Association between clinician factors and a patient's wish to hasten death: Terminally ill cancer patients and their doctors

This study investigated the clinical factors associated with a wish to hasten death among patients with advanced cancer receiving palliative care, with a focus on the role of clinician-related factors. Patients were grouped into high- and low-scoring groups on the basis of their wish to hasten death; doctor-patient pairs were formed. Questionnaire data collected from patients and their treating doctors were subjected to multivariate analysis. Significant predictors of a high wish to hasten death in terminally ill patients from among treating clinicians included the clinician's perception of the patient's lower optimism and greater emotional suffering, the patient indicating a wish to hasten death, the doctor willing to assist the patient in hastening death (if requested and legal), and the doctor reporting less training in psychotherapy. When these variables were combined with patient factors identified in a previous study, the model significantly predicted a wish to hasten death with the following variables patient factors: a higher perceived burden on others, higher depressive symptom scores, and lower family cohesion; physician factors: the doctor willing to assist the patient in hastening death (if requested and legal), the doctor's perception of lower levels of optimism and greater emotional distress in the patient, and the doctor having less training in psychotherapy; and the setting of care: recent admission to a hospice. The findings support the multifactorial influences on the wish to hasten death and suggest that the role of the clinician is a vital context within which the wish to hasten death should be considered.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Obstacles and solutions to maximising urban biodiversity throughout the lifecycles of major developments in England

Thus far, achieving net biodiversity gains through major urban developments has been neither common nor straightforward - despite the presence of incentives, regulatory contexts, and ubiquitous practical guidance tools. A diverse set of obstructions, occurring within different spatial, temporal and actor hierarchies, are experienced by practitioners and render the realisation of maximised biodiversity, a rarity. This research aims to illuminate why this is so, and what needs to be changed to rectify the situation. To determine meaningful findings and conclusions, capable of assisting applied contexts and accommodating a diverse range of influences, a ‘systems approach’ was adopted. This approach led to the use of a multi-strategy research methodology, to identify the key obstructions and solutions to protecting and enhancing biodiversity - incorporating the following methods: action research, a questionnaire to local government ecologists, interviews and personal communications with leading players, and literature reviews. Nevertheless, ‘case studies’ are the predominant research method, the focus being a ‘nested’ case study looking at strategic issues of the largest regeneration area in Europe ‘the Thames Gateway’, and the largest individual mixeduse mega-development in the UK (at the time of planning consent) ‘Eastern Quarry 2’ - set within the Gateway. A further key case study, focussing on the Central Riverside development in Sheffield, identifies the merits of competition and partnership. The nested cases, theories and findings show that the strategic scale - generally relating to governance and prioritisation - impacts heavily upon individual development sites. It also enables the identification of various processes, mechanisms and issues at play on the individual development sites, which primarily relate to project management, planning processes, skills and transdisciplinary working, innovative urban biodiversity design capabilities, incentives, organisational cultures, and socio-ecological resilience. From these findings a way forward is mapped, spanning aspects from strategic governance to detailed project management.

Set-up and maintenance of syringe drivers for subcutaneous drug administration in palliative care

Focal points: Details of syringe driver use were collected from 11 inpatient hospice units in the West Midlands and compared with predetermined standards set by a multidisciplinary group We recorded 294 syringe driver events which complied with standards for the choice of administration site, protection of the syringe driver from light and the reason for initiation of the infusion Issues of nurse training, variability in prescribing practices, provision of written information for patients, labelling and documentation of the diluent used were all identified as areas in which compliance with standards could be improved

Onde fica o sertão rompem-se as águas: processo de territorialização da ribeira do Apodi-Mossoró (1676-1725)

The Portuguese territorial process of the captaincy of Rio Grande was initiated in1598 with the conquest of the Potengi River bar by Mascarenhas Homem. This process lasted until 1633, when it was interrupted by the arrival of the Dutch, and resumed only in 1654. From this year on, the occupation of unknown lands of the captaincy was encouraged, supporting the advancement towards conquering the backlands, breaking the divisive boundaries with the captaincy of Siará Grande so far known: the Assú riverside. This breakthrough resulted in confrontations with the inhabitants of these lands, known as tapuias, leading to outbreak of several conflicts that composed the Barbarians War. The main stage of such events in Rio Grande, between the years 1687 and 1720, was precisely the Assú riverside, one of the spaces to be investigated by this research. Therefore, this paper aims to analyze the advance of the conquerors in Rio Grande, contributing to the territorial process, which resulted in the emergence of a new border between Rio Grande and Siará Grande: the Apodi-Mossoró river. For this purpose, it was used sources produced between the years 1659 and 1725, as the settlement letters, royal charters, correspondence between the City Council of Natal, captains of Rio Grande and the government of Pernambuco and also the general government, as well as the documents related to the militia composed mainly by Paulistas who struggled in the captaincy.

A ribeira da discórdia: terras, homens e relações de poder na territorialização do Assu colonial (1680-1720)

The internalization process of the Portuguese possession in Northern Captaincies - after the Dutch eviction and the development of activities related to livestock in the backlands (Sertão) – expanded the Portuguese territory in America. This process resulted in the advancement of Portuguese conquest over the region and conflicts involving agents of colonization and indigenous groups who inhabited that space, as well as conflicts of interest of captaincy’s major social groups and the defense policies of the Portuguese territory possession. Among the rivers which run through Rio Grande captaincy’s territory, the Açu was the one that aroused conquerors and colonizers of the back lands interest, making that spatiality an area where interest and power exercises converged and generated discord. This research aims to analyze the territorial process of Assu backlands, from the pioneers, conquerors and colonizers action over the space studied, during the event known as the War of the Barbarians in Assu, conflict that ensured the integration of the area the territory and the wishes of the Portuguese crown. Thus, it will be taken as objects of study social phenomena that characterized Assu’s riverside - at the turn of the 17th to the 18th century, in a cutout that extends from 1680 to 1720 - as an area of conflicts of interest, noticeable for analysis from period documents such as records of land grants concessions, correspondence between colonial and kingdom authorities, documents from the exercise of administration of Portuguese America and legislation.

A ribeira da discórdia: terras, homens e relações de poder na territorialização do Assu colonial (1680-1720)

The internalization process of the Portuguese possession in Northern Captaincies - after the Dutch eviction and the development of activities related to livestock in the backlands (Sertão) – expanded the Portuguese territory in America. This process resulted in the advancement of Portuguese conquest over the region and conflicts involving agents of colonization and indigenous groups who inhabited that space, as well as conflicts of interest of captaincy’s major social groups and the defense policies of the Portuguese territory possession. Among the rivers which run through Rio Grande captaincy’s territory, the Açu was the one that aroused conquerors and colonizers of the back lands interest, making that spatiality an area where interest and power exercises converged and generated discord. This research aims to analyze the territorial process of Assu backlands, from the pioneers, conquerors and colonizers action over the space studied, during the event known as the War of the Barbarians in Assu, conflict that ensured the integration of the area the territory and the wishes of the Portuguese crown. Thus, it will be taken as objects of study social phenomena that characterized Assu’s riverside - at the turn of the 17th to the 18th century, in a cutout that extends from 1680 to 1720 - as an area of conflicts of interest, noticeable for analysis from period documents such as records of land grants concessions, correspondence between colonial and kingdom authorities, documents from the exercise of administration of Portuguese America and legislation.

Perfil sociodemográfico dos idosos nas capitais do Nordeste e a mortalidade por doenças crônico-degenerativas desse segmento populacional em Natal (RN)

Population aging is a global demographic trend. This process is a reality that merits attention and importance in recent years, and cause considerable impact in terms of greater demands on the health sector, social security and special care and attention from families and society as a whole. Thus, in the context of addressing the consequences of demographic transition, population aging is characterized as a major challenge for Brazilian society. Therefore, this study was conducted in two main objectives. In the first article, variables of socioeconomic and demographic contexts were employed to identify multidimensional profiles of elderly residents in the Northeast capitals, from specific indicators from the 2010 Census information Therefore, we used the Grade of Membership Method (GoM), whose design profiles admits that an individual belongs to different degrees of relevance to multiple profiles in order to identify socioeconomic and demographic factors associated with living conditions of the elderly in the Northeastern capitals. The second article examined the possible relationship between mortality from chronic diseases and socio-economic indicators in the elderly population, of the 137 districts in Natal, broken down by ten-year age groups (60 to 69 years, 70-79 years and 80 and over. The microdata from the Mortality Information System (SIM), was used, provided by the Health Secretariat of Christmas, and population information came from the Population Census 2010. The method refers to the Global and Local Index neighborhood logic (LISA) Moran, whose spatial distribution from the choropleth maps allowed us to analyze the mortality of the elderly by neighborhoods, according to socioeconomic and demographic indicators, according to the presence of special significance. In the first article, the results show the identification of three extreme profiles. The Profile 1 which is characterized by median socioeconomic status and contributes 35.5% of elderly residents in the area considered. The profile 2 which brings together seniors with low socioeconomic status characteristics, with a percentage of 24.8% of cases. And the Profile 3 composing elderly with features that reveal better socioeconomic conditions, about 29.7% of the elderly. Overall, the results point to poor living conditions represented by the definition of these profiles, mainly expressed by the results observed in more than half of the northeastern elderly experience a situation of social vulnerability given the large percentage that makes up the Profile 1 and Profile 2, adding 60% of the elderly. In the second article, the results show a higher proportion of elderly concentrated in the neighborhoods of higher socioeconomic status, such as Petrópolis and LagoaSeca. Mortality rates, according to the causes of death and standardized by the empirical Bayesian method were distributed locally as follows: Neoplasms (Reis Santos, New Discovery, New Town, Grass Soft and Ponta Negra); Hypertensive diseases (Blue Lagoon, Potengi, Redinha, Reis Santos, Riverside, Lagoa Nova, Grass Soft, Neópolis and Ponta Negra); Acute Myocardial Infarction (Northeast, Guarapes and grass Soft); Cerebrovascular diseases (Petrópolis and Mother Luiza); Pneumonia (Ribeira, Praia do Meio, New Discovery, Grass Soft and Ponta Negra); Chronic Diseases of the Lower Way Airlines (Igapó, Northeast and Thursdays). The present findings at work may contribute to other studies on the subject and development of specific policies for the elderly.

Perfil sociodemográfico dos idosos nas capitais do Nordeste e a mortalidade por doenças crônico-degenerativas desse segmento populacional em Natal (RN)

Population aging is a global demographic trend. This process is a reality that merits attention and importance in recent years, and cause considerable impact in terms of greater demands on the health sector, social security and special care and attention from families and society as a whole. Thus, in the context of addressing the consequences of demographic transition, population aging is characterized as a major challenge for Brazilian society. Therefore, this study was conducted in two main objectives. In the first article, variables of socioeconomic and demographic contexts were employed to identify multidimensional profiles of elderly residents in the Northeast capitals, from specific indicators from the 2010 Census information Therefore, we used the Grade of Membership Method (GoM), whose design profiles admits that an individual belongs to different degrees of relevance to multiple profiles in order to identify socioeconomic and demographic factors associated with living conditions of the elderly in the Northeastern capitals. The second article examined the possible relationship between mortality from chronic diseases and socio-economic indicators in the elderly population, of the 137 districts in Natal, broken down by ten-year age groups (60 to 69 years, 70-79 years and 80 and over. The microdata from the Mortality Information System (SIM), was used, provided by the Health Secretariat of Christmas, and population information came from the Population Census 2010. The method refers to the Global and Local Index neighborhood logic (LISA) Moran, whose spatial distribution from the choropleth maps allowed us to analyze the mortality of the elderly by neighborhoods, according to socioeconomic and demographic indicators, according to the presence of special significance. In the first article, the results show the identification of three extreme profiles. The Profile 1 which is characterized by median socioeconomic status and contributes 35.5% of elderly residents in the area considered. The profile 2 which brings together seniors with low socioeconomic status characteristics, with a percentage of 24.8% of cases. And the Profile 3 composing elderly with features that reveal better socioeconomic conditions, about 29.7% of the elderly. Overall, the results point to poor living conditions represented by the definition of these profiles, mainly expressed by the results observed in more than half of the northeastern elderly experience a situation of social vulnerability given the large percentage that makes up the Profile 1 and Profile 2, adding 60% of the elderly. In the second article, the results show a higher proportion of elderly concentrated in the neighborhoods of higher socioeconomic status, such as Petrópolis and LagoaSeca. Mortality rates, according to the causes of death and standardized by the empirical Bayesian method were distributed locally as follows: Neoplasms (Reis Santos, New Discovery, New Town, Grass Soft and Ponta Negra); Hypertensive diseases (Blue Lagoon, Potengi, Redinha, Reis Santos, Riverside, Lagoa Nova, Grass Soft, Neópolis and Ponta Negra); Acute Myocardial Infarction (Northeast, Guarapes and grass Soft); Cerebrovascular diseases (Petrópolis and Mother Luiza); Pneumonia (Ribeira, Praia do Meio, New Discovery, Grass Soft and Ponta Negra); Chronic Diseases of the Lower Way Airlines (Igapó, Northeast and Thursdays). The present findings at work may contribute to other studies on the subject and development of specific policies for the elderly.

Sediment and pore water data of five cores from the continental slope off Uruguay

Assessing frequency and extent of mass movement at continental margins is crucial to evaluate risks for offshore constructions and coastal areas. A multidisciplinary approach including geophysical, sedimentological, geotechnical, and geochemical methods was applied to investigate multistage mass transport deposits (MTDs) off Uruguay, on top of which no surficial hemipelagic drape was detected based on echosounder data. Nonsteady state pore water conditions are evidenced by a distinct gradient change in the sulfate (SO4**2-) profile at 2.8 m depth. A sharp sedimentological contact at 2.43 m coincides with an abrupt downward increase in shear strength from approx. 10 to >20 kPa. This boundary is interpreted as a paleosurface (and top of an older MTD) that has recently been covered by a sediment package during a younger landslide event. This youngest MTD supposedly originated from an upslope position and carried its initial pore water signature downward. The kink in the SO4**2- profile approx. 35 cm below the sedimentological and geotechnical contact indicates that bioirrigation affected the paleosurface before deposition of the youngest MTD. Based on modeling of the diffusive re-equilibration of SO4**2- the age of the most recent MTD is estimated to be <30 years. The mass movement was possibly related to an earthquake in 1988 (approx. 70 km southwest of the core location). Probabilistic slope stability back analysis of general landslide structures in the study area reveals that slope failure initiation requires additional ground accelerations. Therefore, we consider the earthquake as a reasonable trigger if additional weakening processes (e.g., erosion by previous retrogressive failure events or excess pore pressures) preconditioned the slope for failure. Our study reveals the necessity of multidisciplinary approaches to accurately recognize and date recent slope failures in complex settings such as the investigated area.

Looking for Determinants of Ontological Security in the Spain of the Crisis

The concept of ontological security has a remarkable echo in the current sociology to describe emotional status of men of late modernity. However, the concept created by Giddens in the eighties has been little used in empirical research covering various sources of risk or uncertainty. In this paper, a scale for ontological security is proposed. To do this, we start from the results of a research focused on the relationship between risk, uncertainty and vulnerability in the context of the economic crisis in Spain. These results were produced through nine focus groups and a telephone survey with standardized questionnaire applied to a national sample of 2,408 individuals over 18 years. This work is divided into three main sections. In the fi rst, a scale has been built from the results of the application of different items present in the questionnaire used. The second part explores the relationships of the scale obtained with the variables further approximate the emotional dimensions of individuals. The third part observes the variables that contribute to changes in the scale: These variables show the structural feature of the ontological security.

Duelo, ansiedad y depresión en familiares de pacientes en una unidad de cuidados paliativos a los dos meses de la pérdida

Aim: This study is going to assess the prevalance of prolonged grief diagnoses and it will evaluate the severity of the symptoms of depression, anxiety and complicated grief two months after a loved one is lost. We also intend to study which variables associated with the risk of grief could be more decisive when diagnosing it, its symptoms and the consequent emotional distress.Method: A total of 66 families of patients in the Palliative Care Unit (PCU) at Hospital San Cecilio in Granada have been evaluated. Measurements were taken two months after the death. This investigation has explored the existing emotional distress using the following questionnaires: Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Inventory of Complicated Grief (ICG) and Prolongued Grief Disorder (PG-12).Results: The results show that 33.3% and 21.21% of the sufferers had high levels of depression and clinical anxiety two months after the death. The prevalence of prolongued grief diagnoses, according to the PG-12, is 10.6% and 53.03% of the participants showed symptoms of complicated grief according to the ICG. Additionally, statistically significant differences are found in the sufferers with and without a prolongued grief diagnosis and scores in the ICG and BDI-II. The family’s financial situation is linked to the presence of symptoms of anxiety and depression and complicated grief, with the most determining variable being the risk of grief. Finally, the greater the age of the deceased and the longer the time spent in the PCU is linked to fewer symptoms of grief. However, important links have been found between the sufferers who have experienced stressful critical events prior to losing their loved one, with symptoms of depression, anxiety and complicated grief.Conclusions: The high numbers of cases of symptoms of complicated grief and levels of anxiety and clinical depression two months after a death suggests that early interventions should be carried out in those individuals with greater vulnerability.

Evaluación de la calidad de un servicio de voluntariado en oncología: un Análisis Importancia-Valoración (IPA)

Objective: Using an Importance-Performance Analysis (IPA), this paper examined a Radiotherapy and Oncological Patient and Non-patient perceived importance and performance of ten Humanization Volunteer Program selection factors in the General Hospital in Spain.Methods: The authors identified a list of seven items from the Health-marketing literature reviews, and each item was rated using a 5-point Likert scale. Responses were obtained of 148 usable interviews.Results: The importance-performance patient grid was corrected with literature recommendations and, in the patient sample, shows three items fall in the “Keep up the good work” quadrant, four items fall into the “Low priority” quadrant, zero items fall into the “Possible overkill” quadrant, and no items fall in the “Concentrate here” quadrant. Non-patient (n=80) factors means shows statistical differences with patient (n=68) means in catering (t=-2.38; df.=146; p<0.05), and information (t=2.16; df146; p<0,05).Conclusions: The results are useful in identifying areas for strategic focus to help Health Services managers develop humanization programs with volunteer workers and different program users. Implication to volunteer programs managers and researchers were discussed.