End-of-life care pathways for improving outcomes in caring for the dying (Review)

Background This is an updated version of a Cochrane review first published in Issue 1, 2010 of The Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. There have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the UK. Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways with a systematic review. Objectives To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community). In particular, we aimed to assess the effects on symptom severity and quality of life of people who are dying; those related to the care such as families, carers and health professionals; or a combination of these. Search Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2013), MEDLINE, EMBASE, PsycINFO, CINAHL, review articles and reference lists of relevant articles.We conducted the original search in September 2009, and the updated search in June 2013. Selection Criteria All randomised controlled trials (RCTs), quasi-randomised trial or high-quality controlled before-and-after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Data Collection and Analysis Two review authors assessed the results of the searches against the predetermined criteria for inclusion. Main Results The original review identified 920 titles. The updated search found 2042 potentially relevant titles (including the original 920), but no additional studies met criteria for inclusion in the review update. Authors’ Conclusions With sustained concerns about the safety of the pathway implementation and the lack of available evidence on important patient and relative outcomes, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. Since the last version of this review, no new studies met criteria for inclusion in the review update. With recently documented concerns related to the potential adverse effects associated with Liverpool Care Pathway (the most commonly used end-of-life care pathway), we do not recommend decision making based on indirect or low-quality evidence. All health services using end-of-life care pathways are encouraged to have their use of the pathway, to date, independently audited. Any subsequent use should be based on carefully documented evaluations. Large RCTs or other well-designed controlled studies are urgently required for the evaluation of the use of end-of-life care pathways in caring for dying people in various clinical settings. In future studies, outcome measures should include benefits or harms concerning the outcomes of interest in this review in relation to patients, families, carers and health professionals.

Economic burden of malignant neoplasms in Shandong province [山东省恶性肿瘤经济负担分析]

Objective: To evaluate the economic burden of malignant neoplasms in Shandong province in order to provide scientific evidence for policy-making. Methods: The main sources for this study were the data from the third sampling survey of death cause in 2006 and cancer prevalence survey in 2007 in Shandong province. The direct medical cost was calculated based on the survey data. The indirect cost due to mortality and morbidity were estimated with human capital approach based on the data of disability-adjusted life years derived from the two surveys and gross domestic product (GDP) data. The total economic burden was the sum of direct medical cost and indirect cost. The uncertainty analysis was conducted according to the methodology in global burden of disease study. Results: The total cost of cancer in Shandong province in 2006 estimated was 18 057 million Yuan RMB (95% confidence interval:16 817 － 19 393 million), which accounted for 0. 83% of the total GDP. The direct medical cost，indirect mortality cost and indirect morbidity cost accounted for 17.28%, 78.53%, and 4.20% of total economic burden of malignant neoplasms, respectively. Liver，lung and stomach cancer were the top three tumors with heavier economic burden, with accounted for more than one half (57. 83%) of the total economic burden of all cancers. The uncertainty of total burden estimated was around ± 7%, which mainly derived from the uncertainty of indirect economic burden. Conclusion: The influence of cancers on social economy is dominated by the loss of productivity, especially by the productivity loss due to premature death. Liver, lung and stomach cancer are the major cancers for disease control and prevention in Shandong province. Abstract in Chinese 目的 评价山东省恶性肿瘤经济负担,为卫生决策提供科学依据. 方法 以2006年山东省第3次死因回顾抽样凋查资料和2007年山东省恶性肿瘤现患状况抽样调查资料为基础,测算全省直接医疗成本;采用人力资本法测算死亡间接负担和伤残间接负担;参考全球疾病负担研究的方法对测算结果的不确定性进行分析. 结果 2006年山东省因恶性肿瘤导致的总经济负担为180.57亿元(95%CI=16 817～19 393),占全省GDP总量的0.83%,其中直接医疗成本占总负担的17.28%,死亡造成的间接经济负担占78.53%,伤残所致间接经济负担占4.20%;肝癌、肺癌和胃癌为山东省经济负担最重的3种恶性肿瘤,总经济负担合计占全部恶性肿瘤的57.83%;总经济负担估计结果的不确定性范围在±7%左右,主要取决于间接经济负担的不确定性. 结论 恶性肿瘤对社会经济的影响主要通过生产力的损失产生作用,并以死亡所致生产力损失为主;肝癌、肺癌和胃癌应是山东省恶性肿瘤预防控制的重点.

Family representatives in family firms

Research Question/Issue: Family control in family firms can extend beyond the direct involvement of family members, but identifying these mechanisms is difficult in most markets. We utilize unique disclosures made by Taiwanese firms to examine the role played by family representatives in listed family firms. Family representatives are non-family members that represent the controlling family’s indirect shareholdings in the firm. We examine whether family representatives are used in the same manner as family members and whether they provide net benefits or costs to shareholders. Research Findings/Insights: In our sample of listed family firms, we find that omitting family representatives understates the influence of controlling families by 46 percent. We show that family representatives are associated with net costs to shareholders, but to a lesser extent than family members. We also find that controlling families use family members and family representatives differently. Family members are more involved in older family firms and in firms founded by the family. Family representatives are more involved in acquired and second generation family firms and in larger firms with more fixed assets. Theoretical/Academic Implications: We apply agency theory to the use of family representatives and show that family representatives are being used by controlling families to extend their influence within their firms, increasing agency costs to minority shareholders. Practitioner/Policy Implications: For policymakers, our analysis shows that disclosure of family member and representative relationships within firms is important and value-relevant to investors. Furthermore, our results suggest that firm performance could be improved by limiting the involvement of family members and family representatives in family firms.

Creeping insulation - Hong Kong green wall

Hong Kong is a densely populated city suffering badly from the urban heat island effect. Green wall offers a means of ameliorating the situation but there are doubts over its suitability in Hong Kong’s unique environment. In this paper, we look at the potential for green walls in Hong Kong first by summarising some of the Chinese green walling systems and associated vegetation in use, then by an introduction to three existing green walls in Hong Kong, and finally through a small experiment aimed at identifying the likely main effects of green walled housing. The results indicate that green walling in Hong Kong is likely to provide enhanced internal house environment in terms of warm weather temperature reduction, stabilisation and damping, with direct energy savings in air-conditioning and indirect district benefits of reduced heat island effect and carbon emissions. The green walling insulation properties also suggest the possibility of warmer homes in winter and/or energy savings in mechanical heating provision.

Creeping insulation - Hong Kong green wall

Hong Kong is a densely populated city suffering badly from the urban heat island effect. Green wall offers a means of ameliorating the situation but there are doubts over its suitability in Hong Kong’s unique environment. In this paper, we look at the potential for green walls in Hong Kong first by summarizing some of the Chinese green walling systems and associated vegetation in use, then by an introduction to three existing green walls in Hong Kong, and finally through a small experiment aimed at identifying the likely main effects of green walled housing. The results indicate that green walling in Hong Kong is likely to provide enhanced internal house environment in terms of warm weather temperature reduction, stabilization and damping, with direct energy savings in air-conditioning and indirect district benefits of reduced heat island effect and carbon emissions. The green walling insulation properties also suggest the possibility of warmer homes in winter and/or energy savings in mechanical heating provision.

Flexibility in change practices and job outcomes for nurses : exploring the role of subjective fit

Aims To integrate existing theoretical perspectives on change management, subjective fit and occupational stress to better understand the effects of change on employee adjustment. Background Although subjective fit with organizational goals and objectives has been shown to have positive effects on employee adjustment, its role in the organizational change–occupational stress context is not understood. This represents a caveat in research when considering the notion that those who feel that they fit with the organization's goals may be better equipped to reconcile and deal with change. Design A cross-sectional survey of nurses from public and non-profit sector hospitals was conducted. Method Data were collected from 252 public and non-profit sector nurses via online surveys. Data were collected from June–October in 2010. Structural equation modelling was used to test the direct and indirect effects among the focal variables. Results The results showed that public and non-profit nurses experience flexibility-limiting and flexibility-promoting change initiatives and that these are differentially related to the perception of administrative stressors and adjustment with these relationships directly and indirectly influenced by perceptions of subjective fit. Flexibility-limiting change initiatives led to lower levels of subjective fit, higher levels of administrative stressors and less favourable adjustment. On the other hand, flexibility-promoting change practices led to higher levels of subjective fit, lower levels of administrative stressors and ultimately better adjustment. Conclusion The results further the theoretical understanding of the role of subjective fit in organizational change and occupational stress theories.

Prognostic significance of platelet and microvessel counts in operable non-small cell lung cancer

Background: Microvessel density, an indirect measure of angiogenesis, has been shown to be an independent prognostic marker in many solid tumours including non-small cell lung cancer (NSCLC). Platelets transport and release angiogenic growth factors. Platelets are increasingly likely to adhere to tumour microvessels due to raised expression of platelet-binding proteins and stasis in blood-flow. Increased vascular permeability in tumour microvessels facilitates platelet extravasation into the extracellular matrix. Adherence and extravasation both lead to platelet activation and release of growth factors capable of instigating the angiogenic process. Methods: A total of 181 patients were identified who underwent resection of stage I-IIIa NSCLC with a post-operative survival >60 days. Patients were followed-up for a minimum of 24 months. Sections from the tumour periphery were stained for the endothelial marker CD34 (Novocastra NCL-END) using standard ABC immunohistochemistry. Chalkley counting was used to assess microvessel density. Results: A pre-operative platelet count greater than the median and above the normal range (>400) was associated with a poor outcome (P = 0.01 and P = 0.04, respectively). Tumours with an above median and high Chalkley count (upper tertile) had a worse prognosis (P = 0.007 and P = 0.0006, respectively). There was no association between platelet count and Chalkley count. Conclusions: Platelet and microvessel counts are both potential prognostic markers for NSCLC. The role of platelets in the angiogenic process needs to be further investigated. (C) 2000 Elsevier Science Ireland Ltd.

Platelet-derived endothelial cell growth factor expression and angiogenesis in cervical intraepithelial neoplasia and squamous cell carcinoma of the cervix

Growth and metastatic spread of invasive carcinoma depends on angiogenesis, the formation of new blood vessels. Platelet-derived endothelial cell growth factor (PD-ECGF) is an angiogenic growth factor for a number of solid tumors, including lung, bladder, colorectal, and renal cell cancer. Cervical intraepithelial neoplasia (CIN) is the precursor to squamous cell cervical carcinoma (SCC). Mean vessel density (MVD) increases from normal cervical tissue, through low- and high-grade CIN to SCC. We evaluated PD-ECGF immunoreactivity and correlated its expression with MVD in normal, premalignant, and malignant cervical tissue. PD-ECGF expression was assessed visually within the epithelial tissues and scored on the extent and intensity of staining. MVD was calculated by counting the number of vessels positive for von Willebrand factor per unit area subtending normal or CIN epithelium or within tumor hotspots for SCC. Cytoplasmic and/or nuclear PD-ECGF immunoreactivity was seen in normal epithelium. PD-ECGF expression significantly increased with histologic grade from normal, through low- and high-grade CIN, to SCC (P < .02). A progressive significant increase in the microvessel density was also seen, ranging from a mean of 28 vessels for normal tissue to 57 for SCC (P < .0005). No correlation was found between PD-ECGF expression and MVD (P = .45). We conclude that PD-ECGF expression and MVD increase as the cervix transforms from a normal to a malignant phenotype. PD-ECGF is thymidine phosphorylase, a key enzyme in the activation of fluoropyrimidines, including 5-fluorouracil. Evaluation of PD-ECGF thymidine phosphorylase expression may be important in designing future chemotherapeutic trials in cervical cancer. Copyright (C) 2000 by W.B. Saunders Company.

Posttraumatic growth in family members living with a relative diagnosed with schizophrenia

Family members living with a relative diagnosed with schizophrenia have reported challenges and traumatic stressors, as well as perceived benefits and personal growth. This study explored factors associated with posttraumatic growth (PTG) within such families. Personality, stress, coping, social support and PTG were assessed in 110 family members. Results revealed that a multiplicative mediational path model with social support and emotional or instrumental coping strategies as multi-mediators had a significant indirect effect on the relationship between extraversion and PTG. Clinically relevant concepts that map onto the multi-mediator model are discussed, translating these findings into clinical practice to facilitate naturally occurring PTG processes.

Changes in the site distribution of common melanoma subtypes in Queensland, Australia over time: implications for public health campaigns

Abstract BACKGROUND: An examination of melanoma incidence according to anatomical region may be one method of monitoring the impact of public health initiatives. OBJECTIVES:   To examine melanoma incidence trends by body site, sex and age at diagnosis or body site and morphology in a population at high risk. MATERIALS AND METHODS:   Population-based data on invasive melanoma cases (n = 51473) diagnosed between 1982 and 2008 were extracted from the Queensland Cancer Registry. Age-standardized incidence rates were calculated using the direct method (2000 world standard population) and joinpoint regression models were used to fit trend lines. RESULTS:   Significantly decreasing trends for melanomas on the trunk and upper limbs/shoulders were observed during recent years for both sexes under the age of 40 years and among males aged 40-59years. However, in the 60 and over age group, the incidence of melanoma is continuing to increase at all sites (apart from the trunk) for males and on the scalp/neck and upper limbs/shoulders for females. Rates of nodular melanoma are currently decreasing on the trunk and lower limbs. In contrast, superficial spreading melanoma is significantly increasing on the scalp/neck and lower limbs, along with substantial increases in lentigo maligna melanoma since the late 1990s at all sites apart from the lower limbs. CONCLUSIONS:   In this large study we have observed significant decreases in rates of invasive melanoma in the younger age groups on less frequently exposed body sites. These results may provide some indirect evidence of the impact of long-running primary prevention campaigns.

Optimal camera planning under versatile user constraints in multi-camera image processing systems

The selection of optimal camera configurations (camera locations, orientations, etc.) for multi-camera networks remains an unsolved problem. Previous approaches largely focus on proposing various objective functions to achieve different tasks. Most of them, however, do not generalize well to large scale networks. To tackle this, we propose a statistical framework of the problem as well as propose a trans-dimensional simulated annealing algorithm to effectively deal with it. We compare our approach with a state-of-the-art method based on binary integer programming (BIP) and show that our approach offers similar performance on small scale problems. However, we also demonstrate the capability of our approach in dealing with large scale problems and show that our approach produces better results than two alternative heuristics designed to deal with the scalability issue of BIP. Last, we show the versatility of our approach using a number of specific scenarios.

From Aussiewood Movies to Guerrilla Filmmaking: Independent Filmmaking and Contemporary Australian Cinema

Independent filmmaking within the context of Australian cinema is a multifaceted subject. In comparison to the United States, where production can be characterised as bifurcated between major studio production and so-called “indie” or independent production without the backing of the majors, since the 1970s and until recently the vast majority of Australian feature film production has been independent filmmaking. Like most so-called national cinemas, most Australian movies are supported by both direct and indirect public subvention administered by state and federal government funding bodies, and it could be argued that filmmakers are, to a certain degree, “dependent” on official mandates. As this chapter demonstrates national production slates are subjected to budget restraints and cut-backs, official cultural policies (for example pursuing international co-productions and local content quotas) and shifts in policy directions among others. Therefore, within the context of Australian cinema, feature film production operating outside the public funding system could be understood as “independent”. However, as is the case for most English-language national cinemas, independence has long been defined in terms of autonomy from Hollywood, and – as alluded to above – as Australia becomes more dependent upon international inputs into production, higher budget movies are becoming less independent from Hollywood. As such, this chapter argues that independence in Australian cinema can be viewed as having two poles: independence from direct government funding and independence from Hollywood studios. With a specific focus on industry and policy contexts, this chapter explores key issues that constitute independence for Australian cinema. In so doing it examines the production characteristics of four primary domains of contemporary independent filmmaking in Australia, namely: “Aussiewood” production; government-backed low-to-mid budget production; co-productions; and guerrilla filmmaking.

Designing mobile systems for social navigation in urban public places

This thesis presents social requirements and design considerations from a study evaluating interactive approaches to social navigation and user-generated information sharing in urban environments using mobile devices. It investigates innovative ways to leverage mobile information and communication technology in order to provide a social navigation platform for residents and visitors in and for public urban places. Through a design case study this work presents CityFlocks, a mobile information system that offers an easy way for information-seeking new residents or visitors to access tacit knowledge from local people about their new community. It is intended to enable visitors and new residents in a city to tap into the knowledge and experiences of local residents in order to gather information about their new environment. Its design specifically aims to lower existing barriers of access and facilitate social navigation in urban places. In various user tests it evaluates two general user interaction alternatives – direct and indirect social navigation – and analyses which interaction method works better for people using a mobile device to socially navigate urban environments. The outcomes are relevant for the user interaction design of future mobile information systems that leverage the social navigation approach.

How approach and avoidance constructs of personality and trait emotional intelligence predict core human values

In this paper we focus specifically on explaining variation in core human values, and suggest that individual differences in values can be partially explained by personality traits and the perceived ability to manage emotions in the self and others (i.e. trait emotional intelligence). A sample of 209 university students was used to test hypotheses regarding several proposed direct and indirect relationships between personality traits, trait emotional intelligence and values. Consistent with the hypotheses, Harm Avoidance and Novelty Seeking were found to directly predict Hedonism, Conformity, and Stimulation. Harm Avoidance was also found to indirectly predict these values through the mediating effects of key subscales of trait emotional intelligence. Novelty Seeking was not found to be an indirect predictor of values. Results have implications for our understanding of the relationship between personality, trait emotional intelligence and values, and suggest a common basis in terms of approach and avoidance pathways.

Spiritual wisdom of Taoism in business : through the lens of interpretation realism in a Cisco end-to-end case study

This paper explores how the amalgamated wisdom of East and West can instigate a wisdombased renaissance of humanistic epistemology (Rooney & McKenna, 2005) to provide a platform of harmony in managing knowledge-worker productivity, one of the biggest management challenges of the 21st century (Drucker, 1999). The paper invites further discussions from the social and business research communities on the significance of "interpretation realism" technique in comprehending philosophies of Lao Tzu Confucius and Sun Tzu (Lao/Confucius/Sun] written in "Classical Chinese." This paper concludes with a call to build prudent, responsible practices in management which affects the daily lives of many (Rooney & McKenna, 2005) in today's knowledgebased economy. Interpretation Realism will be applied to an analysis of three Chinese classics of Lao/Confucius/Sun which have been embodied in the Chinese culture for over 2,500 years. Comprehending Lao/Confucius/Sun's philosophies is the first step towards understanding Classical Chinese culture. However, interpreting Chinese subtlety in language and the yin and yang circular synthesis in their mode of thinking is very different to understanding Western thought with its open communication and its linear, analytical pattern of Aristotelian/Platonic wisdom (Zuo, 2012). Furthermore, Eastern ways of communication are relatively indirect and mediatory in culture. Western ways of communication are relatively direct and litigious in culture (Goh, 2002). Furthermore, Lao/Confucius/Sun's philosophies are difficult to comprehend as there are four written Chinese formats and over 250 dialects: Pre-classical Chinese Classical Chinese Literary Chinese and modern Vernacular Chinese Because Classical Chinese is poetic, comprehension requires a mixed approach of interpretation realism combining logical reasoning behind "word splitting word occurrences", "empathetic metaphor" and "poetic appreciation of word.