Quality in palliative care from the patient perspective : Instrument development, perceptions of care received and the importance of care

The overall aim was to investigate the quality of palliative care from the patient perspective, to adapt and psychometrically evaluate the Quality from Patients’ Perspective instrument specific to palliative care (QPP-PC) and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. Methods: In the systematic literature review (I), 23 studies from 6 databases and reference lists in 2014 were synthesized by integrative thematic analysis. The quantitative studies (II–IV) had cross-sectional designs including 191 patients (73% RR) from hospice inpatient care, hospice day care, palliative units in nursing homes and home care in 2013–2014. A modified version of QPP was used. Additionally, person- and organization-related conditions were assessed. Psychometric evaluation, descriptive and inferential statistics were used. Main findings: Patients’ preferences for palliative care included living a meaningful life and responsive healthcare personnel, care environment and organization of care (I). The QPP-PC was developed, comprising 12 factors (49 items), 3 single items and 4 dimensions: medical–technical competence, physical–technical conditions, identity–oriented approach, and socio-cultural atmosphere (II). QPP-PC measured patients’ perceived reality (PR) and subjective importance (SI) of care quality. PR differed across settings, but SI did not (III). All settings exhibited areas of strength and for improvement (II, III). Person-related conditions seemed to be related to SI, and person- and organization-related conditions to PR, explaining 18–30 and 22-29% respectively of the variance (IV). Conclusions: The patient perspective of care quality (SI and PR) should be integrated into daily care and improvement initiatives in palliative care. The QPP-PC can measure patients’ perceptions of care quality. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred care.

On the Cost of Using Happy Eyeballs for Transport Protocol Selection

Concerns have been raised in the past several years that introducing new transport protocols on the Internet has be- come increasingly difficult, not least because there is no agreed-upon way for a source end host to find out if a trans- port protocol is supported all the way to a destination peer. A solution to a similar problem—finding out support for IPv6—has been proposed and is currently being deployed: the Happy Eyeballs (HE) mechanism. HE has also been proposed as an efficient way for an application to select an appropriate transport protocol. Still, there are few, if any, performance evaluations of transport HE. This paper demonstrates that transport HE could indeed be a feasible solution to the transport support problem. The paper evaluates HE between TCP and SCTP using TLS encrypted and unencrypted traffic, and shows that although there is indeed a cost in terms of CPU load to introduce HE, the cost is rel- atively small, especially in comparison with the cost of using TLS encryption. Moreover, our results suggest that HE has a marginal impact on memory usage. Finally, by introduc- ing caching of previous connection attempts, the additional cost of transport HE could be significantly reduced.