scale scores. Admission to a palliative care unit was associated with higher provider assessments of quality of dying for terminally ill cancer patients. These units should be considered as options for hospitals looking for ways to improve the quality of dying for patients.

  3. [The actual conditions and problems of terminal home nursing care at our hospital].

    Science.gov (United States)

    Hara, Tsuyoshi; Kawashiri, Hiroaki; Hirakata, Makoto; Yamasaki, Misaki; Sato, Mariko; Miura, Hiroshi; Murata, Tsuneari; Takagi, Hiroaki

    2009-12-01

    In 2006, we reconfirmed Suwachuo hospital slogan as "When there is a need of community, we will do our best to meet it" and the department of home nursing care is officially established in our hospital next spring. A death rate at home is generally used to evaluate a home nursing care, and this rate at our department was 60.8% in 2008. However, community needs various options in addition to death at home. Keeping an eye on community opinions is of great importance.

  4. Terminal cancer patients' and their primary caregivers' attitudes toward hospice/palliative care and their effects on actual utilization: A prospective cohort study.

    Science.gov (United States)

    An, Ah Reum; Lee, June-Koo; Yun, Young Ho; Heo, Dae Seog

    2014-07-01

    Previous studies on hospice/palliative care indicated that patients' socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated. To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities. A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient's death, caregivers were interviewed whether they utilized hospice/palliative care facilities. A total of 359 patient-caregiver dyads completed baseline questionnaires. After the patients' death, 257 caregivers were interviewed. At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16-3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20-3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver's preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53-4.67). No patient-related factors were associated with hospice/palliative care utilization. Promoting awareness of prognosis and to

  5. You're All Grown up Now: Termination of Foster Care Support at Age 18

    Science.gov (United States)

    Avery, Rosemary J.; Freundlich, Madelyn

    2009-01-01

    This article considers the repercussions of discharging youth from foster care at age 18 based on recent research demonstrating that youth at this age are not developmentally prepared to live independently and have a continued need for strong social scaffolding during emerging adulthood. Drawing upon recent research findings, we make…

  6. [Sharing information of urological cancer patient in terminal stage using Cybozulive® for home medical care].

    Science.gov (United States)

    Yumura, Yasushi; Hattori, Yusuke; Gobara, Ayako; Takamoto, Daiji; Yasuda, Kengo; Nakamura, Masafumi; Noguchi, Kazumi; Asahina, Kan; Kamijo, Takeo

    2014-09-01

    It is very important to share patient information because home patient care involves several different specialties of care. We introduced Cybozulive ® , a cloud-based free groupware, for 14 terminal-stage patients with urological cancer to share information among doctors and co-medical staff. This system enables access to patient information regardless of time and place. Of the 14 patients (mean age 74.4 years), 11 died of cancer. The average period in which Cybozulive® was used for the patients was 210 days. The average number of entries to the electronic bulletin board in this period was 88.4. We were able to obtain more information about the patients from the website. There was no difference in the average number of times that the patient consulted the out patient clinic before and after the introduction of Cybozulive® (before 7.0 ; after 6.3). After introduction of this system, eleven patients were hospitalized in our department 21 times. Eighteen of these 21 times, since we had acquired patient information from the website beforehand, there was a quick response for management of the emergency admission. This system could be used to construct a network for home care and may be helpful for sharing patient information in homecare.

  7. Sequential Assessments of the Eastern Cooperative Oncology Group Performance Scale Enhance Prognostic Value in Patients With Terminally Ill Cancer Receiving Palliative Care.

    Science.gov (United States)

    Peng, Meng-Ting; Liu, Chien-Ting; Hung, Yu-Shin; Kao, Chen-Yi; Chang, Pei-Hung; Yeh, Kun-Yun; Wang, Hung-Ming; Lin, Yung-Chang; Chou, Wen-Chi

    2016-06-01

    This study aimed to assess the utility of the Eastern Cooperative Oncology Group (ECOG) performance scale assessments on days 1 and 8 of palliative care, as well as scale change between these assessments, as prognostic tools for patients with terminally ill cancer. A total of 2392 patients with terminally ill cancer who received palliative care between January 2006 and December 2011 at a single medical center were analyzed. Our study showed that the ECOG scale is a useful prognostic tool to predict life expectancy in patients with terminally ill cancer. The ECOG scale assessments at different time points under palliative care were independent predictors for overall survival. The combined ECOG scale assessments on days 1 and 8 predicted survival more precisely than using day 1 ECOG scale assessment alone. © The Author(s) 2014.

  8. The importance of palliative care provided by the nurse for children with cancer in terminal phase

    Directory of Open Access Journals (Sweden)

    Williana Pires Araujo

    2014-07-01

    Full Text Available Objetivo: Refletir sobre a importância dos cuidados paliativos prestados pelo enfermeiro à criança com câncer em estágio terminal. Métodos: Estudo de caráter descritivo-exploratória, realizado nas bases de dados: LILACS, BDENF e SCIELO no período de 2000 a 2010, onde selecionou 10 bibliografias potencias. Resultados: As categorias emergentes foram “O enfermeiro e as dificuldades de aceitação da criança em fase terminal”, "A comunicação como elo entre a equipe de enfermagem, criança com câncer e sua família" e "A importância da assistência de enfermagem à criança com câncer em cuidados paliativos". Conclusão: Os resultados deste estudo ratificam a importância da atuação do enfermeiro, onde a proximidade de vínculos permitirá uma prática de enfermagem mais efetiva e consciente entre todos os envolvidos. Descritores: Cuidados Paliativos, Câncer na Criança, Assistência de Enfermagem.

  9. The "Palliative Care Quality of Life Instrument (PQLI" in terminal cancer patients

    Directory of Open Access Journals (Sweden)

    Kouvaris John

    2004-02-01

    Full Text Available Abstract Background This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. Methods The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. Results The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item scales met the minimal standards for reliability (Cronbach's alpha coefficient ≥.70 either before or during palliative treatment. Test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p Conclusion The PQLI is a reliable and valid measure for the assessment of quality of life in patients with advanced stage cancer.

  10. The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin.

    Science.gov (United States)

    Michiels, Eva; Deschepper, Reginald; Van Der Kelen, Greta; Bernheim, Jan L; Mortier, Freddy; Vander Stichele, Robert; Deliens, Luc

    2007-07-01

    Exploring terminal patients' perceptions of GPs' role in delivering continuous end-of-life care and identifying barriers to this. Qualitative interview study with patients (two consecutive interviews). Primary care Belgium. Seventeen terminally ill cancer patients, informed about diagnosis and prognosis. Terminal patients attribute a pivotal role to GPs in different aspects of two types of continuity. Relational continuity: having an ongoing relationship with the same GP, of which important aspects are eg, keeping in touch after referral and feeling responsible for the patient. Informational continuity: use of information on past events and personal circumstances to provide individualised care, of which important aspects are eg, exchange of information between GPs, specialists and care facilities. Patients also identify barriers to continuity eg, lack of time and of GPs' initiative. At the end of life when physicians can no longer rely on biomedical models of diagnosis-therapy-cure, patients' perspectives are of utmost importance. This qualitative study made it possible to gain insights into terminal patients' perceptions of continuous primary end-of-life care. It clarifies the concept and identifies barriers to it.

  11. Do patients with lung cancer recall physician-initiated discussions about planning for end-of-life care following disclosure of a terminal prognosis?

    Science.gov (United States)

    Horne, Gillian; Payne, Sheila; Seymour, Jane

    2016-02-03

    Communicating with patients about their prognosis and goals of care, including offering opportunities to engage in advance care planning (ACP) is widely recognised as best practice. Little is known about terminally ill patients' perceptions of communication and ACP practice following disclosure of their terminal prognosis. To examine whether terminally ill patients with lung cancer and their relatives recall conversations with disclosing physicians, about their concerns, goals of care or any offers to engage in ACP. Qualitative study using semistructured interviews with patients and their family members. The study setting was a cancer centre and cancer unit in northern England. 25 patients with advanced lung cancer (18 men and 7 women, aged 47-85) and 19 family members, mainly from lower social economic classes, took part in the study. Participants had little or no recall of physicians initiating discussions about their concerns, or goals of care and did not perceive that they had been provided with either information about or opportunities to engage in ACP. Some participants reported a sense of abandonment following the disclosure of a terminal prognosis. This sense was compounded by a range of difficult emotional experiences following the disclosure. It may be inappropriate to initiate discussions about end-of-life care planning immediately following the disclosure of a terminal prognosis. To avoid patients feeling abandoned physicians need to consider how they or another appropriate person can provide information and opportunities for terminally ill patients to engage in a process of ACP. 06/Q2307/22. 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/

  12. Dying patients' need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers.

    Science.gov (United States)

    Wenrich, Marjorie D; Curtis, J Randall; Ambrozy, Donna A; Carline, Jan D; Shannon, Sarah E; Ramsey, Paul G

    2003-03-01

    This study addressed the emotional and personal needs of dying patients and the ways physicians help or hinder these needs. Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care workers, and physicians. Content analyses were performed based on grounded theory. Emotional support and personalization were 2 of the 12 domains identified as important in end-of-life care. Components of emotional support were compassion, responsiveness to emotional needs, maintaining hope and a positive attitude, and providing comfort through touch. Components of personalization were treating the whole person and not just the disease, making the patient feel unique and special, and considering the patient's social situation. Although the levels of emotional support and personalization varied, there was a minimal level, defined by compassion and treating the whole person and not just the disease, that physicians should strive to meet in caring for all dying patients. Participants also identified intermediate and advanced levels of physician behavior that provide emotional and personal support.

  13. Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit.

    Science.gov (United States)

    Vickery, K; Deva, A; Jacombs, A; Allan, J; Valente, P; Gosbell, I B

    2012-01-01

    Despite recent attention to surface cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. To establish whether reservoirs of MROs exist in the environment as biofilms. Following terminal cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Biofilm containing MROs persist on clinical surfaces from an ICU despite terminal cleaning, suggesting that current cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. Palliative care after attempted suicide in the absence of premorbid terminal disease: a case series and review of the literature.

    Science.gov (United States)

    Eastman, Peter; Le, Brian

    2013-02-01

    Palliative care involvement in the management of incomplete suicide in patients without terminal illness is rare. This paper documents two such cases and explores some of the clinical and ethical issues raised. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  15. Meaning of care for terminally Ill HIV-infected patients by HIV-infected peer caregivers in a simulation-based training program in South Korea.

    Science.gov (United States)

    Kim, Sunghee; Shin, Gisoo

    2015-01-01

    The purpose of this study was to develop a simulation-based training program for people living with HIV (PLWH) as peer caregivers who would take care of terminally ill, HIV-infected patients. We used qualitative research methods and standardized patients to explore the meaning of caring for patients as peer caregivers. Study participants included 32 patients registered as PLWH at the South Korea Federation for HIV/AIDS. The meanings of peer caregiving were categorized into four dimensions: physical, psychological, relational, and economic. Our study had benefits in knowledge acquisition for caregivers as well as care recipients, empathy with HIV-infected care recipients, improvement in self-esteem and social participation, and financial self-sufficiency to enable independent living for caregivers. The simulation training program for PLWH peer caregivers for terminally ill HIV-infected patients demonstrated value, for both PLWH caregivers and terminally ill HIV-infected patients in South Korea, to improve the quality of care. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  16. [Ethics in intensive care and euthanasia : With respect to inactivating defibrillators at the end of life in terminally ill patients].

    Science.gov (United States)

    Trappe, H-J

    2017-04-01

    In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise. Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed. It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.

  17. What influences the willingness of community physicians to provide palliative care for patients with terminal cancer? Evidence from a nationwide survey.

    Science.gov (United States)

    Peng, Jen-Kuei; Chiu, Tai-Yuan; Hu, Wen-Yu; Lin, Cheng-Chieh; Chen, Ching-Yu; Hung, Shou-Hung

    2013-03-01

    Community physicians have a vital role in delivering palliative care, yet their willingness and factors that influence its provision have rarely been explored. Our aims were to identify the willingness of community physicians to provide palliative care for patients with terminal cancer and to investigate the factors that influence their willingness to provide such care. Through a structured questionnaire, this nationwide study surveyed 708 community physicians who were potential pilots to provide palliative care. Four hundred and ten valid questionnaires (58.0%) were retrieved and analysed. The majority of respondents expressed a willingness (92.4%) to provide palliative care if they encountered patients with terminal cancer. However, they would limit their services to consultation (83.4%) and referral (86.8%), and were less likely to see patients and prescribe medicine (62.0%), to provide phone follow-ups (45.6%), to provide home visits (42.2%) or to offer bereavement care for the family (35.1%). The results of stepwise logistic regression analysis for the willingness to provide home visits showed that 'less perception of barriers', 'family medicine specialist' and 'older than 50 years' significantly predicted higher willingness, while 'female' predicted lower willingness. There was no significant association between the willingness and the knowledge score. Community physicians' beliefs and experience in palliative care rather than their knowledge influence their willingness to provide palliative care for patients with terminal cancer. Only through active participation in the real-world clinical setting and active health policy administration can community physicians overcome obstacles to providing palliative care.

  18. Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey.

    Science.gov (United States)

    Huang, Hsien-Liang; Yao, Chien-An; Hu, Wen-Yu; Cheng, Shao-Yi; Hwang, Shinn-Jang; Chen, Chih-Dao; Lin, Wen-Yuan; Lin, Yen-Chun; Chiu, Tai-Yuan

    2017-12-06

    Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death." The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  19. A Structured Approach to End-of-Life Decision Making Improves Quality of Care for Patients With Terminal Illness in a Teaching Hospital in Ghana.

    Science.gov (United States)

    Edwin, Ama Kyerewaa; Johnson McGee, Summer; Opare-Lokko, Edwina Addo; Gyakobo, Mawuli Kotope

    2016-03-01

    To determine whether a structured approach to end-of-life decision-making directed by a compassionate interdisciplinary team would improve the quality of care for patients with terminal illness in a teaching hospital in Ghana. A retrospective analysis was done for 20 patients who consented to participate in the structured approach to end-of-life decision-making. Twenty patients whose care did not follow the structured approach were selected as controls. Outcome measures were nociceptive pain control, completing relationships, and emotional response towards dying. These measures were statistically superior in the study group compared to the control group. A structured approach to end-of-life decision-making significantly improves the quality of care for patients with terminal illness in the domains of pain control, completing relationships and emotional responses towards dying. © The Author(s) 2014.

  20. Planned and unplanned terminations of foster care placements in the Netherlands: Relationships with characteristics of foster children and foster placements

    NARCIS (Netherlands)

    van Rooij, F.; Maaskant, A.; Weijers, I.; Weijers, D.; Hermanns, J.

    2015-01-01

    This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses

  1. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD)

    National Research Council Canada - National Science Library

    Rivera Gorrin, Maite; Teruel-Briones, José Luis; Burguera Vion, Victor; Rexach, Lourdes; Quereda, Carlos

    2015-01-01

    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced...

  2. [Home visiting nursing care for a terminal stage cancer patient with bed sore--coordination through exchanging of advice request memo as a useful tool].

    Science.gov (United States)

    Sugihara, Sachiko; Yamada, Mai; Tayoshi, Mayumi; Kitamikado, Hatsue; Nakajima, Kazuyo; Konno, Hitomi; Akaeda, Kazuko; Yagishita, Toshiyuki; Oka, Yoichi

    2010-12-01

    Visiting nursing care service was provided to a 40s female patient, who had a terminal cancer with bed sore around the sacred bones. We started the nursing service when the patient was still cared at hospital. The nursing service we provided was coordinated by the certified nurse specialized in skin and excrement care and home visiting nurse. A smooth home care transition was resulted because of the coordination provided by the two nurses. We started coaching the family while the patient was still at the hospital with a home care instruction manual until the patient was discharged. All in all, the patient and her family were at ease with two nurses' coordinated efforts. Since the patient was cared at home, her bed sore problem got worse due to an absence of caregiver. In order to solve the bed sore problem, the visiting nurse took pictures of peeled adhesive patch and the bed sore around the sacred bones to show and consult with the certified nurse. With the advice from the certified nurse, the home visiting nurse was able to care the bed sore problem manageable in size. From this experience, we learned that a proper communication channel, in this case an advice request memo exchange, between the certified nurse and visiting nurse was a useful tool for both sides in order to properly assess the patient's medical care needs.

  3. Amino-terminal pro-B-type natriuretic peptide testing to assist the diagnostic evaluation of heart failure in symptomatic primary care patients

    DEFF Research Database (Denmark)

    Hildebrandt, P.; Collinson, P.O.

    2008-01-01

    When used for the evaluation of symptomatic patients in general practice, amino-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is highly sensitive, with an excellent negative predictive value for cost-effective exclusion of the diagnosis of heart failure (HF). Importantly (similar...... to other NP assays), lower values for NT-proBNP are expected among patients with HF in the primary care setting compared with patients with acute dyspnea. Among primary care patients with dyspnea, a noncardiac source of dyspnea is most likely in patients with findings below the recommended age......-stratified NT-proBNP cut points. Conversely, an NT-proBNP result above the age-stratified primary care cut points does not absolutely indicate the presence of HF; a more directed cardiovascular workup is indicated Udgivelsesdato: 2008/2/4...

  4. Comparison of prognostic value of N-terminal pro-brain natriuretic peptide in septic and non-septic intensive care patients.

    Science.gov (United States)

    Ozcan, Namik; Ozcan, Ayse; Kaymak, Cetin; Basar, Hulya; Kotanoglu, Mustafa; Kose, Bektas

    2017-03-01

    The aim of this study is to compare the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in septic and non-septic intensive care patients. Fifty consecutive patients admitted to the intensive care unit (ICU) were enrolled in either the septic or non-septic group according to the criteria in the International Sepsis Definitions Conference in 2001. Demographic and clinical data, procalcitonin and lactate levels at admission, and death within 28 days were registered. Five blood samples were collected from all patients for NT-proBNP measurements. Septic patients had higher APACHE II (19 (16.00-24.25) vs. 16 (13.00-18.25)), and SOFA (8 (5-10) vs. 6 (4-7)) scores (p care patients.

  5. Testing models of care for terminally ill people who live alone at home: is a randomised controlled trial the best approach?

    Science.gov (United States)

    Aoun, Samar M; O'Connor, Moira; Breen, Lauren J; Deas, Kathleen; Skett, Kim

    2013-03-01

    This project implemented and evaluated two models of care for terminally ill people living alone at home: installing personal alarms (PA) and providing extra care aide (CA) support. The primary aim was to assess the feasibility of using a randomised controlled trial (RCT) approach with this group. A secondary aim was to assess the potential impact of the models of care on the participants' quality of life, symptom distress, anxiety and depression, and perceived benefits and barriers to their use. The two models of care were piloted in collaboration with Silver Chain Hospice Care Service (SCHCS) in Western Australia during 2009-2010. Using a pilot RCT design, equal numbers of participants were randomised to receive extra CA time, PAs or standard care. Attrition reduced the sample size from 20 in each group to 12, 14 and 17 respectively. The intervention period was between 6 and 12 weeks depending on prognosis. The participants were functionally and psychologically well and the majority lived alone by choice. There were physical and psychological benefits associated with provision of the two models of care, particularly for the group supported by CAs in terms of improved sleeping and appetite. However, the impact was mostly not statistically significant due to small sample sizes. The study has highlighted two methodological challenges: the wide variation in the degree of living alone at home leading to complex inclusion criteria, and an RCT approach with attrition differing across groups and patients not wanting to be included in the assigned group. The RCT approach is not considered appropriate for the 'home alone' palliative care population that would have been better supported by providing each participant with a personalised model of care according to needs. However, the outcomes of the project have prompted changes in SCHCS practice when providing care to these patients. © 2012 Blackwell Publishing Ltd.

  6. Effect of the duration of hospice and palliative care on the quality of dying and death in patients with terminal cancer: A nationwide multicentre study.

    Science.gov (United States)

    Choi, J Y; Kong, K A; Chang, Y J; Jho, H J; Ahn, E M; Choi, S K; Park, S; Lee, M K

    2017-09-15

    Early referral to hospice and palliative care (HPC) has significant benefits, but little is known about the appropriate time for referral. The purpose of this study of terminal cancer patients was to identify the most appropriate time for referral to HPC. Cross-sectional correlation study design was used. Participants were the bereaved relatives, who were the adult primary caregivers of the 1,829 terminal cancer patients who died 2-6 months previously in nationwide centres that provide HPC in Korea. A post-bereavement survey (Good Death Inventory, GDI) of family caregivers was used to assess patients' quality of dying and death. Relative to patients who were in HPC for 3-7 days and HPC for 8-21 days, those in HPC for 22-84 days had significantly higher quality of dying. Propensity score matched comparison between the group hospitalised for 22-84 days (n = 65) and the group hospitalised for 85 days or longer (n = 65) showed no significant differences in all the items on quality of dying and death. Our results suggest that terminal cancer patients who stay in HPC at least for 22 days have improved quality of dying and death. © 2017 John Wiley & Sons Ltd.

  7. Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey.

    Science.gov (United States)

    Kizawa, Yoshiyuki; Tsuneto, Satoru; Hamano, Jun; Nagaoka, Hiroka; Maeno, Takami; Shima, Yasuo

    2013-11-01

    To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan. We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010. The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision. These findings may reflect positive changes in patients' attitudes toward ADs, in Japan.

  8. End-of-life care and the grieving process: family caregivers who have experienced the loss of a terminal-phase cancer patient.

    Science.gov (United States)

    Dumont, Isabelle; Dumont, Serge; Mongeau, Suzanne

    2008-08-01

    Family caregivers of a loved one with advanced cancer are at risk for developing bereavement complications following the loss of the person they cared for. However, little research has studied caregiving and bereavement experiences as an ongoing process. This study was conducted with the aim of identifying the main elements constitutive of the experience of providing care and assistance to a patient with terminal cancer that influence the grieving process. This qualitative study, conducted among 18 family caregivers, led to the specification of six principal dimensions of the caregiving experience: characteristics of the family caregiver and of the patient, symptoms of the illness, the relational context, social and professional support, and circumstances surrounding the death. Among these dimensions, the constituent elements of the caregiving experience that might positively or negatively influence the grieving process were identified. This knowledge is useful for a more perspicuous identification of caregivers who might experience bereavement complications.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  10. [Clinical features and prognosis of terminally ill patients in a geriatric long-term care hospital with particular regard to the implications of artificial nutrition].

    Science.gov (United States)

    Miyagishi, Ryuji; Higashi, Takuya; Akaishi, Yasuhiro; Arai, Masayoshi; Minemawari, Yoshimori

    2007-03-01

    To clarify the clinical features of terminally ill patients in our hospital and elucidate the implications of administering artificial nutrition. Between April 2004 and March 2005, we assessed 155 patients who died in Nishimaruyama Hospital--a geriatric long-term care facility in Sapporo. We analyzed their clinical backgrounds on admission, the clinical course up to the terminal stage of the illness, and the outcome of patients who received artificial nutrition. In 95 patients, the main cause of the terminal illness was infection. The symptoms of these patients, such as cerebral infarction and cognitive dysfunction, deteriorated progressively, and eventually, eating became difficult. At this point, alternative methods for providing nutrition were discussed. For 60 patients (41 died of acute disease and 19, of advanced cancers), artificial nutrition was not considered. Artificial nutrition was administered to 63 patients; tube feeding was carried out in 30 patients. Because of repeated aspiration pneumonia, 14 of these 30 patients eventually underwent intravenous hyperalimentation (IVH). Thirty-three patients directly underwent IVH. Thirty-two patients did not undergo any feeding course. The mean survival times of the tube feeding and non-artificial nutrition groups were 827 and 60 days, respectively. The difference in the survival times was statistically significant. The outcome of patients who were placed on tube feeding was good. This may be because we selected those patients considered most suitable for tube feeding or IVH. The criteria that were used to select an appropriate method for providing nutrition varied, although the patients in our hospital requested palliative care.

  11. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

    Science.gov (United States)

    Riolfi, Mirko; Buja, Alessandra; Zanardo, Chiara; Marangon, Chiara Francesca; Manno, Pietro; Baldo, Vincenzo

    2014-05-01

    It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Retrospective cohort study. We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

  12. A case report of a patients with hand Succ developed after radiation therapy and the terminal care for the patient

    Energy Technology Data Exchange (ETDEWEB)

    Ikoma, Akihiko; Akiyama, Hajime; Shioiri, Yuko [Kyoto Univ. (Japan). Graduate School of Medicine] [and others

    1998-12-31

    The patient was a 47-year-old male suffering from a skin tumor developing on the dorsal site of his right hand 35 years after the radiation therapy for his tinea manus. The tumor was diagnosed as SCC by biopsy. We removed the tumor by operation followed by chemotherapy, however metastases occurred in succession, for which the combined treatment of radiation and chemotherapy was in vain. Since the patient was under the terminal stage, his severe tumor-induced pain was the first problem to settle. We used a large dosage of morphine and succeeded in controlling his pain without serious side effects. As the number and the size of metastatic tumors rapidly increased, intra-lesional injections of carboplatin were applied and helpful for not only reducing the tumor size but keeping the patient`s mental state stable till his death. (author)

  13. A case report of a patients with hand Succ developed after radiation therapy and the terminal care for the patient

    Energy Technology Data Exchange (ETDEWEB)

    Ikoma, Akihiko; Akiyama, Hajime; Shioiri, Yuko (Kyoto Univ. (Japan). Graduate School of Medicine) (and others)

    1998-01-01

    The patient was a 47-year-old male suffering from a skin tumor developing on the dorsal site of his right hand 35 years after the radiation therapy for his tinea manus. The tumor was diagnosed as SCC by biopsy. We removed the tumor by operation followed by chemotherapy, however metastases occurred in succession, for which the combined treatment of radiation and chemotherapy was in vain. Since the patient was under the terminal stage, his severe tumor-induced pain was the first problem to settle. We used a large dosage of morphine and succeeded in controlling his pain without serious side effects. As the number and the size of metastatic tumors rapidly increased, intra-lesional injections of carboplatin were applied and helpful for not only reducing the tumor size but keeping the patient's mental state stable till his death. (author)

  14. The Effect of Social Support and Meaning of Life on the Quality-of-Life Care for Terminally Ill Patients.

    Science.gov (United States)

    Dobríková, Patricia; Pčolková, Dušana; AlTurabi, Layla Khalil; West, Daniel J

    2015-11-01

    This study examines the effect of 2 indicators on quality of life (QOL): social support and meaning of life for terminally ill patients. These 2 indicators are very important from a psychological and spiritual point of view. The findings suggest that there is a statistically significant correlation between meaning of life and QOL (r = .610, P life fulfillment for dying patients. A significant relationship exists in survival of life meaningfulness and satisfaction with social support. In conclusion, experiencing one's life as meaningful is positively related to the well-being for dying patients. Social support provided by a close relative had a positive influence on the patient's meaning of life and overall life satisfaction. © The Author(s) 2014.

  15. Terminating supervision.

    Science.gov (United States)

    Levendosky, Alytia A; Hopwood, Christopher J

    2017-03-01

    The focus of this paper is on the termination of clinical supervision. Although clinical supervision is considered the backbone of most mental health training programs, it gets relatively little theoretical or empirical attention. The termination of supervision has received even less attention. In this paper, we describe an approach to terminating supervision in our treatment team, which integrates intensive assessment with a relational perspective in a clinical science training program (Levendosky & Hopwood, 2016). We describe our established conceptual framework, review empirical evidence, and provide verbatim examples from final supervision meetings on our team to elaborate the importance of conceptualizing individual differences across trainees and parallels between supervision and psychotherapy dynamics. We conclude by emphasizing the need for research on supervision in general and supervision termination in particular. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Challenges impacting on the quality of care to persons living with HIV/AIDS and other terminal illnesses with reference to Kanye community home-based care programme.

    Science.gov (United States)

    Kang'ethe, S M

    2009-03-01

    HIV/AIDS has been found to be a challenging disease to humanity, its challenge spin-offs falling especially on to the caregivers of those infected and affected by the virus. This paper aims to discuss the challenges influencing the state of caregiving in the Kanye community home-based care (CHBC) programme in Botswana. The study was qualitative in design and explorative in nature, involving 82 primary caregivers in focus group discussions, and 5 CHBC nurses in individual interviews. Caregivers were found challenged by lack of community networks support, inadequate sanitary and care packages, poor shelter compromising privacy, inadequate income and food for their clients, inadequate care motivation as their volunteerism does not attract any payment, inadequate health personnel to offer psychosocial support like counselling, and an unconducive caring environment generally. Putting in place policies to redress caregivers' poverty, helping caregivers start income-generating projects, increasing community assistance and caregiving facilities are recommended as factors to address caregiver challenges.

  17. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care

    DEFF Research Database (Denmark)

    Hildebrandt, Per; Collinson, Paul O; Doughty, Robert N

    2010-01-01

    The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards.......The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards....

  18. Cuidando da família de pacientes em situação de terminalidade internados na unidade de terapia intensiva Caring for the families of terminally ill patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Márcio Soares

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O cuidado dos familiares é uma das partes mais importantes do cuidado global dos pacientes internados nas unidades de terapia intensiva (UTI. No contexto de um paciente terminal ou no qual as perspectivas de recuperação são muito improváveis, esta face do cuidado assume uma importância ainda maior, pois na maioria das vezes o paciente não estará desperto, e será preciso lidar e cuidar dos seus familiares. Os familiares têm necessidades específicas e apresentam freqüências elevadas de estresse, distúrbios do humor e ansiedade durante o acompanhamento da internação na UTI, e que muitas vezes persistem após a morte do seu ente querido. CONTEÚDO: Foram selecionados artigos sobre o cuidado de familiares de pacientes em situação de terminalidade na UTI publicados nos últimos 20 anos na PubMed. CONCLUSÕES: A literatura recente está repleta de evidências de que estratégias voltadas para os familiares como a melhoria da comunicação, da prevenção de conflitos e do conforto espiritual, para citar algumas, resultam em maiores satisfação e percepção da qualidade da assistência prestada ao paciente na UTI.BACKGROUND AND OBJECTIVES: Caring for the families is one of the major tasks of the global care of patients admitted to the intensive care unit (ICU. In the context of a terminally ill patient or a patient in whom the recovery from the acute illness is unlikely, dealing with and caring for their family members becomes even more important as the patient will not be awake in most of situations. Family members have specific needs and present with high incidence of symptoms of stress, depression, anxiety and related disorders during the ICU of their beloved one, which can even persist late after the patient's death. CONTENTS: Review of selected studies on the care of family members of patients at the end-of-life admitted to the ICU published at the PubMed database during the last 20 years. CONCLUSIONS

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

    Science.gov (United States)

    Ruijs, Cees D M; Kerkhof, Ad J F M; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D

    2013-12-28

    Primary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and unbearable suffering, evolvement of symptoms and unbearability over time and quality of unbearable suffering were studied in end-of-life cancer patients in primary care. 44 general practitioners during three years recruited cancer patients estimated to die within six months. Every two months patients quantified intensity as well as unbearability of 69 symptoms with the State-of-Suffering-V (SOS-V). Also overall unbearable suffering was quantified. The five-point rating scale ranged from 1 (not at all) to 5 (hardly can be worse). For symptoms assessed to be unbearable the nature of the suffering was additionally investigated with open-ended questions. The final interviews were analyzed; for longitudinal evolvement also the pre-final interviews were analyzed. Symptom intensity scores 4 and 5 were defined to indicate high intensity. Symptom unbearability scores 4 and 5 were defined to indicate unbearable suffering. Two raters categorized the qualitative descriptions of unbearable suffering. Out of 148 requested patients 51% participated; 64 patients were followed up until death. The SOS-V was administered at least once in 60 patients (on average 30 days before death) and at least twice in 33 patients. Weakness was the most frequent unbearable symptom (57%). Pain was unbearable in 25%. Pain, loss of control over one's life and fear of future suffering frequently were unbearable (89-92%) when symptom intensity was high. Loss of control over one's life, vomiting and not being able to do important things frequently were unbearable (52-80%) when symptom intensity was low. Unbearable weakness significantly increased between pre-final and final interview. Physical suffering, loss of meaning

  20. [The Terminal Phase of an Intractable Neurological Disease from the Viewpoint of Nursing Care: The Importance of the Promotion of a Barrier-Free Mind for ALS Care].

    Science.gov (United States)

    Muraoka, Koko

    2015-08-01

    Amyotrophic lateral sclerosis (ALS) is a particularly serious intractable neurological disease. Patients with ALS have high mortality rates if they are not put on an artificial respirator. Even with an artificial respirator, individuals with ALS are forced to witness their own physical deterioration. Because 24 hour care is usually required, an intense relationship ofter develops between patients with ALS and family caregivers. This relationship forms an invisible barrier and can impede a smooth introduction of external services. As a result, there can be a degradation in the quality of care. The purpose of this paper is to describe the voluntary efforts of patients and family caregivers in order to break down this barrier and to discuss what types of care support are available to promote barrier-free minds.

  1. Piloting a new approach in primary care to identify, assess and support carers of people with terminal illnesses: a feasibility study.

    Science.gov (United States)

    Carduff, Emma; Jarvis, Alison; Highet, Gill; Finucane, Anne; Kendall, Marilyn; Harrison, Nadine; Greenacre, Jane; Murray, Scott A

    2016-02-11

    General practices in the United Kingdom are encouraged to have a protocol for the identification of carers and a mechanism for social care referral. However, a minority of carers are identified and those caring for someone with a terminal illness often cope until the situation becomes overwhelming. Earlier identification could enable more timely support. The aim of this project was to model and pilot a systematic approach to identify, assess and support carers of people with supportive and palliative care needs in primary care. The intervention was modelled on the Medical Research Council complex intervention framework with a preliminary theoretical phase, which has been reported elsewhere. In this study, which lasted 12 months, four general practices were recruited. Each practice identified a 'carer liaison' person to take the lead in identifying carers, followed by assessment and support using a toolkit modelled from the earlier phase. Qualitative evaluation interviews were conducted with carers who had received the intervention and the carer liaisons and general practitioners in the pilot practices. A stakeholder event was held to disseminate and deliberate the findings. The practices' populations ranged from 5840 to 10832 patients and across the four practices, 83 carers were identified. Thirty six carers were identified from practice registers (disease - 16; palliative care - 9; carer - 11; advanced care plan - 12), whilst 28 were identified opportunistically by practice staff at appointments or at home. Seven carers self-identified. Overall, 81 carers received the carer pack and 25 returned the Carer Support Needs Assessment Tool (CSNAT) form. Eleven carers received a follow up call from the practice to discuss support and 12 were also referred/signposted for support. Qualitative interviews suggest carers valued connection with their practices but the paperwork in the toolkit was onerous. This approach to identifying and supporting carers was acceptable, but

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

    Science.gov (United States)

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

    2015-02-01

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

  3. [Difficulty in home care management of a young patient with terminal stage carcinoma--a case report].

    Science.gov (United States)

    Inoue, Akiko; Onose, Akira; Onishi, Hiroka; Isono, Hisayo; Miyamoto, Matakichi; Nagata, Hiroshi; Sakakibara, Terue

    2013-12-01

    A 48-year-old man with no remarkable medical history presented with upper abdominal pain for approximately 1 month. He was diagnosed as having pancreatic carcinoma with liver and lung metastasis and complicating carcinomatous peritonitis. Despite chemotherapy, his performance status worsened, his appetite deteriorated, and his pain became intolerable. The patient opted to return home for palliative care, and his parents, aged over 70 years, supported this decision. Although corticosteroid and opiate administration was attempted to improve appetite loss and pain, oral administration became difficult over a short span of time. Thus, treatment was switched from oxycodone to a fentanyl patch for opioid rotation. We also prescribed risperidone for the treatment of delirium. The patient once opted for "respite hospitalization" at a general hospital to relieve his aged parents' fatigue, and thereafter, he finally died at home. When rapid disease progression is expected, not only should a fully equipped environment for patients be ensured but concern for their caregivers should also be considered. For this purpose, cooperation and communication among multidisciplinary medical staff is indispensable.

  4. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care

    DEFF Research Database (Denmark)

    Hildebrandt, Per; Collinson, Paul O; Doughty, Robert N

    2010-01-01

    The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards....

  5. Terminal Ballistics

    CERN Document Server

    Rosenberg, Zvi

    2012-01-01

    This book covers the important issues of terminal ballistics in a comprehensive way combining experimental data, numerical simulations and analytical modeling. The first chapter reviews the experimental equipment which are used for ballistic tests and the diagnostics for material characterization under impulsive loading conditions. The second chapter covers essential features of the codes which are used for terminal ballistics such as the Euler vs. Lagrange schemes and meshing techniques, as well as the most popular material models. The third chapter, devoted to the penetration mechanics of rigid penetrators, brings the update of modeling in this field. The fourth chapter deals with plate perforation and the fifth chapter deals with the penetration mechanics of shaped charge jets and eroding long rods. The last two chapters discuss several techniques for the disruption and defeating of the main threats in armor design. Throughout the book the authors demonstrate the advantages of numerical simulations in unde...

  6. 'You only have one chance to get it right': A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer.

    Science.gov (United States)

    Totman, Jonathan; Pistrang, Nancy; Smith, Susan; Hennessey, Susan; Martin, Jonathan

    2015-06-01

    Relatives looking after a terminally ill family member at home face numerous challenges. Studies into relatives' experiences of home caregiving have been criticised for their descriptive nature and lack of theoretical underpinnings. To explore the emotional challenges faced by home caregivers, and their experiences of healthcare professionals, from the perspective of existential psychology. A qualitative study using semi-structured interviews. Transcripts were analysed thematically using the Framework approach. The study took place within an inner-city London hospice. Participants (n = 15) were recently bereaved adult relatives of cancer patients who cared for their family member at home. Participants' experiences of being a caregiver and of professional support were highly varied. The analysis generated 15 themes which were organised into a framework based on Yalom's four 'existential conditions': responsibility (e.g. 'being the linchpin of care'; 'you only have one chance to get it right'), isolation (e.g. 'being on my own', 'being held in mind'), death (e.g. 'knowing but not knowing') and meaningfulness (e.g. 'giving something back', 'acceptance and gratitude'). Healthcare professionals were perceived as influential in both helping and hindering relatives in meeting the challenges they faced. Existential psychology provides a theoretical perspective from which to understand the psychological complexity of the emotional challenges home caregivers face and a framework which may usefully inform research and clinical practice. Professionals' attentiveness to caregivers' needs can have powerful effects in assuaging anxiety, reducing isolation and enabling relatives to connect with the meaningfulness of caregiving. © The Author(s) 2015.

  7. Discrepancies Between the Supports Needed for Discharge of Patients With Terminal Cancer to Family Caregivers and What Supports Were Actually Provided in Japan: Assessment of Palliative Care Unit Nurses.

    Science.gov (United States)

    Oosono, Yasufumi; Yokoyama, Kazuhito; Itoh, Hiroaki; Enomoto, Miyuki; Ishiwata, Miki

    2017-01-01

    Even if patients with terminal cancer hope to spend the rest of their lives at home, they are often unable to leave the hospital early due to their family caregivers' anxiety. This study aimed to investigate in Japan the discrepancies between the supports needed by and actually provided by palliative care unit nurses (PCUNs) to the family caregivers for discharge of patients with terminal cancer. In this cross-sectional study, self-administered questionnaires including 6-point Likert-type scales assessing the reasons for difficulties in transition to home-based care were distributed to 1227 PCUNs. Using paired t tests, the differences between the scores on perceived importance and actual supports to family caregivers were examined. The supports actually provided were classified by factor analysis. The relationships between the PCUNs' characteristics and mean scores on the supports in each category were examined using multiple regression analysis. A total of 1023 (83.4%) completed questionnaires were returned. Scores on the actually provided supports for discharge to family caregivers were consistently and significantly lower than the corresponding scores on perceived importance for all 57 items ( P care, receiving necessary training, cooperating with palliative care staff, and cooperating with local service providers were significantly associated with higher levels of actual supply of supports to family caregivers. Our findings suggest that PCUNs need to be encouraged to provide further support to family caregivers for the discharge of patients with terminal cancer.

  8. Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service.

    Science.gov (United States)

    Aiken, Ara; Lohr, P A; Aiken, C E; Forsyth, T; Trussell, J

    2017-04-01

    To examine contraceptive choices among women seeking termination of pregnancy (TOP) and the provision of the chosen methods. Population-based study. British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Between 1 January 2011 and 31 December 2014, 211 215 women had a TOP at BPAS, were offered contraceptive counselling, and were eligible to obtain contraception at no cost. We examined electronic records from BPAS and assessed the proportions of women who accepted contraceptive counselling and chose a contraceptive method, as well as the distributions of methods chosen, analysed by provider and by TOP type. We calculated the proportions receiving their chosen method and the methods chosen by women using no method at conception. We used logistic regression to examine the factors associated with choice of an intrauterine contraceptive (IUC) or implant. Post-TOP contraceptive method choice. Receipt of chosen method post-TOP. Eighty-five per cent of women accepted contraceptive counselling and 51% chose to obtain a method from BPAS rather than from a GP or contraception and sexual health clinic post-TOP. [correction added on 25 November 2016 after first online publication: 51% has been inserted in the preceding sentence.] Among those who wanted to receive contraception from BPAS, 51% chose an IUC or implant and 19% chose oral contraceptives. Ninety-one per cent of women who obtained contraception from BPAS received their chosen method. Women were more likely to choose an IUC or implant if they obtained contraception from BPAS, had a surgical TOP, were parous, young, white, or had one or more previous TOPs. The standards set for patient-centred TOP care should emphasise the need for a full range of contraceptive options to be offered and provided post-TOP. Uptake targets for long-acting reversible methods do not reflect women's post-TOP contraceptive preferences. © 2016 Royal College of Obstetricians and Gynaecologists.

  9. Terminal ballistics

    CERN Document Server

    Rosenberg, Zvi

    2016-01-01

    This book comprehensively discusses essential aspects of terminal ballistics, combining experimental data, numerical simulations and analytical modeling. Employing a unique approach to numerical simulations as a measure of sensitivity for the major physical parameters, the new edition also includes the following features: new figures to better illustrate the problems discussed; improved explanations for the equation of state of a solid and for the cavity expansion process; new data concerning the Kolsky bar test; and a discussion of analytical modeling for the hole diameter in a thin metallic plate impacted by a shaped charge jet. The section on thick concrete targets penetrated by rigid projectiles has now been expanded to include the latest findings, and two new sections have been added: one on a novel approach to the perforation of thin concrete slabs, and one on testing the failure of thin metallic plates using a hydrodynamic ram.

  10. Loss and terminal illness.

    Science.gov (United States)

    Benoliel, J Q

    1985-06-01

    The experience of terminal illness can best be viewed as a situation of multiple losses involving the dying person, family members and friends, and the health care providers engaged in offering services to them. It is a major transition during which the central participants must cope with the personal meanings of the forthcoming death as well as other losses brought about by the disease process, medical treatments, and the need to provide care for the dying person. How families adapt to the stresses and changes imposed by the experience of living with dying depends on their previous experiences with death, their established patterns of communication about serious matters, and their decision-making practices. Some individuals and families are at greater risk than others for developing maladaptive responses and behaviors during and after the experience of terminal illness. Risk factors to be considered in making hypotheses about the potential for maladaptive reactions include the strength of the attachment to the dying person, uncontrollable and distressing symptoms, and coping limitations associated with age and other factors contributing to increased vulnerability to the demands of continuous change. Working effectively with different kinds of families during the transition of terminal illness can best be accomplished within a conceptual framework built upon knowledge about people undergoing change. The concept of safe conduct can serve as an overall guide for the creation of nursing services designed to offer personalized care and accessibility of professional help at times of maximum need by the family. Assisting dying patients and their families toward the achievement of their personal goals is fundamental to the idea of safe conduct. The delivery of nursing care in terminal illness requires an orientation to assessment as an ongoing process that makes use of knowledge about disease processes, medical treatments, individual and group adaptations to loss, risk

  11. [N-terminal pro-B-type natriuretic peptide value for prediction of mortality among critically ill patients in different age groups in intensive care unit].

    Science.gov (United States)

    Li, Hailing; Wang, Hongping; Lou, Yunpeng; Miao, Wenli; Sha, Ning

    2014-07-01

    To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients. A retrospective study was conducted. 295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with agegroup with age≥ 65 years old (n=190)]. The concentrations of serum NT-proBNP, hematocrit (HCT), procalcitonin (PCT), C-reactive protein(CRP), serum creatinine(SCr), estimated glomerular filtration rate (eGFR), acute physiology and chronic health evaluationII (APACHEII) score and probability of survival (PS) were recorded within 24 hours. The primary outcome was ICU mortality. Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality. (1) There were no significant differences in the length of stay in ICU, mechanical ventilation rate, the mortality, the incidence of cardiovascular disease, digestive disease, neurologic disease, and the number of patients having received operation, HCT, PCT and CRP between the two groups (all P>0.05). The percentage of the male, the APACHEII score, the percentage of respiratory disease, and NT-proBNP in group with age≥65 years old were higher than those of the group with agegroup with age≥65 years old were lower than those of the group with age agegroup with age≥65 years old and the entire group [0.825 (0.738-0.892) vs. 0.664 (0.592-0.731) and 0.725 (0.670-0.775), Z1=-2.835, P1=0.005; Z2=-1.995, P2=0.046]. (3) The sensitivity (76.10% vs. 64.10%), specificity (82.35% vs. 67.12%), positive predictive value (90.0% vs. 75.8%), and negative predictive value (62.2% vs. 53.8%) with cutoff value of NT-proBNP (2 882 ng/L) in group with agegroup with age≥65 years old. NT-proBNP cutoff value in different age groups for the prediction of mortality in the critically ill patients maybe more objective and accurate.

  12. An exploration of pregnant teenagers' views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care.

    Science.gov (United States)

    Bell, Emily R; Glover, Lesley; Alexander, Tim

    2014-09-01

    To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. Cross-sectional mixed methods design. Three groups were included: termination of pregnancy (n = 19), antenatal (n = 9) and never pregnant (n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial. © 2013 John Wiley & Sons Ltd.

  13. Pro–A-Type Natriuretic Peptide, Proadrenomedullin, and N-Terminal Pro–B-Type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure

    DEFF Research Database (Denmark)

    Alehagen, Urban; Dahlström, Ulf; Rehfeld, Jens F

    2013-01-01

    Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type natriure......Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro......-A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care....

  14. Termination of pregnancy for maternal indications at the limits of fetal viability : a retrospective cohort study in the Dutch tertiary care centres

    NARCIS (Netherlands)

    van Eerden, L.; Zeeman, G. G.; Page-Christiaens, G. C. M.; Vandenbussche, F.; Oei, S. G.; Scheepers, H. C. J.; van Eyck, J.; Middeldorp, J. M.; Pajkrt, E.; Duvekot, J. J.; de Groot, C. J. M.; Bolte, A. C.

    2014-01-01

    Objective: Maternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal

  15. Elevated admission N-terminal pro-brain natriuretic peptide level predicts the development of atrial fibrillation in general surgical intensive care unit patients.

    Science.gov (United States)

    Chokengarmwong, Nalin; Yeh, Daniel Dante; Chang, Yuchiao; Ortiz, Luis Alfonso; Kaafarani, Haytham M A; Fagenholz, Peter; King, David R; DeMoya, Marc; Butler, Kathryn; Lee, Jarone; Velmahos, George; Januzzi, James Louis; Lee-Lewandrowski, Elizabeth; Lewandrowski, Kent

    2017-09-01

    New onset atrial fibrillation (AF) in critically ill surgical patients is associated with significant morbidity and increased mortality. N-terminal pro-B type natriuretic peptide (NT-proBNP) is released by cardiomyocytes in response to stress and may predict AF development after surgery. We hypothesized that elevated NT-proBNP level at surgical intensive care unit (ICU) admission predicts AF development in a general surgical and trauma population. From July to October 2015, NT-proBNP concentrations were measured at ICU admission. Abnormal NT-proBNP concentrations were defined by age-adjusted cut-offs. We examined the relationship between the development of AF and demographics, clinical variables, and NT-proBNP level using univariate analysis and a multivariable logistic regression model. Three hundred eighty-seven subjects were included in the cohort, none of whom were in AF at ICU admission. The median age was 63 years (52-73 years), and 40.3% were women. The risk of developing AF was higher for abnormal versus normal NT-proBNP (22% vs. 4%; p < 0.0001). Using optimal derived cutoffs (regardless of age), the risk of developing AF was 2% for NT-proBNP less than 600 ng/L, 15% for NT-proBNP of 600 ng/L to 1,999 ng/L, and 27% for NT-proBNP of 2,000 ng/L or greater. Multiple logistic regression analysis identified three independent predictors for new-onset AF: age, older than 70 years (odds ratio [OR], 3.7, 95% confidence interval [CI], 1.5-9.3), history of AF (OR, 25.3; 95% CI, 9.6-67.0), and NT-proBNP of 600 or greater (OR, 4.3; 95% CI, 1.3-14.2). When none or only one predictor was present, AF incidence was less than 1%. When all three predictors were present, AF incidence was 66%. For subjects 70 years or older but no history of AF, AF incidence was 12.8% when NT-proBNP was 600 or greater compared with 0% when NT-proBNP was less than 600. For subjects younger than 70 years with a history of AF, AF incidence was 44.4% when NT-proBNP was 600 or higher compared to 0

  16. 9 CFR 3.65 - Terminal facilities.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.65 Section 3.65... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment and Transportation of Rabbits Transportation Standards § 3.65 Terminal facilities. No person subject to the Animal Welfare regulations shall...

  17. 9 CFR 3.141 - Terminal facilities.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.141 Section 3... ANIMAL WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of... Mammals Transportation Standards § 3.141 Terminal facilities. Carriers and intermediate handlers shall not...

  18. 9 CFR 3.40 - Terminal facilities.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.40 Section 3.40... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Guinea Pigs and Hamsters Transportation Standards § 3.40 Terminal facilities. No person subject to the Animal...

  19. Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients', carers' and clinicians' understanding of heart failure prognosis and its management.

    Science.gov (United States)

    Stocker, Rachel; Close, Helen; Hancock, Helen; Hungin, A Pali S

    2017-12-01

    Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF. We carried out a longitudinal grounded theory study, employing in-depth interviews with 14 clinicians (primary and secondary care) and observations of clinic and home appointments, followed by a series of interviews with 13 patients with HF and 9 carers. Overall, the majority of participants rejected notions of HF as a terminal illness in favour of a focus on day-to-day management and maintenance, despite obvious deterioration in disease stage and needs over time. Clinicians revealed frustration about the uncertain nature of HF prognosis, leading to difficulties in planning. Others highlighted the need to deliver problem-based, individualised care but felt constrained sometimes by the lack of multidisciplinary ACP. Patients reported an absence of prognostic discussions with clinicians. This is the first study exploring the experiences of prognostic communication at all stages of HF. Findings raise questions regarding the pragmatic utility of the concept of HF as a terminal illness and have implications for future HF care pathway development. Findings support the incorporation of a problem-based approach to management, which recognises the importance of everyday functioning for patients and carers as well as the opportunity for ACP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Terminal Disease: A Biolaw Management

    Directory of Open Access Journals (Sweden)

    Francisco Rivas García

    2017-10-01

    Full Text Available There are numerous and varied pathologies that can lead to a state of terminal illness, provoking numerous bioethical dilemmas that are inherent and specific to each circumstance. The objective of the present work has been to provide a current and useful analysis that can help to understand the main bioethical problems, from the perspective of biolaw that must be solved in the inevitable path towards the end of life that any terminal illness implies. The methodology used included a study of bibliographic documentation in the main databases of interest in bioethics. It can be concluded that the biolaw is a very useful tool that helps health care professionals and relatives when it comes to the analysis and decision making regarding a terminal illness. Independently of medical practice based on protocols and scientific knowledge, it is necessary to ensure that not everything that can legally be carried out is accepted in the field of biolaw.

  1. Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany - a single service analysis

    National Research Council Canada - National Science Library

    Stiel, Stephanie; Heckel, Maria; Seifert, Andreas; Frauendorf, Tobias; Hanke, Roland Martin; Ostgathe, Christoph

    2015-01-01

    ...). More insights into specialized palliative home care (SPHC) in NCAs are needed. Retrospective analysis and group comparisons between CAs and NCAs of anonymous data of all patients cared for between December 2009 and June 2012 by one SPHC team in Germany...

  2. Access to palliative care services during a terminal hospital episode reduces intervention rates and hospital costs: a database study of 19 707 elderly patients dying in hospital, 2011-2015.

    Science.gov (United States)

    Ireland, Anthony W

    2017-05-01

    The burden of healthcare costs for persons approaching death is of increasing concern. This study examines cost savings associated with access to palliative care (PC) during a hospital episode ending in death for a large sample of elderly patients. A retrospective cohort study of administrative data for the Department of Veterans' Affairs clients identified patient demographics, hospital characteristics, utilisation data and component costs for the hospital terminal episode for patients aged ≥ 70 years who died in hospital between July 2011 and June 2015. Differences between patients with and without access to PC were analysed with descriptive statistics and negative binomial regression models. Access to PC service was reported for 33.2% of patients, 59.5% for those with a cancer diagnosis and 24.3% for other patients. Rates were significantly lower in private hospitals for all patient groups. For the complete sample, PC access was associated with significantly lower rates of admission into the intensive care unit (1.9% vs 10.6%, P terminal episodes was $10 801 for PC patients and $16 165 for those with no recorded PC access (P < 0.001). All differences remained significant after adjustment for patient age, comorbidity and hospital type. In a hospital episode ending in death, access to PC services was associated with significantly lower rates of medical interventions and total hospital costs. © 2017 Commonwealth of Australia Internal Medicine Journal © 2017 Royal Australasian College of Physicians.

  3. Intermodal freight terminals : terminal business planning

    NARCIS (Netherlands)

    Nijkamp, Peter; Wiegmans, Bart W.

    2000-01-01

    The main purpose of this paper is to provide a framework for existing- and newly proposedinter-modal freight terminals in their business planning process. This framework is importantfor constructing- and improving the central terminal service portfolio of handling (loading,discharging, and

  4. Nurses' identification of important yet under-utilized end-of-life care skills for patients with life-limiting or terminal illnesses.

    Science.gov (United States)

    Reinke, Lynn F; Shannon, Sarah E; Engelberg, Ruth; Dotolo, Danae; Silvestri, Gerard A; Curtis, J Randall

    2010-06-01

    This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care. A 45-item survey was administered to nurses (n = 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions. Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-of-life care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings. This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills.

  5. Psychological and psychiatric symptoms of terminally ill patients with cancer and their family caregivers in the home-care setting: A nation-wide survey from the perspective of bereaved family members in Japan.

    Science.gov (United States)

    Kobayakawa, Makoto; Ogawa, Asao; Konno, Michiko; Kurata, Akiko; Hamano, Jun; Morita, Tatsuya; Kizawa, Yoshiyuki; Tsuneto, Satoru; Shima, Yasuo; Aoyama, Maho; Miyashita, Mitsunori

    2017-12-01

    The psychological and psychiatric symptoms of terminally ill cancer patients are highly problematic and have been associated with greater burden among caregivers. Until now, the extent of these problems in the home care setting was unclear. This retrospective study was conducted as part of a nationwide survey from the perspective of bereaved family members in Japan (J-HOPE3). The bereaved family members rated the symptoms of delirium and suicidal ideation of patients with cancer, and the sleeplessness and depressed mood of family caregivers utilizing home care services in the one month before the patients' deaths. Regression analyses were performed to identify factors associated with caregivers' sleeplessness or depressed mood. Of the 532 subjects analyzed, between 17% and 65% of patients experienced various symptoms of delirium, and 27% suicidal ideation. Among family caregivers, 60% experienced sleeplessness and 35% experienced depressed mood at least once during the week. Caregivers' psychological symptoms were associated with their own poor health status, being the spouse of the patient, and the patients' psychological or psychiatric symptoms. To manage patients' symptoms, 11% of caregivers had consulted psychiatrists or psychologists while another 11% wanted to do so. Psychological problems assessed were common among patients with cancer and their family caregivers in the one month of home care prior to the patient's death. An effective complementary care system, run by home-visit physicians, nurses, and experts in mental disorders, is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 5 CFR 875.412 - When will my coverage terminate?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false When will my coverage terminate? 875.412... REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.412 When will my coverage terminate? Your coverage will terminate on the earliest of the following dates: (a) The date you specify to...

  7. Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom

    DEFF Research Database (Denmark)

    von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E

    2011-01-01

    Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative...

  8. pawg Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  9. kgfk Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  10. kcll Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  11. kden Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  12. kmgm Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  13. kswf Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  14. katy Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  15. krdg Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  16. khot Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  17. kpih Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  18. krdd Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  19. kabq Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  20. klax Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  1. krut Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  2. kpvu Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  3. pagy Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  4. koaj Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  5. khya Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. phog Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  7. kpeq Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  8. keko Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  9. Terminated Multifamily Mortgages Database

    Data.gov (United States)

    Department of Housing and Urban Development — Includes all terminated HUD Multifamily insured mortgages. It includes the Holder and Servicer at the time the mortgage was terminated. The data is good as of...

  10. pail Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  11. kelp Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  12. kdab Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  13. keld Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  14. kewr Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  15. paom Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  16. ksan Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  17. ktix Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  18. kpln Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  19. kgag Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  20. kbuf Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  1. ptkk Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  2. klyh Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  3. kslc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  4. kabe Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  5. pahn Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. kbvo Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  7. kfoe Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  8. kbff Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  9. kprc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  10. kmdt Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  11. kals Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

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    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  13. khdn Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  14. kgso Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  15. khlg Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  16. kjan Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  17. kbce Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  18. ktys Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  19. kcha Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  20. kdug Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  1. Terminated Multifamily Mortgages Database

    Data.gov (United States)

    Department of Housing and Urban Development — This Excel 2010 file includes all terminated HUD Multifamily insured mortgages. It includes the Holder and Servicer at the time the mortgage was terminated. The data...

  2. kpub Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  3. ksrq Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  4. kaeg Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  5. pata Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. klgu Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  7. pamc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  8. kmsl Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  9. kbrl Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  10. ksfb Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  11. kpsc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  12. kely Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  13. ksyr Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  14. katw Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  15. kama Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  16. kpae Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  17. kmli Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  18. kokc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  19. kjst Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  20. kgup Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  1. padl Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  2. klit Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  3. kalb Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  4. kact Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  5. kink Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. kshv Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  7. pajn Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  8. kpna Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  9. ktph Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  10. ksux Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  11. kcon Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  12. khio Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  13. konp Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  14. kpnc Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  15. kmlu Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  16. kgsp Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  17. kgpt Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  18. kflo Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  19. keri Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  20. kcid Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  1. ksaf Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  2. kcvg Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  3. ptya Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  4. katl Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  5. kmth Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. The death of patients with terminal cancer: the distress experienced by their children and medical professionals who provide the children with support care.

    Science.gov (United States)

    Otani, Hiroyuki; Ozawa, Miwa; Morita, Tatsuya; Kawami, Ayako; Sharma, Sahana; Shiraishi, Keiko; Oshima, Akira

    2016-02-04

    Few studies have been conducted on the experiences of children of terminally ill patients or hospital-based medical professionals supporting such children. This study explored distress among individuals whose parents died of cancer in childhood and among hospital-based medical professionals supporting such children. A qualitative study. The sample was 12 adults whose parents had died of cancer in childhood and 20 hospital-based medical professionals supporting children of patients' with terminal cancer. In-depth interviews were conducted, focusing on the distress experienced by the participants. The data were analysed thematically. Among adults whose parents died of cancer in childhood, we identified themes related to the period before death (eg, concealing the parent's illness), the time of death (eg, alienation due to isolation from the parent), soon after death (eg, fear and shock evoked by the bizarre circumstances, regrets regarding the relationship with the deceased parent before death), several years thereafter (ie, distinctive reflection during adolescence, prompted by the parent's absence) and the present time (ie, unresolved feelings regarding losing the parent). We identified seven themes among the medical professionals (eg, lack of knowledge/experience with children, the family's attempts to shield the child from the reality of death, estrangement from the family once they leave the hospital). An important finding of the study is that the participants' grief reaction to their parents' deaths during childhood was prolonged. Moreover, hospital medical professionals may find it difficult to directly support affected children. Comprehensive support involving organisations (eg, local communities) may be necessary for children who have lost a parent. 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/

  7. Intermodal freight terminals : terminal business planning

    OpenAIRE

    Nijkamp, Peter; Bart W Wiegmans

    2000-01-01

    The main purpose of this paper is to provide a framework for existing- and newly proposedinter-modal freight terminals in their business planning process. This framework is importantfor constructing- and improving the central terminal service portfolio of handling (loading,discharging, and transhipping) and storage of containerised cargo. Supportive activities (e.g. administration, customs) are taken into account as well.In particular, its aim is to investigate whether business planning offer...

  8. Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

    Science.gov (United States)

    Pang, Zhibo; Zheng, Lirong; Tian, Junzhe; Kao-Walter, Sharon; Dubrova, Elena; Chen, Qiang

    2015-01-01

    In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients' home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.

  9. Anxiety in Terminally Ill Cancer Patients

    Science.gov (United States)

    Kolva, Elissa; Rosenfeld, Barry; Pessin, Hayley; Breitbart, William; Brescia, Robert

    2011-01-01

    Context Anxiety in terminal cancer is linked to diminished quality of life, yet overall it is poorly understood with regard to prevalence and relationship to other aspects of psychological distress. Objectives This study examines anxiety in terminally ill cancer patients, including the prevalence of anxiety symptoms, the relationship between anxiety and depression, differences in anxiety between participants receiving inpatient palliative care and those receiving outpatient care, and characteristics that distinguish highly anxious from less anxious patients. Methods Participants were 194 patients with terminal cancer. Approximately half (n = 103) were receiving inpatient care in a palliative care facility and half (n = 91) were receiving outpatient care in a tertiary care cancer center. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression, and was administered along with measures of hopelessness, desire for hastened death, and social support. Results Moderately elevated anxiety symptoms were found in 18.6% of participants (n = 36) and 12.4% (n = 24) had clinically significant anxiety symptoms. Level of anxiety did not differ between the two treatment settings. However, participants receiving palliative care reported significantly higher levels of depression and desire for hastened death. A multivariate prediction model indicated that belief in an afterlife, social support, and anxiolytic and antidepressant use were unique, significant predictors of anxiety. Conclusion Severity of anxiety symptoms did not differ between the study sites, suggesting that anxiety may differ from depression and desire for hastened death in the course that it takes over the duration of terminal cancer. PMID:21565460

  10. Perspectives of cardiac care unit nursing staff about developing hospice services in iran for terminally ill cardiovascular patients: A qualitative study

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2015-01-01

    Full Text Available Introduction: The present study was conducted aiming to determine the points of view of cardiac care units′ nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful.

  11. 29 CFR 4043.24 - Termination or partial termination.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Termination or partial termination. 4043.24 Section 4043.24....24 Termination or partial termination. (a) Reportable event. A reportable event occurs when the Secretary of the Treasury determines that there has been a termination or partial termination of a plan...

  12. Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: The study protocol of the PalTeC-H project

    NARCIS (Netherlands)

    F.E. Witkamp (Frederika); L. van Zuylen (Lia); P.J. van der Maas (Paul); H.V. Dijk (Helma Van); C.C.D. van der Rijt (Carin); A. van der Heide (Agnes)

    2013-01-01

    textabstractBackground: The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a

  13. CONTAINER TERMINALS IN EUROPE

    Directory of Open Access Journals (Sweden)

    Bart W. WIEGMANS

    2001-01-01

    Full Text Available This paper aims to address the linkage between logistics (in particular, the management of marketing channel flows and transport markets, while also the interaction between these two markets and intermodal container terminals is analysed. The marketing channel theory is used to describe all relevant actors and flows that run through marketing channels, starting with customer needs and ending with customer satisfaction. Porter's theory of competitive advantages is used to review competitive forces in both markets. Finally, a competitor analysis is performed for the logistics and transport market. These theories are applied so as to be able to determine the competitive position of intermodal container terminals with a view to the management of marketing channel flows and the physical transport of freight flows. Hence, the central question of this paper is: Which markets are served by intermodal container terminals and with whom are they competing? At present, neither the maritime container terminals nor the continental container terminals appear to have a significant influence in the logistics service market; they concentrate mainly on the physical movement of containers (transshipment. Furthermore, maritime container terminals and continental container terminals are not dominant players in the transport service market. Our conclusion is that continental terminals are predominantly competing with unimodal road transport, with neighbouring continental terminals and with barge transport companies.

  14. End of Life Care

    Science.gov (United States)

    ... the person is not terminally ill. An informed refusal of medical treatment should always be respected. (Read ... to dry up secretions may also be used. Care and Treatment Palliative Care Palliative care is specialized ...

  15. Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project.

    Science.gov (United States)

    Witkamp, Frederika E; van Zuylen, Lia; van der Maas, Paul J; van Dijk, Helma; van der Rijt, Carin C D; van der Heide, Agnes

    2013-03-25

    The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands. We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying. With this study we aim to improve the understanding of and attention for patients' needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses.

  16. Rational suicide in the terminally ill.

    Science.gov (United States)

    Fontana, Joyce S

    2002-01-01

    To examine the current debate over the right to die specific to the rational suicide of terminally ill patients. Literature was reviewed for information concerning historical end-of-life practices and the past acceptance of suicide. Another review showed philosophical opinions and perspectives that spanned from ancient Greece and the Roman Empire to modern philosophical discourse. A case study of a terminally ill woman who chose suicide is presented to apply the history and philosophy to nursing care today. As more nursing care is delivered in patients' homes, nurses will face this situation with increasing frequency. A call is made for organizations to provide guidelines for nursing practice.

  17. Organizational Relationship Termination Competence

    DEFF Research Database (Denmark)

    Ritter, Thomas; Geersbro, Jens

    2011-01-01

    that a firm's percentage of unwanted customers decreases significantly as acceptance of termination increases, if the firm's definition of unwanted customers is well understood, and if a firm has clear termination routines. In addition, general focus on profitability and external constraints on relationship...

  18. Estudo fenomenológico sobre a visita domiciliária do enfermeiro à família no processo de terminalidade Estudio fenomenológico sobre la visita a domicilio del enfermero a la familia durante un proceso terminal Phenomenological study about the nurse's home care for families of terminally ill patients

    Directory of Open Access Journals (Sweden)

    Silvia Helena Valente

    2009-09-01

    research aimed to understand the phenomenon Nurses working in the FHP (Family Health Program and home care provided to the family living in a home where terminality of one of its members is being experienced. The study was carried out with healthcare providers who work in the Southeastern Region of the city of Sao Paulo/SP, Brazil. Existential phenomenology was used as the theoretical background. This study made possible the comprehension of what this experience meant to healthcare providers in a moment of being with the family in an existential situation of loss and death, creating a home protection network in order to make this process of terminality of one of the family members as smooth as possible. Even though permeated by care giving filled with humane feelings, thus representing a unique and remarkable experience, it was also a weary and difficult event that triggered labor health problems.

  19. Comsat's TDMA traffic terminal

    Science.gov (United States)

    Benjamin, M. C.; Bogaert, W. M.

    1985-06-01

    Comsat has installed two traffic terminals in the Etam earth-station and is currently installing a third in the new Roaring Creek earth-station to access the Intelsat TDMA network. This paper describes the Comsat TDMA traffic terminal equipment from the supergroup interface to the antenna. Comsat's 1: N redundancy approach for terrestrial interface equipment and DSI unit back-up is described as well as electrical path length, amplitude and group delay equalization techniques, special on-line RF monitoring and failure reporting facilities and the operation and maintenance center which can operate and perform diagnostic testing on up to four traffic terminals from a central location.

  20. Terminated Multifamily Mortgages Database

    Data.gov (United States)

    Department of Housing and Urban Development — This dataset includes all terminated HUD Multifamily mortgages except those from the Hospital Mortgage Insurance Program. It includes the Holder and Servicer at the...

  1. Antecedents of Customer Relationship Termination

    DEFF Research Database (Denmark)

    Geersbro, Jens; Ritter, Thomas

    relationships as a managerial task. This paper contributes by (1) developing a conceptualization of relationship termination competence and (2) analyzing its antecedents. The empirical results identify termination acceptance, definition non-customers, organizational relationship termination routines...

  2. Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom

    DEFF Research Database (Denmark)

    von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E

    2011-01-01

    Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative...... phase of the disease. Furthermore we discuss the prognostic and ethical challenges for patients, their families and their caregivers. Finally, we summarize the current evidence for palliative treatment of dyspnoea and ways to evaluate response to treatment....

  3. 42 CFR 418.22 - Certification of terminal illness.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Certification of terminal illness. 418.22 Section... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.22 Certification of terminal illness. (a) Timing of certification—(1) General rule. The hospice must obtain written...

  4. Knowledege And Attitudes Of Terminally Ill Patents And Their Family ...

    African Journals Online (AJOL)

    Knowledege And Attitudes Of Terminally Ill Patents And Their Family To Pallative Care And Hospice Services In Nigeria. ... Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 [84%] agreed that symptoms of the terminally ill patients should be treated to improve their quality ...

  5. Coal terminal guide 1999

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-08-01

    IBJ`s third edition of its annual guide to the world`s multi-user coal terminals includes comprehensive details of terminals in 44 countries. The guide sets out information for rapid and easy reference comprising contact, full address and communication details as well as berth dimensions and constraints, loading equipment and daily loading rate, annual loading capacity, daily discharge rate, annual discharge capacity, annual throughput capacity, storage facilities, stockyard capacity and equipment, processing facilities and so on. All information has been compiled from specific questionnaires and is presented alphabetically in country order.

  6. Windows Terminal Servers Orchestration

    Science.gov (United States)

    Bukowiec, Sebastian; Gaspar, Ricardo; Smith, Tim

    2017-10-01

    Windows Terminal Servers provide application gateways for various parts of the CERN accelerator complex, used by hundreds of CERN users every day. The combination of new tools such as Puppet, HAProxy and Microsoft System Center suite enable automation of provisioning workflows to provide a terminal server infrastructure that can scale up and down in an automated manner. The orchestration does not only reduce the time and effort necessary to deploy new instances, but also facilitates operations such as patching, analysis and recreation of compromised nodes as well as catering for workload peaks.

  7. EXTREME AND TERMINAL STATES

    Directory of Open Access Journals (Sweden)

    P.F. Litvitsky

    2010-01-01

    Full Text Available Author brings modern conception of extreme and terminal states, their types, likenesses and differences, etiology, key common chains of pathogenesis, principles and methods of their treatment. Pathophysiological data on one of extreme states — collapse — is described in details. Next publications will present the data on shock and coma.Key words: extreme and terminal states, vicious circle of pathogenesis, extreme regulation, principles of treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3:74-80

  8. Electrical termination techniques

    Science.gov (United States)

    Oakey, W. E.; Schleicher, R. R.

    1976-01-01

    A technical review of high reliability electrical terminations for electronic equipment was made. Seven techniques were selected from this review for further investigation, experimental work, and preliminary testing. From the preliminary test results, four techniques were selected for final testing and evaluation. These four were: (1) induction soldering, (2) wire wrap, (3) percussive arc welding, and (4) resistance welding. Of these four, induction soldering was selected as the best technique in terms of minimizing operator errors, controlling temperature and time, minimizing joint contamination, and ultimately producing a reliable, uniform, and reusable electrical termination.

  9. Terminal oxidases of cyanobacteria.

    Science.gov (United States)

    Hart, S E; Schlarb-Ridley, B G; Bendall, D S; Howe, C J

    2005-08-01

    The respiratory chain of cyanobacteria appears to be branched rather than linear; furthermore, respiratory and photosynthetic electron-transfer chains co-exist in the thylakoid membrane and even share components. This review will focus on the three types of terminal respiratory oxidases identified so far on a genetic level in cyanobacteria: aa3-type cytochrome c oxidase, cytochrome bd-quinol oxidase and the alternative respiratory terminal oxidase. We summarize here their genetic, biochemical and biophysical characterization to date and discuss their interactions with electron donors as well as their physiological roles.

  10. N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study.

    Science.gov (United States)

    Cheng, Hui; Fan, Wei-Ze; Wang, Sheng-Chi; Liu, Zhao-Hui; Zang, Hui-Ling; Wang, Li-Zhong; Liu, Hong-Juan; Shen, Xiao-Hui; Liang, Shao-Qing

    2015-06-01

    Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock. The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers. A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment. The levels of NT-proBNP and cTnI (P APACHE-II score alone was low but largely improved, when it was combined with both NT-proBNP and cTnI (P APACHE-II score was improved only when combined with NT-proBNP and cTnI. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in Côte d'Ivoire.

    Science.gov (United States)

    Schwartz, Sheree; Papworth, Erin; Thiam-Niangoin, Marguerite; Abo, Kouame; Drame, Fatou; Diouf, Daouda; Bamba, Amara; Ezouatchi, Rebecca; Tety, Josiane; Grover, Elise; Baral, Stefan

    2015-03-01

    HIV infection and unintended pregnancy are occupational risks of commercial female sex work (FSW). The burden of unintended pregnancy among FSW including maternal and infant outcomes in the context of HIV is largely unknown. FSW ≥18 years were recruited through respondent driven sampling into a cross-sectional study in Abidjan, Côte d'Ivoire. Participants completed a sociobehavioral questionnaire and HIV counseling and testing. Pregnancy history by HIV status and contraceptive use were described, and Poisson regression used to estimate correlates of termination of pregnancy (TOP). From March to July 2014, 466 FSW were enrolled. Unintended pregnancy was common, and 64% of participants had ≥1 TOP. Half of FSW experiencing TOPs did so without a medical professional, resulting in frequent complications. Contraceptive use was lowest among younger FSW, and 37% of 20-24 year olds reported multiple TOPs. FSW with a TOP history reported 19% less consistent condom use with clients than women who never had a TOP (adjusted-prevalence ratio, 0.81; 95% confidence interval: 0.74 to 0.88), whereas use of reliable nonbarrier contraceptive methods was comparable between the groups. Although FSW were engaged in HIV testing and prevention services, only 59% of FSW had received HIV testing before childbirth during their last pregnancy, and 30% of HIV-infected FSW had lost ≥1 children. Low contraceptive use and high burden of unintended pregnancy result in poor reproductive outcomes for FSW and avoidable mother-to-child HIV transmission risks. Integration of family planning and antenatal services into HIV prevention and care programs accessed by FSW could enhance reproductive outcomes and HIV prevention goals.

  12. Terminalidade e condutas de final de vida em unidades de terapia intensiva pediátrica Terminal ill children and dnd-of-life practices in the pediatric intensive care units

    Directory of Open Access Journals (Sweden)

    Patrícia Miranda Lago

    2007-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Analisar e discutir os aspectos médicos relacionados a terminalidade e cuidados de final de vida oferecidos a crianças internadas, principalmente, em unidades de terapia intensiva pediátrica (UTIP no Brasil e em alguns países do hemisfério norte. CONTEÚDO: Foram selecionados artigos sobre cuidados de final de vida publicados nos últimos 20 anos na PubMed, MedLine e LILACS com ênfase nos estudos sobre morte em UTIP no Brasil, América Latina, Europa e Norte América, usando as palavras-chave: morte, bioética, tratamento intensivo pediátrico, reanimação cardiopulmonar e limitação de suporte de vida. CONCLUSÕES: Observou-se maior incidência de limitação de suporte vital (LSV ~60% nas UTIP Norte-Americanas e européias que na América Latina (30%-40%. No Brasil a LSV tem diferentes incidências de acordo com a região, tendo aumentado na última década de 6% para 40%, sendo a ordem de não reanimar a forma mais freqüente. A participação da família no processo decisório no nosso meio é desestimulada e muito incipiente. Baseados na literatura revisada e em sua experiência os autores apresentam as medidas que consideram mais eficazes e recomendadas no seu manuseio. Apesar da LSV em crianças em fase final de doença irreversível ter amparos ético, moral e legal; essas medidas são ainda adotadas de forma tímida. Entre as mudanças urgentes neste comportamento, destaca-se a necessidade do envolvimento da família no processo decisório.BACKGROUND AND OBJECTIVES: To analyze and discuss the medical practices related to the end-of-life care provided to children admitted to pediatric intensive care unit (PICU in Brazil and in some countries located in the northern hemisphere. CONTENTS: Selected articles on end-of-life care published during the last years searching the PubMed, MedLine and LILACS database, with special interest on studies of death conducted in pediatric intensive care units in Brazil

  13. Termination of protein synthesis.

    Science.gov (United States)

    Tuite, M F; Stansfield, I

    1994-05-01

    One of three mRNA codons--UAA, UAG and UGA--is used to signal to the elongating ribosome that translation should be terminated at this point. Upon the arrival of the stop codon at the ribosomal acceptor(A)-site, a protein release factor (RF) binds to the ribosome resulting in the peptidyl transferase centre of the ribosome switching to a hydrolytic function to remove the completed polypeptide chain from the peptidyl-tRNA bound at the adjacent ribosomal peptidyl(P)-site. In this review recent advances in our understanding of the mechanism of termination in the bacterium Escherichia coli will be summarised, paying particular attention to the roles of 16S ribosomal RNA and the release factors RF-1, RF-2 and RF-3 in stop codon recognition. Our understanding of the translation termination process in eukaryotes is much more rudimentary with the identity of the single eukaryotic release factor (eRF) still remaining elusive. Finally, several examples of how the termination mechanism can be subverted either to expand the genetic code (e.g. selenocysteine insertion at UGA codons) or to regulate the expression of mammalian retroviral or plant viral genomes will be discussed.

  14. Making Wireless Terminals Simpler

    DEFF Research Database (Denmark)

    Christensen, Søren Skovgaard; Popovski, Petar; De Carvalho, Elisabeth

    2005-01-01

    The exponential growth of user demands and the limitations of 3G systems have brought researchers and industry to propose solutions for the next generation. Among the requirements are higher bit rates and cheaper deployment. In this paper we focus on a terminal complexity problem related to channel...

  15. Retrospective study on prognostic importance of serum procalcitonin and amino - terminal pro - brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

    Directory of Open Access Journals (Sweden)

    Chitra Mehta

    2016-01-01

    Full Text Available Background: Timely decision making in Intensive Care Unit (ICU is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643 and morbidity (P = 0.000, AUC = 0.763, comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045. Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study.

  16. Ice age terminations.

    Science.gov (United States)

    Cheng, Hai; Edwards, R Lawrence; Broecker, Wallace S; Denton, George H; Kong, Xinggong; Wang, Yongjin; Zhang, Rong; Wang, Xianfeng

    2009-10-09

    230Th-dated oxygen isotope records of stalagmites from Sanbao Cave, China, characterize Asian Monsoon (AM) precipitation through the ends of the third- and fourthmost recent ice ages. As a result, AM records for the past four glacial terminations can now be precisely correlated with those from ice cores and marine sediments, establishing the timing and sequence of major events. In all four cases, observations are consistent with a classic Northern Hemisphere summer insolation intensity trigger for an initial retreat of northern ice sheets. Meltwater and icebergs entering the North Atlantic alter oceanic and atmospheric circulation and associated fluxes of heat and carbon, causing increases in atmospheric CO2 and Antarctic temperatures that drive the termination in the Southern Hemisphere. Increasing CO2 and summer insolation drive recession of northern ice sheets, with probable positive feedbacks between sea level and CO2.

  17. Equilibrium and Termination

    Directory of Open Access Journals (Sweden)

    Nicolas Oury

    2010-06-01

    Full Text Available We present a reduction of the termination problem for a Turing machine (in the simplified form of the Post correspondence problem to the problem of determining whether a continuous-time Markov chain presented as a set of Kappa graph-rewriting rules has an equilibrium. It follows that the problem of whether a computable CTMC is dissipative (ie does not have an equilibrium is undecidable.

  18. Coal terminal project report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-03-01

    Malaysia is building the necessary infrastructure to cope with an increasing demand for electricity. Its restructured energy policy has led to construction of the 2,100 MW Manjung coal-fired power plant in the state of Perak, for which coal has to be imported via the new Lekiv Bulk Terminal (LBT) adjacent to the plant. Contracts for the LBC and the TNBJ coal stockyard were awarded to the Koch Consortium. The article describes equipment for handling and storing coal. 4 photos.

  19. Terminal Satisfiability in GSTE

    OpenAIRE

    Yongsheng Xu; Guowu Yang; Zhengwei Chang; Desheng Zheng; Wensheng Guo

    2014-01-01

    Generalized symbolic trajectory evaluation (GSTE) is an extension of symbolic trajectory evaluation (STE) and a method of model checking. GSTE specifications are given as assertion graphs. There are four efficient methods to verify whether a circuit model obeys an assertion graph in GSTE, Model Checking Strong Satisfiability (SMC), Model Checking Normal Satisfiability (NMC), Model Checking Fair Satisfiability (FMC), and Model Checking Terminal Satisfiability (TMC). SMC, NMC, and FMC have been...

  20. Unstable terminality: negotiating the meaning of chronicity and terminality in motor neurone disease.

    Science.gov (United States)

    Lerum, Sverre Vigeland; Solbraekke, Kari Nyheim; Holmøy, Trygve; Frich, Jan C

    2015-01-01

    This paper explores the meaning of chronicity and terminality in motor neurone disease (MND), also known as amyotrophic lateral sclerosis (ALS). There is no known cause or cure for MND, and expected survival is 2-5 years, but several interventions may improve or prolong life. This study draws on qualitative interview data with health professionals in hospitals and primary care, and family carers, in Norway. The actors emphasised chronic and terminal aspects in subtly different ways along the entire illness trajectory, also when recounting the trajectory in retrospect. As a consequence of improved health services and medical technology the distinction between chronicity and terminality has become more vague and sometimes ambiguous. We suggest the concept unstable terminality to describe this ambiguity. While MND is a fatal diagnosis; it may be contested, as contingencies and interventions create an indefinite time scope. The instability creates challenges for primary care which is dependent on prognostic information to organise their effort; hospitals tackle the instability by pre-scheduled consultations allowing for avoidance of an explicit prognosis. Some carers experienced what we understand as a disruption within the disruption, living with chronic and terminal illness simultaneously, which made the limbo phase more challenging to overcome. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  1. Terminal sedation and euthanasia: a comparison of clinical practices.

    Science.gov (United States)

    Rietjens, Judith A C; van Delden, Johannes J M; van der Heide, Agnes; Vrakking, Astrid M; Onwuteaka-Philipsen, Bregje D; van der Maas, Paul J; van der Wal, Gerrit

    2006-04-10

    An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices. Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases. Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.

  2. Extensions to regret-based decision curve analysis: an application to hospice referral for terminal patients

    National Research Council Canada - National Science Library

    Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin

    2011-01-01

    Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed...

  3. Acetylene terminated matrix resins

    Science.gov (United States)

    Goldfarb, I. J.; Lee, Y. C.; Arnold, F. E.; Helminiak, T. E.

    1985-01-01

    The synthesis of resins with terminal acetylene groups has provided a promising technology to yield high performance structural materials. Because these resins cure through an addition reaction, no volatile by-products are produced during the processing. The cured products have high thermal stability and good properties retention after exposure to humidity. Resins with a wide variety of different chemical structures between the terminal acetylene groups are synthesized and their mechanical properties studied. The ability of the acetylene cured polymers to give good mechanical properties is demonstrated by the resins with quinoxaline structures. Processibility of these resins can be manipulated by varying the chain length between the acetylene groups or by blending in different amounts of reactive deluents. Processing conditions similar to the state-of-the-art epoxy can be attained by using backbone structures like ether-sulfone or bis-phenol-A. The wide range of mechanical properties and processing conditions attainable by this class of resins should allow them to be used in a wide variety of applications.

  4. Termination: A Case Study.

    Science.gov (United States)

    Friedberg, Ahron L

    2015-12-01

    In this article I posit and examine certain criteria and qualities for ending an analysis. The case study describes the end phase of a four-year psychoanalysis in which the patient's decision to move to another area forced the end of his analysis. We continued to explore and work through his core neurotic conflicts that included issues of competitive rivalry, dominance and submission, control, and anxiety about birth and death. A shift in the transference from me as a negative father to me as a supportive but competitive older brother was also examined in the context of ending treatment as well as other aspects of the transference. In addition, we analyzed the meaning of his ending treatment based on an extra-analytic circumstance. In discussing this phase of treatment, the definition and history of the term "termination" and its connotations are reviewed. Various criteria for completing an analysis are examined, and technical observations about this phase of treatment are investigated. It was found that while a significant shift in the transference occurred in this phase of the patient's analysis, conflicts related to the transference were not "resolved" in the classical sense. Terminating treatment was considered as a practical matter in which the patient's autonomy and sense of choice were respected and analyzed.

  5. Palliative care in the intensive care unit.

    Science.gov (United States)

    Restau, Jame; Green, Pamela

    2014-12-01

    Most patients who receive terminal care in the intensive care setting die after withdrawing or limiting of life-sustaining measures provided in the intensive care setting. The integration of palliative care into the intensive care unit (ICU) provides care, comfort, and planning for patients, families, and the medical staff to help decrease the emotional, spiritual, and psychological stress of a patient's death. Quality measures for palliative care in the ICU are discussed along with case studies to demonstrate how this integration is beneficial for a patient and family. Integrating palliative care into the ICU is also examined in regards to the complex adaptive system. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. 77 FR 38817 - Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2012-06-29

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... procedures for terminating Underwriting Authority of Direct Endorsement mortgagees. Termination of Direct...

  7. Resolution and termination

    Directory of Open Access Journals (Sweden)

    Adina FOLTIŞ

    2012-01-01

    Full Text Available The resolution, the termination and the reduction of labour conscription are regulated by articles 1549-1554 in the new Civil Code, which represents the common law in this matter. We appreciate that the new regulation does not conclusively clarify the issue related to whether the existence of liability in order to call upon the resolution is necessary or not, because the existence of this condition has been inferred under the previous regulation from the fact that the absence of liability shifts the inexecution issue on the domain of fortuitous impossibility of execution, situation in which the resolution of the contract is not in question, but that of the risk it implies.

  8. Mobile termination and mobile penetration

    OpenAIRE

    Hurkens, Sjaak; Jeon, Doh-Shin

    2009-01-01

    In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can apply termination-based price discrimination. In the case of a fixed per minute termination charge, we find that a reduction of the termination charge below cost has two oppos- ing effects: it softens competition but helps to internalize network externalities. The former reduces mobile penetration while the latter boosts it. We find that fi...

  9. Is Lake Tahoe Terminal?

    Science.gov (United States)

    Coats, R. N.; Reuter, J.; Heyvaert, A.; Lewis, J.; Sahoo, G. B.; Schladow, G.; Thorne, J. H.

    2014-12-01

    ) the climatic water deficit will increase, especially at high elevations that will be most affected by the loss of snow, with likely consequences for existing vegetation and fire frequency. Hydrologically, Lake Tahoe is intermittently terminal; in a medical sense it is not yet terminal, but its condition—especially its valued clarity and deep blue color--is serious.

  10. Terminal Satisfiability in GSTE

    Directory of Open Access Journals (Sweden)

    Yongsheng Xu

    2014-01-01

    Full Text Available Generalized symbolic trajectory evaluation (GSTE is an extension of symbolic trajectory evaluation (STE and a method of model checking. GSTE specifications are given as assertion graphs. There are four efficient methods to verify whether a circuit model obeys an assertion graph in GSTE, Model Checking Strong Satisfiability (SMC, Model Checking Normal Satisfiability (NMC, Model Checking Fair Satisfiability (FMC, and Model Checking Terminal Satisfiability (TMC. SMC, NMC, and FMC have been proved and applied in industry, but TMC has not. This paper gives a six-tuple definition and presents a new algorithm for TMC. Based on these, we prove that our algorithm is sound and complete. It solves the SMC’s limitation (resulting in false negative without extending from finite specification to infinite specification. At last, a case of using TMC to verify a realistic hardware circuit round-robin arbiter is achieved. Avoiding verifying the undesired paths which are not related to the specifications, TMC makes it possible to reduce the computational complexity, and the experimental results suggest that the time cost by SMC is 3.14× with TMC in the case.

  11. Acetylene-Terminated Polyimide Siloxanes

    Science.gov (United States)

    St. Clair, Terry L.; Maudgal, Shubba

    1987-01-01

    Siloxane-containing addition polyimides yield toughened high-temperature adhesives and matrix resins. Addition polyimide made by reaction of aromatic tetracarboxylic acid dianhydride with aromatic diamine in presence of ethynyl-substituted aromatic monoamine. Acetylene-terminated siloxane imide cured by heating to yield acetylene-terminated polyimide siloxane.

  12. Selection of Air Terminal Device

    DEFF Research Database (Denmark)

    Nielsen, Peter V.

    This paper discusses the selection of the air terminal device for the experiments and numerical prediction in the International Energy Agency Annex 20 work: Air Flow Pattern within Buildings,......This paper discusses the selection of the air terminal device for the experiments and numerical prediction in the International Energy Agency Annex 20 work: Air Flow Pattern within Buildings,...

  13. Women’s experience of termination of a pregnancy

    Directory of Open Access Journals (Sweden)

    M Poggenpoel

    2006-09-01

    Full Text Available In November 1996 the Act on the Termination of Pregnancies (no 92 of 1996 was promulgated. This Act enabled women from the age of twelve years old to decide to terminate their pregnancies before twelve weeks gestation without permission of anybody else. Since February 1997 almost 160 000 terminations of pregnancy have been carried out in South Africa. Little research has been conducted to explore and describe the effect of the termination of pregnancies on women Two aims were formulated for the research project described in this article: (1 the exploration and description of the women’s experience of terminating a pregnancy, and (2 the description of counselling guidelines for caring professionals to assist these women. Participants were included in the sample through purposive sampling. Phenomenological interviews were conducted individually. Data were analysed by means of Tesch’s descriptive approach. Counselling guidelines for educational psychologists and other caring professionals to empower the involved were being logically inferred from the results of the interviews. Measures to ensure trustworthiness have been applied in the research and ethical measures have been strictly adhered to during the research. One central theme was identified from the results of the interviews and naïve sketches, namely women’s experiences of a negative relationship with themselves and other persons as well as their focus on their terminated pregnancies.

  14. Caracterización de los pacientes terminales y su atención domiciliaria por parte de un equipo básico de salud Characterization of patients presenting terminal diseases and their home care by a health basic staff

    Directory of Open Access Journals (Sweden)

    Dulce V. Romeo Cepero

    2007-09-01

    Full Text Available Trabajar en cuidados paliativos nos motiva a formarnos para ofrecer una asistencia integral a la unidad paciente-familia. La filosofía de los cuidados paliativos no excluye los cuidados curativos, porque siempre es posible proporcionar confort y calidad de vida al paciente cuando se aplica el tratamiento. Con el objetivo de caracterizar los pacientes terminales y la atención domiciliaria brindada en la comunidad por un Equipo Básico de Salud (EBS del Policlínico “Wilfredo Santana Rivas”, se realizó un estudio descriptivo, transversal, y retrospectivo de serie de casos que incluyó 9 enfermos terminales atendidos por un EBS en la comunidad del área de salud del Policlínico “Wilfredo Santana Rivas” en el período de enero de 2000 a junio de 2005. Se pudo concluir que contar con un equipo coordinado que administre sus cuidados, que tanto el paciente como su familia se interesen por dicho tratamiento, así como que exista apoyo constante y fuentes de educación para el paciente y su familia, constituyen los componentes claves del tratamiento en el domicilio para los pacientes con enfermedad terminal. Incorporar a la familia en la atención y cuidados de su familiar aquejado, ayuda a que el paciente se encuentre en un ambiente hogareño, con un entorno de alto calor humano, y ello es algo esencial en esta modalidad, por lo que se establece así que la meta de la atención debe estar encaminada a la preservación de la calidad de vida mediante el control adecuado de los síntomas, la satisfacción de sus necesidades, y el apoyo emocional necesario para el paciente y su familia.Palliative care training allow us to offer an integral assistance to patient-family unit. Philosophy of palliative care not excludes curative care because always it is possible to procure comfort and life quality to patient when treatment is applied. To characterize patients presenting terminal diseases and home care offered in community by a Health Basic Staff

  15. Shared Care in Basic Level Palliative Home Care: Organizational and Interpersonal Challenges

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde

    2010-01-01

    Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care.......Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care....

  16. Models of Care

    Science.gov (United States)

    Wilson, Dottie C.; And Others

    1978-01-01

    This section describes hospice or palliative care programs for terminally ill patients and their families. The programs described are in Montreal, Quebec; Halifax, Nova Scotia; New Haven, Connecticut; Marin County, California; Tucson, Arizona; and Springfield, Illinois. (Author/JEL)

  17. Ports and Terminals : Planning and Functional Design

    NARCIS (Netherlands)

    Groenveld, R.; Velsink, H.

    1993-01-01

    1. Maritime transport, means and commodities 3. Principles of integrated port planning 4. Planning and design of a port's water areas 5. Port terminals - introduction 6. Conventional general cargo terminals 7. Container terminals 8. Oil & liquid gas terminals 9. Dry bulk cargo terminals 10. Fishery

  18. Living with a terminal illness: patients' priorities.

    Science.gov (United States)

    Carter, Helen; MacLeod, Rod; Brander, Penny; McPherson, Kath

    2004-03-01

    Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill. The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives. Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory. Over 30 categories were identified and collated into five inter-related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on 'life and living' in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, 'taking charge', concerned with people's levels of life engagement, was integrally connected to all other themes. The findings suggest that the way in which health professionals manage patients' involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional 'expert-defined' outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented.

  19. Terminal Antennas in ACE2

    Directory of Open Access Journals (Sweden)

    M. Martinez-Vazquez

    2008-06-01

    Full Text Available The ACE Network of Excellence was a European Commission funded Network of Excellence, which lasted from 2004 to 2007. One of the activities performed by this Network was in the frame of terminal antennas. In this activity, three aspects were covered in three projects: Small antenna technologies, small terminal antenna technologies and benchmarking of small terminal antennas measurement facilities. The overall aim was to identify the newest trends in antenna design and measurement for personal communications devices, and suggest novel solutions and design methodologies for various applications. The results of this work are presented in this paper.

  20. 75 FR 61165 - Credit Watch Termination Initiative Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2010-10-04

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... advised the extended procedures for ] terminating Underwriting Authority of Direct Endorsement mortgagees...

  1. 76 FR 38407 - Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2011-06-30

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... advised the extended procedures for ] terminating Underwriting Authority of Direct Endorsement mortgagees...

  2. 77 FR 5262 - Credit Watch Termination Initiative Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2012-02-02

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... the extended procedures for terminating Underwriting Authority of Direct Endorsement (DE) mortgagees...

  3. 76 FR 53148 - Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2011-08-25

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... advised the extended procedures for terminating Underwriting Authority of Direct Endorsement mortgagees...

  4. Mechanisms of DNA replication termination.

    Science.gov (United States)

    Dewar, James M; Walter, Johannes C

    2017-08-01

    Genome duplication is carried out by pairs of replication forks that assemble at origins of replication and then move in opposite directions. DNA replication ends when converging replication forks meet. During this process, which is known as replication termination, DNA synthesis is completed, the replication machinery is disassembled and daughter molecules are resolved. In this Review, we outline the steps that are likely to be common to replication termination in most organisms, namely, fork convergence, synthesis completion, replisome disassembly and decatenation. We briefly review the mechanism of termination in the bacterium Escherichia coli and in simian virus 40 (SV40) and also focus on recent advances in eukaryotic replication termination. In particular, we discuss the recently discovered E3 ubiquitin ligases that control replisome disassembly in yeast and higher eukaryotes, and how their activity is regulated to avoid genome instability.

  5. Flight Termination Systems Commonality Standard

    Science.gov (United States)

    2014-09-01

    EFI exploding foil initiator EFTR enhanced flight termination receiver EFTS enhanced flight termination system ELS equivalent level of safety EMC ...account shielding effectiveness of the vehicle. 3.3.13 Other Environments An FTS component shall satisfy all of its performance requirements and not...solid-state power transfer switches, and arm-and-enable circuits. 3.9.6 Circuit Isolation, Shielding , and Grounding The circuitry of an FTS

  6. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands

    NARCIS (Netherlands)

    A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit); J.A.C. Rietjens (Judith)

    2004-01-01

    textabstractBACKGROUND: Terminal sedation in patients nearing death is an important issue related to end-of-life care. OBJECTIVE: To describe the practice of terminal sedation in the Netherlands. DESIGN: Face-to-face interviews. SETTING: The Netherlands. PARTICIPANTS: Nationwide

  7. Symptoms, signs, problems, and diseases of terminally ill nursing home patients: a nationwide observational study in the Netherlands

    NARCIS (Netherlands)

    Brandt, H.E.; Deliens, L.H.J.; Ooms, M.E.; van der Steen, J.T.; van der Wal, G.; Ribbe, M.W.

    2005-01-01

    Background: Nursing homes (NHs) are less well studied than hospices or hospitals as a setting for terminal care. For more targeted palliative care, more information is needed about the patient characteristics, symptoms, direct causes and underlying diseases, and incidence of terminally ill NH

  8. Chromatin condensation during terminal erythropoiesis.

    Science.gov (United States)

    Zhao, Baobing; Yang, Jing; Ji, Peng

    2016-09-02

    Mammalian terminal erythropoiesis involves gradual but dramatic chromatin condensation steps that are essential for cell differentiation. Chromatin and nuclear condensation is followed by a unique enucleation process, which is believed to liberate more spaces for hemoglobin enrichment and enable the generation of a physically flexible mature red blood cell. Although these processes have been known for decades, the mechanisms are still unclear. Our recent study reveals an unexpected nuclear opening formation during mouse terminal erythropoiesis that requires caspase-3 activity. Major histones, except H2AZ, are partially released from the opening, which is important for chromatin condensation. Block of the nuclear opening through caspase inhibitor or knockdown of caspase-3 inhibits chromatin condensation and enucleation. We also demonstrate that nuclear opening and histone release are cell cycle regulated. These studies reveal a novel mechanism for chromatin condensation in mammalia terminal erythropoiesis.

  9. SIRKULASI TERMINAL PENUMPANG KAPAL LAUT

    Directory of Open Access Journals (Sweden)

    Etsa Purnama Sari

    2014-01-01

    Full Text Available Wilayah Indonesia yang terdiri dari pulau dan perairan menjadikan angkutan laut menjadi salah satu sarana transportasi yang cukup efektif di negara ini. Daya angkut yang besar dan beragam serta biaya yang lebih murah dengan jarak jangkauan yang luas, membuat sarana ini banyak diminati oleh masyarakat sekaligus juga merupakan pendukung utama perkembangan kehidupan sosial budaya dan roda perekonomian. Untuk mendukung proses transportasi laut ini perlu sarana berupa pelabuhan. Pelabuhan dalam melakukan pelayanan terhadap kapal memiliki beberapa fasilitas pokok dan penunjang yang wajib dimiliki. Salah satunya adalah terminal penumpang kapal laut dengan berbagai kegiatan di dalamnya untuk kedatangan maupun keberangkatan. Masalah ketidaknyamanan dalam berkegiatan, jauhnya akses sirkulasi antara satu kegiatan dengan kegiatan kegiatan embarkasi dan debarkasi yang tidak teratur, pembagian jalur sirkulasi penumpang dan pengantar penumpang yang tidak jelas seringkali muncul akibat sirkulasi yang tidak direncanakan dengan baik pada terminal penumpang kapal laut. Bahkan tidak jarang dapat menimbulkan adanya calo tiket hingga adanya penumpang tanpa tiket yang dapat masuk ke dalam kapal hingga kapal berlayar. Perencanaan sebuah sirkulasi yang tepat pada terminal penumpang kapal laut memerlukan kajian terhadap unsur-unsur sirkulasi seperti pencapaian, pola sirkulasi, jalur sirkulasi, serta bentuk ruang sirkulasi. Kajian unsur-unsur ini selanjutnya diselidiki melalui penelusuran masalah dengan analisis deskriptif melalui penggambaran objek penelitian yang terdapat pada Terminal Penumpang Pelabuhan International Yokohama, Terminal Penumpang Pelabuhan Kobe dan Terminal Penumpang Pelabuhan Osanbashi Hall   As one of the largest archipelago country, sea transportation acts as one of the most effective means of transportation in Indonesia. Large and diverse carrying capacity, lower cost with wide range of distances, are factors which making sea

  10. The Relationship between Dignity Status and Quality of Life in Iranian Terminally Ill Patients with Cancer

    OpenAIRE

    Hosseini, Abbas; Rezaei, Masoud; Bahrami, Masoud; Abbasi, Mohammad; Hariri, Hesammodin

    2017-01-01

    Background: Palliative care is an approach that has been used to care for terminally ill patients. The current study was performed to assess the association between the status of patient dignity and quality of life (QOL) in Iranian terminally ill patients with cancer. Materials and Methods: This descriptive correlational study was conducted on 210 end-stage cancer patients (102 men and 108 women) who were referred to Seyed Al-Shohada Hospital, Isfahan, Iran, in 2015. To assess dignity status,...

  11. Sistem Pengelolaan Terminal Mangkang Kota Semarang

    OpenAIRE

    Sushernawan, Prasetya; Sulistyowati; Fitriyah

    2014-01-01

    This study, entitled "SYSTEM MANAGEMENT TERMINAL CITY MangkangSemarang". Terminal Mangkang a master terminal type A that is in the province of CentralJava is managed by Dishubkominfo. Terminal is a facility for public service units, as publicfacilities, the terminal should be able to provide services to the community as well as possible.So that they can be expected to contribute the maximum to PAD (the original income) withoutcompromising service to the community.Formulation of the problem in...

  12. Getting a Suitable Terminal Cost and Maximizing the Terminal Region for MPC

    Directory of Open Access Journals (Sweden)

    Wang Ya-feng

    2010-01-01

    Full Text Available The model predictive control (MPC subject to control and state constraint is studied. Given a terminal cost, a terminal region is obtained through iterative estimation by using support vector machine (SVM. It is proved that the obtained terminal region is the largest terminal region when the terminal cost is given. The relationships between terminal cost and terminal region and between terminal cost and total cost are discussed, respectively. Based on these relationships, a simple method to get a suitable terminal cost is proposed and it can be adjusted according to our need. Finally, some experiment results are presented.

  13. New offshore terminal for Ecuador

    Energy Technology Data Exchange (ETDEWEB)

    1979-04-15

    W. Halcrow and Partners will design and supervise construction of the second phase of Corporacion Estatal Petrolera Ecuatoriana's offshore tanker terminal for the export of refined products from its 65,000 bbl/day Esmeraldas refinery, which will be expanded to 130,000 bbl/day. Ewbank and Partners Ltd. will handle mechanical and electrical engineering of the terminal. Halcrow also designed and built the first stage of the terminal, which comprised a four-hose seabed manifold 4 km offshore in water depths of 16 m and which became operational in Nov. 1977 with capacity to handle tankers up to 20,000 dwt and with pipeline connection to the Esmeradas refinery. The seabed manifold will be replaced by a two-berth sea island terminal to handle tankers up to 50,000 dwt; a contract for this has been signed. Future plans call for a two-berth central loading platform, separate berthing and mooring dolphins, an accommodation platform, and auxiliary services. The main structure will be a steel-piled jacket design interconnected by steel access bridges. The additional works should be completed by the end of 1981.

  14. The impact of 'terminator' technology

    NARCIS (Netherlands)

    Visser, B.; Meer, van der I.J.M.; Louwaars, N.; Beekwilder, J.; Eaton, D.

    2001-01-01

    Genetic use-restriction technologies enable the developers of transgenic plants or animals to protect their variety or breed from unauthorized use in a biological way. The use of 'terminator technology' can have different impacts on farmers and breeders. If the technology is effective, it impacts on

  15. What Determines Joint Venture Termination?

    DEFF Research Database (Denmark)

    Nielsen, Bo Bernhard

    2012-01-01

    Joint venture (JV) research continues to flourish as researchers seek to advance our understanding of why so many JVs fail. Cui and Kumar (this issue) take a contingency approach to explain how and why business relatedness may provide new insights as to what determines JV termination...

  16. Combining norms to prove termination

    DEFF Research Database (Denmark)

    Genaim, S.; Codish, M.; Gallagher, John Patrick

    2002-01-01

    Automatic termination analysers typically measure the size of terms applying norms which are mappings from terms to the natural numbers. This paper illustrates howt o enable the use of size functions defined as tuples of these simpler norm functions. This approach enables us to simplify the problem...

  17. 26 CFR 1.411(d)-2 - Termination or partial termination; discontinuance of contributions.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Termination or partial termination... Bonus Plans, Etc. § 1.411(d)-2 Termination or partial termination; discontinuance of contributions. (a... such plan is not a qualified trust) unless the plan provides that— (i) Upon the termination or partial...

  18. Terminal decline in motor function.

    Science.gov (United States)

    Wilson, Robert S; Segawa, Eisuke; Buchman, Aron S; Boyle, Patricia A; Hizel, Loren P; Bennett, David A

    2012-12-01

    The study aim was to test the hypothesis that motor function undergoes accelerated decline proximate to death. As part of a longitudinal clinical-pathologic study, 124 older Roman Catholic nuns, priests, and monks completed at least 7 annual clinical evaluations, died, and underwent brain autopsy and uniform neuropathologic examination. Each evaluation included administration of 11 motor tests and 19 cognitive tests from which global measures of motor and cognitive function were derived. The global motor measure (baseline M = 0.82, SD = 0.21) declined a mean 0.024 unit per year (95% confidence interval [CI]: -0.032, -0.016) until a mean of 2.46 years (95% CI: -2.870, -2.108) before death when rate of decline increased nearly fivefold to -0.117 unit per year (95% CI: -0.140, -0.097). The global cognitive measure (baseline M = 0.07, SD = 0.45) declined a mean of 0.027-unit per year (95% CI: -0.041, -0.014) until a mean of 2.76 years (95% CI: -3.157, -2.372) before death when rate of decline increased more than 13-fold to -0.371 unit per year (95% CI: -0.443, -0.306). Onset of terminal motor decline was highly correlated with onset of terminal cognitive decline (r = .94, 95% CI: 0.81, 0.99), but rates of motor and cognitive change were not strongly correlated (preterminal r = .20, 95% CI: -0.05, 0.38; terminal r = .34, 95% CI: 0.03, 0.62). Higher level of plaques and tangles was associated with earlier onset of terminal decline in motor function, but no pathologic measures were associated with rate of preterminal or terminal motor decline. The results demonstrate that motor and cognitive functions both undergo a period of accelerated decline in the last few years of life. 2013 APA, all rights reserved

  19. The termination phase of psychoanalysis in a narcissistic personality.

    Science.gov (United States)

    Warnes, H

    This paper describes a patient whose termination phase of analysis activated an intense mourning reaction that helped to overcome the stalemate of therapy. After I attempted to demonstrate how her narcissistic armouring yielded when the termination of analysis was agreed upon, the psychological reenactment of a split off (disavowed) trauma of an early loss (her father) and the failure of essential attributes in maternal care became manifested behind her narcissistic defenses. The reconstruction of these events was possible during the process of mourning. At the termination phase she behaved as if she "had lost the war"; from the point of view of her masochism it was a Pyrrhic victory, "a victory through defeat". Contrary to mother, I let her go but then she refused to go, which created a situation that activated a profound mourning reaction leading to important structural changes. A review of the pertinent psychoanalytic literature on termination along with clinical material derived from the termination phase of a patient with a narcissistic personality is presented.

  20. Palliative care

    Directory of Open Access Journals (Sweden)

    Mônica Estuque Garcia de Queiroz

    2012-09-01

    Full Text Available According to the World Health Organization (WHO, palliative care can be defined as active and totalcare measures that improve the life quality of patients with terminal diseases and their family/relatives, throughprevention and suffering relieve by means of early identification, adequate evaluation, and treatment of painand other physical, psychosocial and spiritual problems. This article deals with the attention of the occupationaltherapist in palliative care, as from the definition of this philosophy and its principles. The occupational therapist’spractice is described through the author’s theoretical and practical references. In palliative care, occupationaltherapy helps the patient and caregiver to deal with the difficulties mentioned and observed in order to achievegreater comfort, dignity and quality of life in the hospital or at home, in order to promote the maximum levelof independence and/or occupational performance with autonomy with the aim to improve the quality of life,despite the functional loss, cognitive, emotional and social.

  1. Clothes Dryer Automatic Termination Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    TeGrotenhuis, Ward E.

    2014-10-01

    Volume 2: Improved Sensor and Control Designs Many residential clothes dryers on the market today provide automatic cycles that are intended to stop when the clothes are dry, as determined by the final remaining moisture content (RMC). However, testing of automatic termination cycles has shown that many dryers are susceptible to over-drying of loads, leading to excess energy consumption. In particular, tests performed using the DOE Test Procedure in Appendix D2 of 10 CFR 430 subpart B have shown that as much as 62% of the energy used in a cycle may be from over-drying. Volume 1 of this report shows an average of 20% excess energy from over-drying when running automatic cycles with various load compositions and dryer settings. Consequently, improving automatic termination sensors and algorithms has the potential for substantial energy savings in the U.S.

  2. Complexity of Terminating Preference Elicitation

    OpenAIRE

    Walsh, Toby

    2009-01-01

    Complexity theory is a useful tool to study computational issues surrounding the elicitation of preferences, as well as the strategic manipulation of elections aggregating together preferences of multiple agents. We study here the complexity of determining when we can terminate eliciting preferences, and prove that the complexity depends on the elicitation strategy. We show, for instance, that it may be better from a computational perspective to elicit all preferences from one agent at a time...

  3. The Jewish patient and terminal dehydration: a hospice ethical dilemma.

    Science.gov (United States)

    Bodell, J; Weng, M A

    2000-01-01

    Culturally competent nursing care regarding the ethical dilemma of terminal dehydration (withholding or withdrawing food and fluid) for the Jewish hospice patient involves applying the ethical principles of justice, autonomy, beneficence, and nonmaleficence to nursing interventions by identifying outcomes that focus on the high value Jews place on life; avoiding stereotyping as to what it means to be Jewish; knowledge of various Jewish traditions surrounding death and dying; and good communication with the patient and his or her family.

  4. High Octane Fuel: Terminal Backgrounder

    Energy Technology Data Exchange (ETDEWEB)

    Moriarty, Kristi [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-02-11

    The Bioenergy Technologies Office of the U.S. Department of Energy Office of Energy Efficiency and Renewable Energy sponsored a scoping study to assess the potential of ethanol-based high octane fuel (HOF) to reduce energy consumption and greenhouse gas emissions. When the HOF blend is made with 25%-40% ethanol by volume, this energy efficiency improvement is potentially sufficient to offset the reduced vehicle range often associated with the decreased volumetric energy density of ethanol. The purpose of this study is to assess the ability of the fuel supply chain to accommodate more ethanol at fuel terminals. Fuel terminals are midstream in the transportation fuel supply chain and serve to store and distribute fuels to end users. While there are no technical issues to storing more ethanol at fuel terminals, there are several factors that could impact the ability to deploy more ethanol. The most significant of these issues include the availability of land to add more infrastructure and accommodate more truck traffic for ethanol deliveries as well as a lengthy permitting process to erect more tanks.

  5. k36u Terminal Aerodrome Forecast

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

  6. THE FORMALIZATION PROCESS OF CARGO TERMINAL OPERATION

    Directory of Open Access Journals (Sweden)

    N. Yu. Shramenko

    2011-01-01

    Full Text Available The mathematical formalization of operation process for a terminal complex is proposed and a model taking into account characteristics of a freight terminal and all the possible states of a system is developed.

  7. Nursing professionals' anxiety and feelings in terminal situations in oncology

    OpenAIRE

    Faria,Daniella Antunes Pousa; Maia,Eulália Maria Chaves

    2007-01-01

    This study aimed to investigate, through a cross-sectional study, factors that influence anxiety levels and feelings of a nursing team who care for terminal patients with cancer. The sample consisted of 50 Nursing Assistants and Technicians from the Hospital reference on cancer care in Rio Grande do Norte, Brazil. Data were collected through the State-Trait Anxiety Inventory. Results showed that 69.8% of the professionals have medium anxiety levels and 30.2% have high levels of anxiety. The N...

  8. 29 CFR 402.5 - Terminal reports.

    Science.gov (United States)

    2010-07-01

    ... organization at the time of its termination or loss of reporting identity and, together with a copy thereof... such termination or loss of reporting identity, as the case may be. (b) Labor organizations which... other form of termination of its existence as a labor organization, or which loses its identity as a...

  9. Kajian Kinerja Terminal Batu Ampar Kota Balikpapan

    Directory of Open Access Journals (Sweden)

    Randha Alief Chikita

    2018-01-01

    Full Text Available Batu Ampar Terminal Balikpapan is the only type A passenger terminal in Balikpapan City. The purpose of this study is to determine the operational performance of the terminal at this time and also to determine the level of service in the terminal. The results of this study indicate that for FIFO queue discipline analysis on AKDP and AKAP bus lines, it is known that ρ <1 means that there is currently no queue in the terminal. For the analysis of terminal facilities it is known that there are still some terminal facilities that are not yet available from the main facilities and supporting facilities, therefore the need for additional facilities in order to meet the standard of passenger terminal type A. In the next 15 years analysis for traffic intensity value is approaching 1 which means in the future will cause the queue in the terminal, so it is necessary for the improvement of terminal performance. For the service performance with IPA method there are 35 variables that there are 7 variables that enter in quadrant I. In the next step to do analysis to know the priority of handling by using QFD method. Keywords: Batu Ampar Terminal Balikpapan, IPA, terminal performance, QFD

  10. 42 CFR 460.54 - Termination procedures.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Termination procedures. 460.54 Section 460.54 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... ELDERLY (PACE) Sanctions, Enforcement Actions, and Termination § 460.54 Termination procedures. (a) Except...

  11. Percepção de enfermeiros sobre dilemas éticos relacionados a pacientes terminais em Unidades de Terapia Intensiva Percepción de enfermeros sobre dilemas éticos relacionados a pacientes terminales en unidades de terapia intensiva Perception of nurses about ethical dilemmas related to terminal patients in intensive care units

    Directory of Open Access Journals (Sweden)

    Adriano Aparecido Bezerra Chaves

    2009-03-01

    was to learn about nurses' perception about ethical dilemmas in nursing care for terminal patients in the context of a general hospital ICU in the city of São Paulo, and what they take into account when making decisions. The study was performed through interviews with ten nurses working at the ICU, using a qualitative approach based on content analysis. Ethical dilemmas were found to be linked to: diversity of values; presence of terminal patients at the ICU; uncertainties about terminality and the limits of intervention to prolong the patients' lives; disagreements in decision-making; non-acceptance of the process of dying by the patients' families and the lack of clarifications for the patient and the family. In addition, the nurses consider their values, the professional ethics, empathy and dialogue with co-workers to make decisions in view of such ethical dilemmas.

  12. Como melhorar a comunicação e prevenir conflitos nas situações de terminalidade na Unidade de Terapia Intensiva How to improve the communication and to prevent the conflicts at terminality situations in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rachel Duarte Moritz

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A angústia diante do morrer e o maior tempo de permanência dos pacientes críticos nas unidades de terapia intensiva (UTI são fatores que têm levado a necessidade da melhoria da comunicação entre todos os envolvidos no tratamento desses enfermos, o que justifica esse trabalho, que visa a abordagem desse tema. CONTEÚDO: Foi utilizada a experiência da autora e foram revisados, através da MedLine, do UptoDate, do Google e da Revista Brasileira de Terapia Intensiva, os artigos escritos, nos últimos cinco anos, abordando os temas morte, comunicação, UTI. CONCLUSÕES: A adequada comunicação entre o médico, o paciente, seus familiares e a equipe multiprofissional da UTI é um dos principais fatores que interferem na satisfação, tanto dos pacientes quanto daqueles que trabalham nessa unidade. Para a adequada informação o médico intensivista deve ter a consciência dos seus limites terapêuticos curativos e deve aprender a tratar do paciente durante o processo do morrer. Dessa forma sentir-se-á seguro para falar sobre a morte. Seria ideal que o profissional responsável por fornecer a notícias fosse experiente, tanto do ponto de vista técnico quanto ético e que fosse, sempre que possível, o mesmo emissor. O principal envolvido no processo do morrer, pouco poderá influir. Entretanto, caso haja possibilidade de comunicação essa deverá ser realizada de forma simples, honesta e humana. A família do paciente tem o direito de estar ao lado daquele que ama e de ser informada, com constância, sobre a verdade do seu quadro clínico. Todos os atores do processo devem saber a verdade e as linhas terapêuticas escolhidas. A comunicação, idealmente, será efetuada em ambientes tranqüilos e reservados.BACKGROUND AND OBJECTIVES: The suffering with the death and the prolonged time of patient's admission in a intensive care unit (ICU are factors that leads to necessity the best communication with the personal

  13. 76 FR 22119 - Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2011-04-20

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval.... SUMMARY: This notice advises of the cause and effect of termination of Direct Endorsement (DE) Approval... Endorsement mortgagees. Termination of Direct Endorsement Approval: Approval of a DE mortgagee by HUD/FHA...

  14. Atención hospitalaria al paciente con enfermedad terminal

    Directory of Open Access Journals (Sweden)

    Angel Julio Romero Cabrera

    2011-01-01

    Full Text Available El objetivo principal de la atención hospitalaria al paciente con enfermedad terminal es brindar asistencia a estos pacientes en sus últimas semanas o días de vida, que por  determinadas condiciones no pueden mantenerse en su domicilio. El paciente presentará las características que definen la "situación de últimos días". La siguiente revisión sienta las pautas a seguir con los enfermos terminales en las salas hospitalarias, así como la interdisciplinariedad que conlleva la atención a estos pacientes.The main objective of hospital care for terminal patients is to assist terminal patients that for different reasons can not remain in their homes to spend their last weeks or days of life. They will present the features that typically define the last days of life in this kind of patients. The following review states the guidelines to be followed when treating hospitalized terminal patients and the interdisciplinary approach that it requires.

  15. Favored subjects and psychosocial needs in music therapy in terminally ill cancer patients: a content analysis

    OpenAIRE

    Preissler, Pia; Kordovan, Sarah; Ullrich, Anneke; Bokemeyer, Carsten; Oechsle, Karin

    2016-01-01

    Background Research has shown positive effects of music therapy on the physical and mental well-being of terminally ill patients. This study aimed to identify favored subjects and psychosocial needs of terminally ill cancer patients during music therapy and associated factors. Methods Forty-one Patients receiving specialized inpatient palliative care prospectively performed a music therapy intervention consisting of at least two sessions (total number of sessions: 166; per patient average: 4,...

  16. Diversity Properties of Multiantenna Small Handheld Terminals

    Directory of Open Access Journals (Sweden)

    Wim A. Th. Kotterman

    2004-08-01

    Full Text Available Experimental data are presented on the viability of multiple antennas on small mobile handsets, based on extensive measurement campaigns at 2.14 GHz with multiple base stations, indoors, from outdoor to indoor, and outdoors. The results show medium to low correlation values between antenna branch signals despite small antenna separations down to 0.16λ. Amplitude distributions are mainly Rayleigh-like, but for early and late components steeper than Rayleigh. Test users handling the measurement handset caused larger delay spread, increased the variability of the channel, and induced rather large mean branch power differences of up to 10 dB. Positioning of multiple antennas on small terminals should therefore be done with care. The indoor channels were essentially flat fading within 7 MHz bandwidth (−6 dB; the outdoor-to-indoor and outdoor channels, measured with 10 MHz bandwidth, were not. For outdoor-to-indoor and outdoor channels, we found that different taps in the same impulse response are uncorrelated.

  17. Diversity Properties of Multiantenna Small Handheld Terminals

    Science.gov (United States)

    Kotterman, Wim A. Th.; Pedersen, Gert F.; Olesen, Kim

    2004-12-01

    Experimental data are presented on the viability of multiple antennas on small mobile handsets, based on extensive measurement campaigns at 2.14 GHz with multiple base stations, indoors, from outdoor to indoor, and outdoors. The results show medium to low correlation values between antenna branch signals despite small antenna separations down to[InlineEquation not available: see fulltext.]. Amplitude distributions are mainly Rayleigh-like, but for early and late components steeper than Rayleigh. Test users handling the measurement handset caused larger delay spread, increased the variability of the channel, and induced rather large mean branch power differences of up to 10 dB. Positioning of multiple antennas on small terminals should therefore be done with care. The indoor channels were essentially flat fading within 7 MHz bandwidth ([InlineEquation not available: see fulltext.]); the outdoor-to-indoor and outdoor channels, measured with 10 MHz bandwidth, were not. For outdoor-to-indoor and outdoor channels, we found that different taps in the same impulse response are uncorrelated.

  18. Gambling with video lottery terminals.

    Science.gov (United States)

    Doiron, J P; Mazer, D B

    2001-09-01

    Semistructured interviews were conducted with 7 persons who had significant involvements with video lottery terminal (VLT) gambling, and themes associated with different phases of the gambling experience were identified. The preinvolvement phase was characterized by lack of meaningful relationships, problematic relationships, and feelings of loss. Early involvement reflected attempts to "fill the void" and the casual innocence of initial VLT playing. The deepening involvement phase indicated themes of the language of relationship, for example, focused engagement, emotional highs and lows, and the escape and competition offered by gambling. Ending involvement themes included the emotional difficulty of quitting and strategies used to break the habit. Implications of these results for models of addiction and for the treatment of gambling problems are explored.

  19. Issues of Institutionalization: Five Percent Fallacies and Terminal Care.

    Science.gov (United States)

    Rosenberg, Edwin; And Others

    1983-01-01

    Discusses the "5 percent fallacy," which refers to the number of older people living in institutions at a given time, and the likelihood of an older person dying in an institution. Three articles discuss research methodology, data interpretation, and measuring techniques. (JAC)

  20. How music-inspired weeping can help terminally ill patients.

    Science.gov (United States)

    Norton, Kay

    2011-09-01

    Music's power to improve the 'human condition' has been acknowledged since ancient times. Something as counter-intuitive as weeping in response to music can ameliorate suffering for a time even for terminally ill patients. Several benefits-including catharsis, communication, and experiencing vitality-can be associated with grieving in response to "sad" music. In addressing the potential rewards of such an activity for terminally ill patients, this author combines concepts from philosopher Jerrold R. Levinson's article, entitled "Music and Negative Emotion," an illustration from a major motion picture, and supporting research from medical reports and aesthetic writings. Carefully offering this experience is recommended for patients who retain the capacity to express preference.

  1. Faced with a dilemma: Danish midwives' experiences with and attitudes towards late termination of pregnancy

    DEFF Research Database (Denmark)

    Christensen, Anne Vinggaard; Hjøllund Christiansen, Anne; Petersson, Birgit

    2012-01-01

    Background: The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives’ experiences with late termination of pregnancy are still poorly described in scientific ...... thorough investigation of how to secure the best possible working conditions for midwives and how to optimise the care for women/couples going through late termination of pregnancy....... literature. Aim: To explore Danish midwives’ experiences with and attitudes towards late termination of pregnancy. Focus was on how midwives perceive their own role in late termination of pregnancy and how their professional identity is influenced by working with late termination of pregnancy in a time where...... ethical status of the foetus and the emotional reactions of the women/couples going through late termination of pregnancy. Other professions as well as structural factors at the hospital highly influenced the midwives’ ability to organize their work with late terminations. There is a need for more...

  2. Faced with a dilemma: Danish midwives' experiences with and attitudes towards late termination of pregnancy

    DEFF Research Database (Denmark)

    Christensen, Anne Vinggaard; Hjøllund Christiansen, Anne; Petersson, Birgit

    2012-01-01

    Background: The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives’ experiences with late termination of pregnancy are still poorly described in scientific ...... thorough investigation of how to secure the best possible working conditions for midwives and how to optimise the care for women/couples going through late termination of pregnancy.......Background: The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives’ experiences with late termination of pregnancy are still poorly described in scientific...... literature. Aim: To explore Danish midwives’ experiences with and attitudes towards late termination of pregnancy. Focus was on how midwives perceive their own role in late termination of pregnancy and how their professional identity is influenced by working with late termination of pregnancy in a time where...

  3. A large-scale biomass bulk terminal

    OpenAIRE

    Wu, M.R.

    2012-01-01

    This research explores the possibility of a large-scale bulk terminal in West Europe dedicated to handle solid and liquid biomass materials. Various issues regarding the conceptual design of such a terminal have been investigated and demonstrated in this research: the potential biomass materials that will be the major international trade flows in the future, the characteristics of these potential biomass materials, the interaction between the material properties and terminal equipment, the pe...

  4. Dynamic optimization problems with bounded terminal conditions

    Science.gov (United States)

    Lee, A. Y.

    1987-01-01

    Bounded terminal conditions of nonlinear optimization problems are converted to equality terminal conditions via Valentine's device. In so doing, additional unknown parameters are introduced into the problem. The transformed problems can still be easily solved using the sequential gradient-restoration algorithm (SGRA) via a simple augmentation of the unknown parameter vector pi. Three example problems with bounded terminal conditions are solved to verify this technique.

  5. Performance Evaluation and Modelling of Container Terminals

    Science.gov (United States)

    Venkatasubbaiah, K.; Rao, K. Narayana; Rao, M. Malleswara; Challa, Suresh

    2017-11-01

    The present paper evaluates and analyzes the performance of 28 container terminals of south East Asia through data envelopment analysis (DEA), principal component analysis (PCA) and hybrid method of DEA-PCA. DEA technique is utilized to identify efficient decision making unit (DMU)s and to rank DMUs in a peer appraisal mode. PCA is a multivariate statistical method to evaluate the performance of container terminals. In hybrid method, DEA is integrated with PCA to arrive the ranking of container terminals. Based on the composite ranking, performance modelling and optimization of container terminals is carried out through response surface methodology (RSM).

  6. Providing Culturally Sensitive Palliative Care in the Desert—The Experience, the Need, the Challenges, and the Solution

    National Research Council Canada - National Science Library

    Singer, Yoram; Rotem, Bosmat; Alsana, Sa'id; Shvartzman, Pesach

    2009-01-01

    .... A mobile palliative care unit (MPCU) has been established, with the aims of delivering palliative care to terminal patients living in remote regions not easily accessible to the community health care teams and to provide palliative care...

  7. St. James marine terminal facility description

    Energy Technology Data Exchange (ETDEWEB)

    1993-10-01

    The US Department of Energy (DOE) currently owns and operates a marine terminal on the west bank of the Mississippi River at St. James, Louisiana. The St. James facility was constructed by the Department to provide marine services associated with the fill and drawdown of the Strategic Petroleum Reserve (SPR) crude oil storage facilities located at Bayou Choctaw and Weeks Island, Louisiana. Although strategic to the mission of the SPR in the event of a national emergency, the St. James terminal is situated such that it has a high potential to also serve the commercial industry`s needs for crude oil terminalling and storage. The St. James terminal is located approximately 45 miles west of New Orleans and 30 miles southeast of Baton Rouge, and approximately 160 miles upstream from the mouth of the Mississippi River. Construction of the St. James terminal was initiated in 1978 and was completed in 1980. Since then, the terminal has received and transferred over 125 million barrels of crude oil to the SPR sites for storage. For crude oil distribution, the St. James terminal was connected to the neighboring LOCAP terminal by a 0.1 mile 36-inch pipeline in 1981 and to the Capline terminal by a 0.5 mile 30-inch pipeline in 1988. The terminal also has a 30-inch pipeline connection to the Koch oil terminal which was used for initial fill purposes; however, this pipeline has been disconnected and is currently inactive. A complete description of the St. James terminal facilities, operational capabilities, operational certifications, and future Government requirements are presented in Sections 2, 3, 4, and 5 respectively.

  8. Euthanasia versus letting die: Christian decision-making in terminal patients.

    Science.gov (United States)

    Sullivan, Dennis

    2005-01-01

    Utilitarianism and quality-of-life considerations have increased the pressure to devalue life in terminal situations, leading to ethical confusion among caregivers. Where is the balance between a commitment to life and a commonsense willingness to "let go" when the time comes? This paper explores this balance, using a case history of a man with respiratory failure. This provides an opportunity to define and discuss some commonly misunderstood concepts related to end-of-life care. The ethical principles of terminal care are presented from the viewpoint of both secular and Christian ethics.

  9. Reasons, methods used and decision-making for pregnancy termination among adolescents and older women in Mulago Hospital, Uganda.

    Science.gov (United States)

    Kaye, D K; Mirembe, F; Bantebya, G; Johansson, A; Ekstrom, A M

    2005-11-01

    To explore the methods, reasons and decision-making process for termination of pregnancy among adolescents and older women, in Mulago hospital, Kampala, Uganda. Comparative study. Nine hundred and forty two women seeking postabortion care, of which 333 had induced abortion (of whom 115 were adolescents). The emergency gynaecological ward of Mulago Hospital, Kampala, Uganda from September 2003 through June 2004. Women with induced abortion were single, in polygamous marital relationships and of lower parity (pDecision-making for induced abortion was influenced by socio-economic, educational and personal considerations. Instrumentation and use of local herbs in the genitalia were the most common methods for pregnancy termination. Neither methods used for pregnancy termination nor reasons differed when adolescents were compared with older women. Relationship issues influence the decision-making process for pregnancy termination. Neither methods used for pregnancy termination nor reasons for pregnancy termination differ when adolescents are compared with older women.

  10. 78 FR 5717 - Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal...

    Science.gov (United States)

    2013-01-28

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal Concord, CA AGENCY: Coast Guard, DHS. ACTION: Interim rule and... Suisun Bay near Military Ocean Terminal Concord, CA in support of military onload and offload operations...

  11. Challenges encountered by women seeking termination of ...

    African Journals Online (AJOL)

    The purpose of the study was to identify possible challenges that prevented women from utilising termination of pregnancy services in the North West Province of South Africa. Fifty structured interviews were conducted with conveniently selected women who requested termination of pregnancy services but who could not ...

  12. A large-scale biomass bulk terminal

    NARCIS (Netherlands)

    Wu, M.R.

    2012-01-01

    This research explores the possibility of a large-scale bulk terminal in West Europe dedicated to handle solid and liquid biomass materials. Various issues regarding the conceptual design of such a terminal have been investigated and demonstrated in this research: the potential biomass materials

  13. [Terminal phase hydration, pain and delirium

    DEFF Research Database (Denmark)

    Heick, A.

    2009-01-01

    Hydration of the terminal patient may relieve confusion and complaints of "dry mouth". But it may worsen oedema of the brain, lungs, and extremities, worsen terminal rattling and cause a need for frequent changing of diapers. The decision of whether and how to treat a dying patient with fluids sh...

  14. 29 CFR 406.4 - Terminal report.

    Science.gov (United States)

    2010-07-01

    ... immediately prior to the time of the person's loss of reporting identity (or by the person himself if he is an individual), together with a statement of the effective date of termination or loss of reporting identity... year ending on the effective date of the termination or loss of identity. ...

  15. Functionalization of hydroxyl terminated polybutadiene with ...

    Indian Academy of Sciences (India)

    ... hydroxyl value and microstructure of the parent HTPB. The formation of hydrogen bonding between the terminal hydroxyl groups and the nitrogen atoms of triazine moiety is the driving force for the terminal attachment chemistry. The functionalized HTPB (HTPB–CBDT) shows a strong fluorescence emission at 385 nm.

  16. 30 CFR 755.15 - Termination.

    Science.gov (United States)

    2010-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INDIAN LANDS... by either party upon written notice to the other specifying the date upon which the agreement will be terminated. The date of termination shall be no less than 30 days from the date of the notice. ...

  17. Bargaining in Mergers and Termination Fees

    NARCIS (Netherlands)

    Weitzel, U.; Rosenkranz, S.

    We model takeovers as a bargaining process and explain termination fees for, both, the target and the acquirer, subject to parties’ bargaining power and outside options. In equilibrium, termination fees are offered by firms with outside options in exchange for a greater share of merger synergies.

  18. Paediatric palliative care - the role of the GP

    National Research Council Canada - National Science Library

    Armitage, Nicole; Trethewie, Susan

    2014-01-01

    Background: Paediatric palliative care (PPC) is a growing specialty area in Australia and many families aim to care for their child at home as much as possible, including during the terminal phase. Objective...

  19. Two-terminal video coding.

    Science.gov (United States)

    Yang, Yang; Stanković, Vladimir; Xiong, Zixiang; Zhao, Wei

    2009-03-01

    Following recent works on the rate region of the quadratic Gaussian two-terminal source coding problem and limit-approaching code designs, this paper examines multiterminal source coding of two correlated, i.e., stereo, video sequences to save the sum rate over independent coding of both sequences. Two multiterminal video coding schemes are proposed. In the first scheme, the left sequence of the stereo pair is coded by H.264/AVC and used at the joint decoder to facilitate Wyner-Ziv coding of the right video sequence. The first I-frame of the right sequence is successively coded by H.264/AVC Intracoding and Wyner-Ziv coding. An efficient stereo matching algorithm based on loopy belief propagation is then adopted at the decoder to produce pixel-level disparity maps between the corresponding frames of the two decoded video sequences on the fly. Based on the disparity maps, side information for both motion vectors and motion-compensated residual frames of the right sequence are generated at the decoder before Wyner-Ziv encoding. In the second scheme, source splitting is employed on top of classic and Wyner-Ziv coding for compression of both I-frames to allow flexible rate allocation between the two sequences. Experiments with both schemes on stereo video sequences using H.264/AVC, LDPC codes for Slepian-Wolf coding of the motion vectors, and scalar quantization in conjunction with LDPC codes for Wyner-Ziv coding of the residual coefficients give a slightly lower sum rate than separate H.264/AVC coding of both sequences at the same video quality.

  20. Do Korean Doctors Think a Palliative Consultation Team Would Be Helpful to Their Terminal Cancer Patients?

    Science.gov (United States)

    Shim, Hye-Young; Chang, Yoon Jung; Kawk, Kiu-Sang; Mai, Tran Thi Xuan; Choi, Jin Young; Ahn, Eun Mi; Jho, Hyun Jung; Park, So-Jung

    2017-01-01

    Purpose Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea. Materials and Methods We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed. Results In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities. Conclusion The PCT activities were expected to fill the doctor’s perceived unmet HPC needs of terminal cancer patients and difficulties in communications. PMID:27506213

  1. The Palliative Performance Scale Applied in High-Care Residential Hospice: A Retrospective Study

    NARCIS (Netherlands)

    Jansen, W.J.J.; Buma, S.A.; Gootjes, J.R.G.; Zuurmond, W.W.A.; Perez, R.S.G.M.; Loer, S.A.

    2015-01-01

    Background: The Palliative Performance Scale (PPS) is a tool that is widely used to predict end of life. In Ontario, Canada, the PPS is used to mark the terminal phase of life and eligibility for terminal care.

  2. When the adoption becomes termination.

    Science.gov (United States)

    Cheung, Viola; Weitzman, Carol; Albers Prock, Lisa; Augustyn, Marilyn

    2015-05-01

    Steven is an 11-year-old boy who was adopted from an orphanage in Eastern Europe 8 years ago, when he was 3 years old along with his biological sister who is 1 year older. You have cared for him in your practice since that time seeing them annually for well child care. His mother reports that the first 2 years after adoption were very difficult, and Steven has never really bonded with her or her husband. Currently, he is reported to steal possessions of family members and instigate arguments with his older sister and act defiantly. The parents have put locks on their bedroom door due to fears of violence, primarily by Steven's older sister. Steven's mother reports that she and her husband no longer attempt to "parent" the children and provide minimal supervision to avoid conflict. In school, Steven is reported to have symptoms of inattention and hyperactivity that improved with treatment with stimulant medication and some learning challenges, but otherwise he is described as a lovely boy who has good relationships with his teachers.They present to urgent care clinic when mom stated "We have had enough." That day both children were caught taking $10 from the mother's wallet. On further discussion, it was discovered that they had done this several times over the last month to buy ice cream for neighborhood friends to "welcome them" to the neighborhood. Steven's mother presents today stating that the family has exhausted therapy services and are experiencing financial hardship secondary to investing time and money into behavioral and psychiatric services for Steven and his sister. They want to dissolve the adoption and have the children removed from their home. They seek guidance on how to do this. What would be your initial approach with the parents?

  3. Participation of Private Investors in Container Terminal Operation: Influence of Global Terminal Operators

    Directory of Open Access Journals (Sweden)

    Heejung YEO

    2015-09-01

    Full Text Available Private container terminal operators have begun to participate in the port business in Asia since the late 1980s. Terminal operators decide whether to invest in terminal infrastructures, and the enhancement of the quality of service level. The paper analyses the influence of global terminal operators and the port ownership structure on the container terminal's efficiency. Two hundred and sixty container terminal data for China, Korea, and Japan were collected. The paper applies a negative binomial regression analysis. The paper finds that the port restructuring has contributed to productivity gains. It is found that the influence of GTO on the efficiency is evident and positively related to the port efficiency. The paper also finds that the country effect prevails over a terminal operator group effect.

  4. Concept Layout Model of Transportation Terminals

    Directory of Open Access Journals (Sweden)

    Li-ya Yao

    2012-01-01

    Full Text Available Transportation terminal is the key node in transport systems. Efficient terminals can improve operation of passenger transportation networks, adjust the layout of public transportation networks, provide a passenger guidance system, and regulate the development of commercial forms, as well as optimize the assembly and distribution of modern logistic modes, among others. This study aims to clarify the relationship between the function and the structure of transportation terminals and establish the function layout design. The mapping mechanism of demand, function, and structure was analyzed, and a quantitative relationship between function and structure was obtained from a design perspective. Passenger demand and terminal structure were decomposed into several demand units and structural elements following the principle of reverse engineering. The relationship maps between these two kinds of elements were then analyzed. Function-oriented concept layout model of transportation terminals was established using the previous method. Thus, a technique in planning and design of transportation structures was proposed. Meaningful results were obtained from the optimization of transportation terminal facilities, which guide the design of the functional layout of transportation terminals and improve the development of urban passenger transportation systems.

  5. Acetylene terminated aspartimides and resins therefrom

    Science.gov (United States)

    Hergenrother, Paul M. (Inventor); Connell, John W. (Inventor); Havens, Stephen J. (Inventor)

    1989-01-01

    Acetylene terminated aspartimides are prepared using two methods. In the first, an amino-substituted aromatic acetylene is reacted with an aromatic bismaleimide in a solvent of glacial acetic acid and/or m-cresol. In the second method, an aromatic diamine is reacted with an ethynyl containing maleimide, such an N-(3-ethynyl phenyl) maleimide, in a solvent of glacial acetic acid and/or m-cresol. In addition, acetylene terminated aspartimides are blended with various acetylene terminated oligomers and polymers to yield composite materials exhibiting improved mechanical properties.

  6. International Joint Venture Termination: An Empirical Investigation

    DEFF Research Database (Denmark)

    Nielsen, Ulrik B.; Rasmussen, Erik Stavnsager; Siersbæk, Nikolaj

    for the article stems from data from the project portfolio of a Danish Investment Fund for Developing Countries with a total of 773 investments. A number of hypotheses are established from the literature review and tested related to the empirical data. The result indicates that the most important factor...... the difference between intended termination and unintended termination has left a significant gap in the literature. The purpose of this article is to contribute to a better understanding of IJV exit literature by differentiating empirically between intended and unintended IJV termination. The empirical data...

  7. Graded junction termination extensions for electronic devices

    Science.gov (United States)

    Merrett, J. Neil (Inventor); Isaacs-Smith, Tamara (Inventor); Sheridan, David C. (Inventor); Williams, John R. (Inventor)

    2007-01-01

    A graded junction termination extension in a silicon carbide (SiC) semiconductor device and method of its fabrication using ion implementation techniques is provided for high power devices. The properties of silicon carbide (SiC) make this wide band gap semiconductor a promising material for high power devices. This potential is demonstrated in various devices such as p-n diodes, Schottky diodes, bipolar junction transistors, thyristors, etc. These devices require adequate and affordable termination techniques to reduce leakage current and increase breakdown voltage in order to maximize power handling capabilities. The graded junction termination extension disclosed is effective, self-aligned, and simplifies the implementation process.

  8. Operational Optimization in Port Container Terminals

    DEFF Research Database (Denmark)

    As a result of the significant increase in worldwide containerized transportation the development of efficient handling systems in marine terminals has become very important for port competitiveness. In order to optimize the productivity the total handling time for containers in the terminal must...... be minimized. An overview of the different operational problems in port container terminals is presented and an aggregated model and solution approach is shown. Next, there will be focused on the yard storage problem and a mathematical formulation and solution proposals will be presented....

  9. Duplication of the ureter with extravesical termination

    Energy Technology Data Exchange (ETDEWEB)

    Steidle, B.; Wolf, K.J.

    1984-02-01

    The renal segment supplying an ectopic ureter is nearly always dysplastic. Usually the ureters cross and the ectopic ureter terminates caudally in relation to the ureter from the normal portion of the kidney. Extravesical termination in women leads to urinary incontinence, since it frequently ends in the vagina or the labia. In men, the effects are much less noticeable. The ureters usually terminate in the urethra, the seminal vesicles, the ductus deferens or the epididymis. Duplication of a ureter or mega-ureter with dysplasia of the appropriate part of the kidney can be readily explained embryologically.

  10. Tyrolean termination tool: Techniques and features

    OpenAIRE

    Hirokawa, Nao; Middeldorp, Aart

    2007-01-01

    The Tyrolean Termination Tool (T_T for short) is a powerful tool for automatically proving termination of rewrite systems. It incorporates several new refinements of the dependency pair method that are easy to implement, increase the power of the method, result in simpler termination proofs, and make the method more efficient. T_T employs polynomial interpretations with negative coefficients, like x − 1 for a unary function symbol or x − y for a binary function symbol, which are useful for ex...

  11. Ever decreasing circles: terminal illness, empowerment and decision-making.

    Science.gov (United States)

    Richardson, Kate; Cert, P G; MacLeod, Rod; Kent, Bridle

    2010-06-01

    Empowerment is the personal and political processes patients go through to enhance and restore their sense of dignity and self-worth. However, there is much rhetoric surrounding nurses facilitating patients' daily choices and enabling empowerment. Furthermore, there is frequently an imbalance of power sharing, with the patient often obliged to do what the health professional wants them to do. This phenomenological study describes the lived experience of patients attending an outpatient clinic of a community hospice. A qualitative study using Max van Manen's phenomenological hermeneutic method was conducted to explore issues surrounding empowerment and daily decision-making with terminally ill patients. The participants' stories became a stimulus for learning about the complexities of autonomy and empowerment. It also engendered reflection and analysis of issues related to power and control inequities in current nursing practices. The results revealed not only the themes of chaoticum, contracting worlds and capitulation, but that health professionals should be mindful of the level of control they exert. Within the palliative care setting they need to become partners in care, enhancing another person's potential for autonomous choice. Empowerment must not be somethingthat simply occurs from within, nor can it be done by another. Intentional efforts by health professionals must enable terminally ill people to be able to stay enlivened and connected with a modicum of autonomy and empowerment over daily decisions, no matter how mundane or monumental they might be.

  12. [Dyspnea in the terminal stage].

    Science.gov (United States)

    Binsack, T

    2001-10-01

    From all symptoms in palliative medicine those concerning respiration are most excruciating and most difficult to treat. No other symptom is more dependent on psychosocial circumstances and on the atmosphere around the patient. Therefore the relief of respiratory problems is as important as the therapy of pain. A consequent therapy comprises besides drug therapy (adrenocortical steroids, brochodilators, opioids, sedatives and sometimes antibiotics) also physiotherapy and in special cases oncological treatment and radiotherapy. A team present twenty-four hours a day, the training of relatives and friends, the frank dealing with the patient's anxiety of suffocation are the basis of all therapeutic measures. Dyspnea often is the reason for a longer stay in a palliative care unit.

  13. Oligomers Terminated By Maleimide And Acetylene

    Science.gov (United States)

    St. Clair, Terry L.; Pater, Ruth H.; Gerber, Margaret K.

    1994-01-01

    Oligomeric molecules terminated with maleimide and acetylene groups synthesized and thermally treated to form cross-linked polymers exhibiting high or undetectable glass-transition temperatures and high thermo-oxidative stabilities. Compounds used to make thermally stable, glassy polymers.

  14. 38 CFR 36.4322 - Loan termination.

    Science.gov (United States)

    2010-07-01

    ... require prior approval from VA. VA will maintain the loan termination time allowable timeframes on a Web... writing a shorter validity period, not less than 90 calendar days, for a liquidation appraisal or...

  15. Keerukas terminal valiti aasta betoonehitiseks / Aivo Vahemets

    Index Scriptorium Estoniae

    Vahemets, Aivo

    2002-01-01

    Aasta Betoonehitise nimetuse võitis Muuga kuivpuisteainete terminal, projekteerija Randväli&Karema AS. Eriauhind arhitektuurse osa eest - Birgitta klooster Pirital. Eriauhind tellijale - büroohoone Tallinnas Toompuiestee 33. Eriauhind ehitajale - konteinerterminal Muugal, projekteerija AS Merin

  16. Location of terminals in a communications network

    DEFF Research Database (Denmark)

    2015-01-01

    A method (400, 500) of identifying nodes in a communications network is disclosed, the nodes being for use in locating wireless terminals within the network based upon reports from the wireless terminals of transmissions received from the nodes. The method (400, 500) comprises prioritising......, a reference node. Also disclosed is a method (100, 200) for locating a plurality of wireless terminals in a communications network, the network comprising a plurality of network nodes at known locations, wherein the nodes emit wireless transmissions in an unsynchronised manner, such that a time difference...... exists between the emission time of corresponding transmissions from different nodes. The method comprises receiving reports from a plurality of wireless terminals of transmissions received from the network nodes (110, 210), selecting a subset of network nodes (120, 220) and identifying a plurality...

  17. 22 CFR 62.78 - Termination.

    Science.gov (United States)

    2010-04-01

    ... Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Student and Exchange Visitor Information System (SEVIS) § 62.78 Termination. An exchange visitor who willfully or negligently... from the Exchange Visitor Program by the sponsor. ...

  18. Cholesterol: the debate should be terminated.

    Science.gov (United States)

    Nathan, David G

    2017-07-01

    Here, I offer personal perspectives on cholesterol homeostasis that reflect my belief that certain aspects of the debate have been overstated.-Nathan, D. G. Cholesterol: the debate should be terminated. © FASEB.

  19. Conflict Termination: Every Conflict Must End

    National Research Council Canada - National Science Library

    Garza, Mario

    1997-01-01

    .... The operational commander and his staff must understand the nature of conflict termination and the post-conflict activities so that they will be able to effectively translate the desired end state...

  20. Terminal Area Conflict Detection and Resolution Tool

    Science.gov (United States)

    Verma, Savita Arora

    2011-01-01

    This poster will describe analysis of a conflict detection and resolution tool for the terminal area called T-TSAFE. With altitude clearance information, the tool can reduce false alerts to as low as 2 per hour.

  1. Multiemployer Pension Plan Terminations, Mergers, and Insolvencies

    Data.gov (United States)

    Pension Benefit Guaranty Corporation — A listing of multiemployer pension plan terminations, mergers, and insolvencies reported to the PBGC for the current fiscal year. This data set will be updated...

  2. Four Terminal Gallium Nitride MOSFETs

    Science.gov (United States)

    Veety, Matthew Thomas

    All reported gallium nitride (GaN) transistors to date have been three-terminal devices with source, drain, and gate electrodes. In the case of GaN MOSFETs, this leaves the bulk of the device at a floating potential which can impact device threshold voltage. In more traditional silicon-based MOSFET fabrication a bulk contact can be made on the back side of the silicon wafer. For GaN grown on sapphire substrates, however, this is not possible and an alternate, front-side bulk contact must be investigated. GaN is a III-V, wide band gap semiconductor that as promising material parameters for use in high frequency and high power applications. Possible applications are in the 1 to 10 GHz frequency band and power inverters for next generation grid solid state transformers and inverters. GaN has seen significant academic and commercial research for use in Heterojunction Field Effect Transistors (HFETs). These devices however are depletion-mode, meaning the device is considered "on" at zero gate bias. A MOSFET structure allows for enhancement mode operation, which is normally off. This mode is preferrable in high power applications as the device has lower off-state power consumption and is easier to implement in circuits. Proper surface passivation of seminconductor surface interface states is an important processing step for any device. Preliminary research on surface treatments using GaN wet etches and depletion-mode GaN devices utilizing this process are discussed. Devices pretreated with potassium pursulfate prior to gate dielectric deposition show significant device improvements. This process can be applied to any current GaN FET. Enhancement-mode GaN MOSFETs were fabricated on magnesium doped p-type Wurtzite gallium nitride grown by Metal Organic Chemical Vapor Deposition (MOCVD) on c-plane sapphire substrates. Devices utilized ion implant source and drain which was activated under NH3 overpressure in MOCVD. Also, devices were fabricated with a SiO2 gate dielectric

  3. An Axiomatization for the Terminal Cycle

    OpenAIRE

    Fokkink, W. J.

    1996-01-01

    Milner proposed an axiomatization for the Kleene star in basic process algebra, in the presence of deadlock and empty process, modulo bisimulation equivalence. In this paper, Milner's axioms are adapted to the terminal cycle xω, which executes x infinitely many times in a row, and it is shown that this axiomatization is complete for the terminal cycle in basic process algebra with deadlock and empty process modulo bisimulation.

  4. Termination of dependently typed rewrite rules

    OpenAIRE

    Jouannaud, Jean-Pierre; Li, Jian-Qi

    2015-01-01

    International audience; Our interest is in automated termination proofs of higher-order rewrite rules in presence of dependent types modulo a theory T on base types. We first describe an original transformation to a type discipline without type dependencies which preserves non-termination. Since the user must reason on expressions of the transformed language, we then introduce an extension of the computability path ordering CPO for comparing dependently typed expressions named DCPO. Using the...

  5. Size-change termination and transition invariants

    DEFF Research Database (Denmark)

    Heizmann, Matthias; Jones, Neil; Podelski, Andreas

    2010-01-01

    Two directions of recent work on program termination use the concepts of size-change termination resp. transition invariants. The difference in the setting has as consequence the inherent incomparability of the analysis and verification methods that result from this work. Yet, in order to facilit...... to facilitate the crossover of ideas and techniques in further developments, it seems interesting to identify which aspects in the respective formal foundation are related. This paper presents initial results in this direction....

  6. La calidad de vida en la fase terminal Life quality for the terminal patient

    Directory of Open Access Journals (Sweden)

    Oscar Velásquez Acosta

    1994-02-01

    Full Text Available

    Se define al paciente tem1inal desde los puntos de vista terapéutico y biológico y se explica cómo el concepto de calidad de vida se puede aplicar a dicho paciente para definir sus prioridades y las de su entorno familiar. Se hace énfasis en los aspectos psicosociales, que el modelo biomédico predominante no tiene en cuenta; de ellos depende en gran medida la calidad de vida; son ellos el económico, el emocional, el espiritual, el intelectual y las relaciones interpersonales, sociales y culturales.

    Terminally III patients are defined from the therapeutic and biologic points of view, and the applicability of the quality of life concept to these patients Is explained. Such quality depends to a great extent, on several psychosocial aspects of life that are not considered by the biomedical model of patient care predominant nowadays and they include the interpersonal, social, and cultural relationships as well as the economic, emotional, spiritual and intellectual ones.

  7. International palliative care: Middle East experience as a model for global palliative care.

    Science.gov (United States)

    Hajjar, Ramzi R; Charalambous, Haris A; Baider, Lea; Silbermann, Michael

    2015-05-01

    Care for elderly people with life-limiting illness cannot be delivered primarily by geriatricians or palliative care practitioners. The role of these clinicians is to help carers become adept in palliative care medicine. In a culture in which family ties run deep, the offer of palliative care from an outsider may be met with suspicion. The family bond in the Middle East is strong, but the emotional response to terminal illness may push families to request futile treatments, and physicians to comply. When palliative care is well developed and well understood, it provides a viable alternative to such extreme terminal measures. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. The use of life review to enhance spiritual well-being in patients with terminal illnesses: An integrative review.

    Science.gov (United States)

    Kwan, Cecilia W M; Ng, Marques S N; Chan, Carmen W H

    2017-12-01

    To conduct an integrative review of the current literature on using life review as an intervention to address the spiritual need of patients with terminal illnesses. Palliative care highlights the holistic approach of care including the spiritual aspect. Life review has been used in palliative nursing intending to enhance patients' emotional and spiritual well-being, and quality of life. However, there is a lack of publications that provide a structured overview on life review programmes and their effectiveness. Integrative review. The Whittemore and Knafl integrative review method was used. Five major online databases were included in our literature search. The keywords used were "life review" and "palliative care, terminal care, terminally ill, death & dying, hospice, spiritual wellbeing, spirituality". Seven primary papers were identified, critically appraised and synthesised in the final review. There are limited clinical studies on life review programmes for patients with terminal illness. The research design of these studies is too widely varied for meta-analysis. Here, we identified two major programmes of life review as an intervention to address the spiritual well-being of patients with terminal illness. However, repeated studies on the effectiveness of these two programmes are lacking. The shorter programme of life review is more likely to be applicable and effective for terminal patients. Further research in this area is required to provide strong evidence on the effectiveness and applicability of life review in patients receiving palliative care. This review adds weight to the need of a better understanding on the use of life review in addressing the spiritual needs of patients with terminal illness. Such understanding would provide evidence for the use of life review as an alternative approach in palliative care delivery. © 2017 John Wiley & Sons Ltd.

  9. Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit.

    Science.gov (United States)

    Vahedian-Azimi, Amir; Ebadi, Abbas; Saadat, Soheil; Ahmadi, Fazlollah

    2015-11-01

    Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients. The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU. This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient's reports and documents were used. Information saturation was determined as an interview termination criterion. Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications). Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

  10. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  11. Antecedents and Consequences of Sales Representatives' Relationship Termination Competence

    DEFF Research Database (Denmark)

    Geersbro, Jens; Ritter, Thomas

    2013-01-01

    . The impact of the constructs "termination acceptance", "definition of non-customer", "termination routines" and "termination incentives" on termination competence are analyzed using PLS. Findings: A sales representative's termination competence is positively influenced by greater clarity and wider...... dissemination of the definition of a "non-customer", higher prevalence of termination routines, and increasing degrees of termination incentives. Acceptance of relationship termination at the firm level does not appear to have a significant impact on sales representatives' relationship termination competence......'s customer portfolio, managers must not only provide a clear definition of the types of customers the organization does not want to serve, but must also implement termination routines within the organization. Managers also need to establish incentives for sales representatives to terminate relationships...

  12. Dying with Dementia in Long-Term Care

    Science.gov (United States)

    Sloane, Philip D.; Zimmerman, Sheryl; Williams, Christianna S.; Hanson, Laura C.

    2008-01-01

    Purpose: To better understand the experiences and potential unmet need of persons who die in long-term care. Design and Methods: We conducted after-death interviews with staff who had cared for 422 decedents with dementia and 159 who were cognitively intact and received terminal care in U.S. nursing homes (NHs) or residential care-assisted living…

  13. Supporting palliative care clients who live alone: Nurses' perspectives on improving quality of care.

    Science.gov (United States)

    Aoun, Samar M; Breen, Lauren J; Skett, Kim

    2016-01-01

    Terminally ilL people who live alone at home are disadvantaged in terms of their places of care and death and health outcomes. There is a need to trial models of care that can extend the period of care at home for as long as possible for this group. The objective was to explore the experiences of nurses providing care to terminally ill clients who live at home alone and who were receiving either additional care aide support or a personal alarm through an RCT. Nine nurses in a home-based palliative care service in Western Australia completed a questionnaire (82% response rate). Client willingness to accept additional support from care aides, development of rapport between the client and care staff, and willingness to use the alarm appropriately all influenced the effectiveness of the models of care. These models of care may negate the need for frequent nurses' visits when nurses feeL confident that the care aide can pass on relevant information or that the client will use the alarm when required. Both models of care assisted in meeting the challenges to care provision; however, further larger trials are needed to test whether these might translate into granting clients their wishes regarding places of terminal care and death. This study is the first account of nurses' perspectives on service provision to support palliative care clients who live alone. It has prompted changes in practice and will inform service planning for this growing and challenging population group.

  14. Gait termination in individuals with multiple sclerosis.

    Science.gov (United States)

    Roeing, Kathleen L; Wajda, Douglas A; Motl, Robert W; Sosnoff, Jacob J

    2015-09-01

    Despite the ubiquitous nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine planned gait termination in individuals with MS and healthy controls with and without cognitive distractors. Individuals with MS and age matched controls completed a series of gait termination tasks over a pressure sensitive walkway under non-distracting and cognitively distracting conditions. As expected the MS group had a lower velocity (89.9±33.3 cm/s) than controls (142.8±22.4 cm/s) and there was a significant reduction in velocity in both groups under the cognitive distracting conditions (MS: 73.9±30.7 cm/s; control: 120.0±25.9 cm/s). Although individuals with MS walked slower, there was no difference between groups in the rate a participant failed to stop at the target (i.e. failure rate). Overall failure rate had a 10-fold increase in the cognitively distracting condition across groups. Individuals with MS were more unstable during termination. Future research examining the neuromuscular mechanisms contributing to gait termination is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Terminal addition in a cellular world.

    Science.gov (United States)

    Torday, J S; Miller, William B

    2017-12-19

    Recent advances in our understanding of evolutionary development permit a reframed appraisal of Terminal Addition as a continuous historical process of cellular-environmental complementarity. Within this frame of reference, evolutionary terminal additions can be identified as environmental induction of episodic adjustments to cell-cell signaling patterns that yield the cellular-molecular pathways that lead to differing developmental forms. Phenotypes derive, thereby, through cellular mutualistic/competitive niche constructions in reciprocating responsiveness to environmental biophysical stresses and epigenetic impacts. In such terms, Terminal Addition flows according to a logic of cellular needs confronting environmental challenges over space-time. A reconciliation of evolutionary development and Terminal Addition can be achieved through a combined focus on cell-cell signaling, molecular phylogenies and a broader understanding of epigenetic phenomena among eukaryotic organisms. When understood in this manner, Terminal Addition has an important role in evolutionary development, and chronic disease might be considered as a form of 'reverse evolution' of the self-same processes. Copyright © 2017. Published by Elsevier Ltd.

  16. [Palliative care in Primary Care: presentation of a case].

    Science.gov (United States)

    Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B

    2013-10-01

    We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. 76 FR 4364 - Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval

    Science.gov (United States)

    2011-01-25

    ... URBAN DEVELOPMENT Credit Watch Termination Initiative; Termination of Direct Endorsement (DE) Approval..., Department of Housing and Urban Development, 451 Seventh Street, SW., Room B133-P3214, Washington, DC 20410.... NTFN Inc 5301 Village Creek Oklahoma City.... 11/26/10 Denver. Dr., Ste B, Plano, TX 75093. Pine State...

  18. Termination Criteria for Computerized Classification Testing

    Directory of Open Access Journals (Sweden)

    Nathan A. Thompson

    2011-02-01

    Full Text Available Computerized classification testing (CCT is an approach to designing tests with intelligent algorithms, similar to adaptive testing, but specifically designed for the purpose of classifying examinees into categories such as - pass- and - fail.- Like adaptive testing for point estimation of ability, the key component is the termination criterion, namely the algorithm that decides whether to classify the examinee and end the test or to continue and administer another item. This paper applies a newly suggested termination criterion, the generalized likelihood ratio (GLR, to CCT. It also explores the role of the indifference region in the specification of likelihood-ratio based termination criteria, comparing the GLR to the sequential probability ratio test. Results from simulation studies suggest that the GLR is always at least as efficient as existing methods.

  19. Three-Terminal Amorphous Silicon Solar Cells

    Directory of Open Access Journals (Sweden)

    Cheng-Hung Tai

    2011-01-01

    Full Text Available Many defects exist within amorphous silicon since it is not crystalline. This provides recombination centers, thus reducing the efficiency of a typical a-Si solar cell. A new structure is presented in this paper: a three-terminal a-Si solar cell. The new back-to-back p-i-n/n-i-p structure increased the average electric field in a solar cell. A typical a-Si p-i-n solar cell was also simulated for comparison using the same thickness and material parameters. The 0.28 μm-thick three-terminal a-Si solar cell achieved an efficiency of 11.4%, while the efficiency of a typical a-Si p-i-n solar cell was 9.0%. Furthermore, an efficiency of 11.7% was achieved by thickness optimization of the three-terminal solar cell.

  20. 22 CFR 42.83 - Termination of registration.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Termination of registration. 42.83 Section 42... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusal, Revocation, and Termination of Registration § 42.83 Termination of registration. (a) Termination following failure of applicant to apply for visa. In accordance...

  1. 47 CFR 68.610 - Database of terminal equipment.

    Science.gov (United States)

    2010-10-01

    ... Attachments § 68.610 Database of terminal equipment. (a) The Administrative Council for Terminal Attachments... Administrative Council for Terminal Attachments shall ensure that the database is created and maintained in an... how the Administrative Council for Terminal Attachments will administer the database, the pertinent...

  2. Fuzzy containers allocation problem in maritime terminal

    Directory of Open Access Journals (Sweden)

    Seyed-Mohammad Seyed-Hosseini

    2009-09-01

    Full Text Available Normal.dotm 0 0 1 140 799 UPC 6 1 981 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:??; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Containers allocation in terminals has attracted lots of research works due to practical & theoretical importance in transportation literature. In this paper, we developed a fuzzy mathematical programming model for solving problem of allocating the containers in terminal area. The objective is minimizing the total distance traversed by the containers from the ship to the terminal area they are assigned. Fuzzy set concepts are used to treat imprecision regarding the distances between berth and terminals area, number of containers in an arrived ship and estimation of available area in each terminal at a port. We proposed two types of models for optimistic and pessimistic situations. The proposed models have been coded in LINGO8.0 solver and a numerical example has been solved for illustration purpose. The full analysis of the proposed models can cause an optimum allocation of containers of several ships to different terminals of berths in fuzzy environment.

  3. Nueva terminal del aeropuerto de Barcelona

    Directory of Open Access Journals (Sweden)

    Bofill, Ricardo

    1992-02-01

    Full Text Available The lack of integral and modernized design and the saturation of the Barcelona Airport made the remodelling of the old terminal building necessary. The old building elements conditioned the lineal solution in the remodelling. An elevated street forms the backbone of the building which, like the Ramblas in Barcelona, has shops, news stands, etc. Other new elements are the pre-boarding modules and the International terminal. The former have a glazed gallery in their perimeter: a transparent division which allows the separation of the arrival and departure flows. The new terminal rests on four large columns and has double glazing in the entire perimeter

    Ante la saturación y falta de diseño unitario y actualizado del Aeropuerto de Barcelona se aborda la remodelación del antiguo edificio terminal. La situación de los antiguos elementos de edificación, condiciona la solución lineal de la misma. Una calle elevada es la espina dorsal del edificio que al modo de las Ramblas de Barcelona ofrecen comercios, kioscos, etc. Los otros nuevos elementos de edificación son los módulos de preembarque y la terminal de Internacional. Los primeros tienen una galería acristalada en su perímetro: una división transparente que permite separar los flujos de llegadas y salidas. La nueva terminal, se apoya sobre cuatro grandes columnas, y está dotada de un doble acristalamiento en todo su perímetro.

  4. Terminating a long-term clinical trial.

    Science.gov (United States)

    Klimt, C R

    1981-05-01

    Long-term clinical trials often include more than one active treatment group. These may be discontinued independently if found to be ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet another kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  5. Enhancing data locality by using terminal propagation

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, B.; Leland, R. [Sandia National Labs., Albuquerque, NM (United States); Van Driessche, R. [Katholieke Univ. Leuven (Belgium). Dept. Computer Sciences

    1995-12-31

    Terminal propagation is a method developed in the circuit placement community for adding constraints to graph partitioning problems. This paper adapts and expands this idea, and applies it to the problem of partitioning data structures among the processors of a parallel computer. We show how the constraints in terminal propagation can be used to encourage partitions in which messages are communicated only between architecturally near processors. We then show how these constraints can be handled in two important partitioning algorithms, spectral bisection and multilevel-KL. We compare the quality of partitions generated by these algorithms to each other and to Partitions generated by more familiar techniques.

  6. OPTIMAL GOODS STOWAGE IN AIR CARGO TERMINALS

    Directory of Open Access Journals (Sweden)

    Gennadiy Yun

    2011-03-01

    Full Text Available Abstract. Lack of system research done by domestic and foreign scientists in the field of optimal cargostraffic distribution problem in Air Cargo Terminal, proves necessity of investigation and optimization of thisprocess. Mathematical models and algorithms of optimal problem solving for air cargos distribution inwarehouses on the basis of established functional dependence between freight flow stowage in warehousesand transport vehicle loading (unloading processes are presented in the article.Keywords:algorithms, dimensions of air cargo terminal, effectiveness of loading-unloading processes,freight flow, models.

  7. Size-change termination and bound analysis

    DEFF Research Database (Denmark)

    Avery, James Emil

    2006-01-01

    Despite its simplicity, the size-change termination principle, presented by Lee, Jones and Ben-Amram in [LJB01], is surprisingly strong and is able to show termination for a large class of programs. A significant limitation for its use, however, is the fact that the SCT requires data types to be ...... implemented in a subject language independent shared library, libesct (available at http://esct.kvante.org), as well as for the ANSI C specializer C-Mix/ii, handling a subset of its internal language Core-C....

  8. Storage Allocation in Automated Container Terminals: the Upper Level

    OpenAIRE

    Mengjue Xia; Ning Zhao; Weijian Mi

    2016-01-01

    Nowadays automation is a trend of container terminals all over the world. Although not applied in current automated container terminals, storage allocation is indispensable in conventional container terminals, and promising for automated container terminals in future. This paper seeks into the storage allocation problem in automated container terminals and proposed a two level structure for the problem. A mixed integer programming model is built for the upper level, and a modified Particle Sw...

  9. 47 CFR 25.134 - Licensing provisions of Very Small Aperture Terminal (VSAT) and C-band Small Aperture Terminal...

    Science.gov (United States)

    2010-10-01

    ... Terminal (VSAT) and C-band Small Aperture Terminal (CSAT) networks. 25.134 Section 25.134 Telecommunication... Applications and Licenses Earth Stations § 25.134 Licensing provisions of Very Small Aperture Terminal (VSAT) and C-band Small Aperture Terminal (CSAT) networks. (a)(1) VSAT networks operating in the 12/14 GHz...

  10. Meaninglessness in terminally ill cancer patients: a validation study and nurse education intervention trial.

    Science.gov (United States)

    Morita, Tatsuya; Murata, Hisayuki; Hirai, Kei; Tamura, Keiko; Kataoka, Jun; Ohnishi, Hideki; Akizuki, Nobuya; Kurihara, Yukie; Akechi, Tatsuo; Uchitomi, Yosuke

    2007-08-01

    Recent empirical studies revealed that fostering patients' perception of meaning in their life is an essential task for palliative care clinicians. However, few studies have reported the effects of training programs for nurses specifically aimed at improving skills to relieve the meaninglessness of terminally ill cancer patients, and we have had no specific measurement instruments. The primary aims of this study were 1) to validate measurement tools to quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness and 2) to explore the effects of the five-hour educational workshop focusing on meaninglessness on nurses' self-reported practice, attitudes toward caring for such patients, confidence, burnout, death anxiety, and meaning of life. A quasi-experimental pre-post questionnaire survey was performed on 147 nurses. The questionnaire was distributed before the intervention workshop and one and six months after. The workshop consisted of lecture, role-play, and the exercise of assessment and care planning based on two vignette verbatim records. First, using the first questionnaire sample and an additional sample of 20 nurses for the test-retest examination, we validated a six-item Self-Reported Practice scale, and an eight-item Attitudes Toward Caring for Patients Feeling Meaninglessness scale with three subscales (Willingness to Help, Positive Appraisal, and Helplessness). The nurses also completed a scale to assess confidence in caring for terminally ill patients with meaninglessness, the Maslach Burnout Inventory, the Death Attitude Inventory, the Frommelt Attitudes Toward Care of the Dying scale, the Self-Reported Practice Score in General Communication, and the three pain-related items from the Palliative Care Quiz for Nursing. For the Self-Reported Practice scale and the subscales of the Attitudes Toward Caring for Patients Feeling Meaninglessness scale, the Cronbach's alpha coefficients were 0

  11. Concept analysis of good death in terminally ill patients.

    Science.gov (United States)

    Granda-Cameron, Clara; Houldin, Arlene

    2012-12-01

    The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers' evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient's dignity, family presence, family support, and communication among patient, family, and health care providers.

  12. 29 CFR 405.4 - Terminal report.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Terminal report. 405.4 Section 405.4 Labor Regulations... of this part, who during its fiscal year loses its identity as a reporting employer through merger... of the employer's loss of reporting identity, together with a statement of the effective date of such...

  13. Termination Criteria in Evolutionary Algorithms: A Survey

    DEFF Research Database (Denmark)

    Ghoreishi, Newsha; Clausen, Anders; Jørgensen, Bo Nørregaard

    2017-01-01

    Over the last decades, evolutionary algorithms have been extensively used to solve multi-objective optimization problems. However, the number of required function evaluations is not determined by nature of these algorithms which is often seen as a drawback. Therefore, a robust and reliable termin...

  14. Kolmveerand miljardit maksev terminal avatud / Koit Brinkmann

    Index Scriptorium Estoniae

    Brinkmann, Koit

    2006-01-01

    21. juulil avati 750 miljonit krooni maksma läinud AS-i Trendgate nafta ja tumedate naftaproduktide ümberlaadimise terminal. Avamisel viibisid ka majandus- ja kommunikatsiooniminister Edgar Savisaar ja Vene transpordiminister Igor Levitin. Lisa: Trendigate'i neli aastat

  15. Optimizing yard operations in port container terminals

    DEFF Research Database (Denmark)

    Kallehauge, Louise Sibbesen

    2005-01-01

    This paper deals with the problem of positioning containers in a yard block of a port container terminal. The objective of the container positioning problem (CPP) is to minimise the total handling time in the block, i.e. the time required for storage and reshuffling of containers. One...

  16. 49 CFR 212.113 - Program termination.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Program termination. 212.113 Section 212.113 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.113 Program...

  17. Terminal investment in multiple sexual signals

    DEFF Research Database (Denmark)

    Nielsen, Mattias Lange; Holman, Luke

    2012-01-01

    examples of such facultative terminal investment are known. 2. In the mealworm beetle, Tenebrio molitor, males"odours become more attractive to females following a life-threatening immune challenge. However, the pheromones involved are unknown, hindering further insight into the proximate mechanisms...

  18. 77 FR 21981 - Maher Terminal, LLC

    Science.gov (United States)

    2012-04-12

    ... unreasonable preference or advantage with respect to Maersk, APM, MSC, PNCT, NYCT, and Global, and other marine... considerations, restrictions on transfers and/or changes in ownership or control interests, lost business, forgone business, and additional obligations not required of * * * other marine terminals and other...

  19. Self-Terminating, Oxidative Radical Cyclizations

    Directory of Open Access Journals (Sweden)

    Uta Wille

    2004-05-01

    Full Text Available The recently discovered novel concept of self-terminating, oxidative radical cyclizations, through which alkynes can be converted into carbonyl compounds under very mild reaction conditions using O-centered inorganic and organic radicals as oxidants, is described

  20. An Axiomatization for the Terminal Cycle

    NARCIS (Netherlands)

    Fokkink, W.J.

    Milner proposed an axiomatization for the Kleene star in basic process algebra, in the presence of deadlock and empty process, modulo bisimulation equivalence. In this paper, Milner's axioms are adapted to the terminal cycle xω, which executes x infinitely many times in a row, and it is shown