Impacte d'un programa d'informació sobre l'elaboració del document de voluntats anticipades

Tot i que en el nostre territori comptem des de els anys 80 amb diferents models de Document de Voluntats Anticipades (DVA), aquests continuen essent desconeguts tant per la ciutadania com pels professionals de la salut. Aquesta situació ha fet que ens plantegem com a objectiu d’aquest estudi descriure si existeix la correlació entre el fet de proporcionar informació sobre el DVA i la motivació per la seva realització. En aquest estudi hem agafat com a mostra els usuaris del servei de psicogeriatria de la Fundació Sociosanitaria de Manresa l’Hospital de Sant Andreu de Manresa, tenint en compte les recomanacions del Document Sitges del 2005 i d’altres autors que recomanen fer el DVA en situació de demència lleu o moderada. També s’ha tingut present l’elevada prevalença d’aquesta patologia. S'ha dissenyat un assaig clínic comunitari amb aleatorització de dos consultoris d'un servei de psicogeriatria. Els metges del consultori assignat al grup control feien el tractament habitual en relació al DVA, és a dir, no informar els pacients atesos sobre l'existència i característiques del DVA, i els metges del consultori assignat al grup intervenció donaven informació reglada als seus pacients sobre el DVA. En el moment de la inclusió es registrava informació sociodemogràfica i clínica per poder classificar els participants i, també a tots els subjectes inclosos en l'assaig, al cap de tres setmanes se'ls feia una enquesta telefònica per avaluar l'opinió i el coneixement sobre el DVA. De les respostes de l’enquesta podem extreure com a resultats que més del 90% dels subjectes del grup control no coneixen el DVA. També s’observa de manera significativa com les persones del grup intervenció parlen amb el metge,la infermera i/o la família sobre la dependència i la mort, tenint en compte que la mort i la dependència continuen sent un tema tabú, i que la majoria de la població de l’estudi no planifiquen com volen ser atesos. Tanmateix s’observa com un 2’3 % tenia fet el DVA i un 22’7% manifesten la seva voluntat de realitzar-lo. Amb aquest estudi es conclou que el fet de proporcionar informació sobre el DVA als usuaris del servei de psicogeriatria afavoreix que aquests estiguin motivats per la realització d’aquest document; al mateix temps també afavoreix la planificació de les cures i el parlar sobres temes com la mort i/o la dependència amb la família, el metge la infermera.

Aportaciones del área de educación física a la competencia básica "aprender a aprender"

In front of a moment of change in the education, with the entry into force of the LOE (Ley Orgánica de Educación, 2006), the aim of thisarticle is to face the challenge of trying to answer to the need to make concrete learning agreements with the new curriculum based on competences.The present article arises from the interest of being able to offer an approach that facilitates the exposition to show the didactic units from the areaof physical education in relation with the pedagogic principles of the LOE. Departing from this commitment, let’s sense beforehand an offer of thecontributions of the Physical Education to the Basic Competence to learn to learn which entails to develop some capacities in fuction of knowing todo skills

Definição de shelf life para produtos químicos: a importância de um guia de estabilidade específico para o segmento

The chemical industries worldwide are passing through a very particular moment of re-adaptation due to the implementation of an European regulation called, Registration, Evaluation, Authorization and Restriction of Chemicals (REACH). In Brazil, the Brazilian Chemical Industry needs urgently a specific guide of chemical products stability. The main purpose of this work is to present a proposal of a guide of stability for chemical products based on the reference guides of the International Conference on Harmonization (ICH). Thus, this work proposes an innovation in terms of methodology which will be useful for shelf life definition purpose for chemical industry products.

UNA PROPUESTA PARA ENSEÑAR EL EFECTO DE LA FORMA DE LAS MOLÉCULAS EN LA REACTIVIDAD QUÍMICA

We address the concept of steric effect in the pursuit of establishing quantitative correlations between reactivity of molecules and their molecular shape. To this end, a set of series of SN2 reactions were modeled to compute the energy barrier height and the molecular volume, atomic charges and dipole moment of molecules. We introduced the Kappa index to characterize the shape of molecules. Quantitative correlations between the change in the energy barrier with properties of molecules and Kappa index were presented and discussed.

Studies on Neuromuscular Blocking Agents and Their Antagonists During Anaesthesia

Neuromuscular blocking agents (NMBAs) are widely used in clinical anaesthesia and emergency medicine. Main objectives are to facilitate endotracheal intubation and to allow surgery by reducing muscle tone and eliminating sudden movements, which may otherwise lead to trauma and complications. The most commonly used NMBAs are non-depolarizing agents with a medium duration of action, such as rocuronium and cisatracurium. They bind to the acetylcholine receptors in the neuromuscular junction, thus inhibiting the depolarization of the postsynaptic (muscular) membrane, which is a prerequisite for muscle contraction to take place. Previously, it has been assumed that nitrous oxide (N2O), which is commonly used in combination with volatile or intravenous anaesthetics during general anaesthesia, has no effect on NMBAs. Several studies have since claimed that N2O in fact does increase the effect of NMBAs when using bolus administration of the relaxant. The effect of N2O on the infusion requirements of two NMBAs (rocuronium and cisatracurium) with completely different molecular structure and pharmacological properties was assessed. A closed-loop feedback controlled infusion of NMBA with duration of at least 90 minutes at a 90% level of neuromuscular block was used. All patients received total intravenous anaesthesia (TIVA) with propofol and remifentanil. In both studies the study group (n=35) received N2O/Oxygen and the control group (n=35) Air/Oxygen. There were no significant differences in the mean steady state infusion requirements of NMBA (rocuronium in Study I; cisatracurium in Study II) between the groups in either study. In Study III the duration of the unsafe period of recovery after reversal of rocuronium-induced neuromuscular block by using neostigmine or sugammadex as a reversal agent was analyzed. The unsafe period of recovery was defined as the time elapsed from the moment of no clinical (visual) fade in the train-of-four (TOF) sequence until an objectively measured TOF-ratio of 0.90 was achieved. The duration of these periods were 10.3 ± 5.5 and 0.3 ± 0.3 min after neostigmine and sugammadex, respectively (P < 0.001). Study IV investigated the possible effect of reversal of a rocuronium NMB by sugammadex on depth of anaesthesia as indicated by the bispectral index and entropy levels in thirty patients. Sugammadex did not affect the level of anaesthesia as determined by EEG-derived indices of anaesthetic depth such as the bispectral index and entropy.

Motoneuronitautiin liittyvä hengitysvajaus: hengitystoiminnan ja energia-aineenvaihdunnan mittaaminen

Tavoitteet: Tämän tutkimussarjan tavoitteena oli tutkia hengitystoiminnan sekä energia-aineen¬vaihdunnan muutoksia motoneuronitautia (amyotrofinen lateraaliskleroosi, ALS) sairastavilla potilailla. Erityisenä mielenkiinnon kohteena olivat kotihoitoon soveltuvan hengityslaitteen vai¬kutus elinajan ennusteeseen sekä hengitysvajauksen etenemistä kuvaavien keuhkotoimintakokei¬den arviointi ALS-potilailla, epäsuoran kalorimetrian mittaustarkkuus ja perusaineenvaihdunnan (PAV) suuruus kajoavaa hengityslaitetta käyttävillä ALS-potilailla. Aineisto ja menetelmät: Kajoamattoman hengityslaitteen käytön ja iän vaikutusta elinajan en¬nusteeseen arvioitiin 84:llä ja hengitystoiminnan muutoksia 42 ALS-potilaalla. Epäsuoran kalo¬rimetrian mittaustarkkuutta kajoamatonta hengityslaitetta käytettäessä arvioitiin hereillä olevilla 12 vapaaehtoisella mieshenkilöllä. PAV:n suuruutta arvioitiin viidellä kajoavaa hengityslaitetta käyttävällä ALS-potilaalla. Osatöistä kaksi ensimmäistä olivat luonteeltaan havainnoivia (retros¬pektiivisiä) ja kaksi viimeistä seurantatutkimuksia (prospektiivisia). Tulokset: Alle 65-vuotiailla ALS-potilailla ei havaittu eroa elinajan ennusteessa kajoamaton¬ta hengityslaitetta käyttävien ja käyttämättömien potilaiden välillä. Sen sijaan yli 65-vuotiail¬la ALS-potilailla elinajan ennuste piteni merkittävästi kajoamatonta hengityslaitetta käyttävillä potilailla (elinaika diagnoosin jälkeen 22 vs. 8 kk, Hazard Ratio = 0.25, 95 % luottamusväli 0.11 – 0.55, p <0.001). ALS-potilailla, joilla kajoamaton hengityslaite katsottiin tarpeelliseksi kuuden kuukauden kuluessa diagnoosihetkestä, hengitystiheys osoittautui diagnoosihetkellä mer-kittävästi kiihtyneeksi (21/min) ja rintakehän liike merkittävästi alentuneeksi (2.9 cm) verrattuna ALS-potilaisiin, joille kajoamaton hengityslaite katsottiin tarpeelliseksi myöhemmin (16/min ja 4.0 cm). Kajoamattoman hengityslaitehoidon aikana keskimääräinen mitattu PAV vapaaehtoisilla miehillä oli 1858 kcal/vrk kun PAV ilman hengityslaitetta oli 1852 kcal/vrk, p = 0.8. Kajoavaa hengityslaitehoitoa käyttävien viiden ALS-potilaan keskimääräinen PAV vastaavalla mittausase¬telmalla mitattaessa oli 1130 kcal/vrk, kun vastaava PAV laskettuna viidellä eri laskentakaavalla oli 1700 kcal/vrk, p < 0.001. Johtopäätökset: Yli 65-vuotiailla ALS-potilailla, jotka eivät sopeutuneet kajoamattomaan hen¬gityslaitehoitoon, oli nelinkertainen riski menehtyä aiemmin kuin kajoamattomaan hengityslai¬tehoitoon sopeutuneilla ALS-potilailla. Hengitystiheys osoittautui merkittävästi kiihtyneeksi ja rintakehän liike alentuneeksi ALS-potilailla, joille kajoamaton hengityslaitehoito katsottiin ai¬heelliseksi kuuden kuukauden kuluessa diagnoosihetkestä. Kajoamattoman hengityslaitehoidon aikana mitattu PAV ei poikennut mitatusta PAV:sta itsenäisen hengityksen aikana. Näin ollen epäsuoraa kalorimetriamenetelmää voidaan käyttää luotettavasti PAV:n määrittämiseen käytet¬täessä samanaikaisesti kotihoitoon soveltuvaa hengityslaitehoitoa. Elämää ylläpitävää kajoavaa hengityslaitehoitoa käyttävien ALS-potilaiden PAV oli merkittävästi hidastunut laskennallisella menetelmällä arvioituun PAV verrattuna.

Modelos de crescimento kaleckianos: uma apreciação

The purpose of this article is to survey the main papers that founded a kaleckian approach of the economic growth. It presents a certain moment of the historical evolution of the non-neoclassical macrodynamics. This analysis can be understood under the political economy tradition in putting together social classes (capitalists and workers), distributive conflict and the relationship between distribution and accumulation.

Heidegger and Blumenberg on modernity

The debate surrounding the way in which Heidegger and Blumenberg understand the modern age is an opportunity to discuss two different approaches to history. On one hand, from Heidegger's perspective, history should be understood as starting from how Western thought related to Being, which, in metaphysical thinking, took the form of the forgetfulness of Being. Thus, the modern age represents the last stage in the process of forgetfulness of Being, which announces the moment of the rethinking of the relationship with Being by appealing to the authentic disclosure of Being. On the other hand, Blumenberg understands history as the result of the reoccupation process, which means replacing old theories with other new ones. Thus, to the historical approach it is not important to identify epochs as periods of time between two events, but to think about the discontinuities occurring throughout history. Starting from here, the modern age will be thought of not as an expression of the radicalization of the forgetfulness of Being, but as a response to the crises of medieval conceptions. For the same reason, the interpretation of history as a history of the forgetfulness of Being is considered by Blumenberg to subordinate history to an absolute principle, without taking into account its protagonists' needs and necessities.

Tehohoitopotilaan siirtotiedote hoitotyön päätöksenteon tukena - retrospektiivinen asiakirja-analyysi vuosilta 2001-2013

Tuija Lehtikunnas: Intensive care patient handover document in support of decision-making in nursing work - Retrospective document analysis for the period 2001–2013 University of Turku, Faculty of Medicine, Nursing Science Annales Universitatis Turkuensis Turku 2016 ABSTRACT The continuity of care and flow of information must be ensured when transferring the responsibility of care, whether this is done within an organisation or from one organisation to another. The purpose of this study was to describe and compare the nursing handover documents of long-term intensive care patients and changes to these documents during the years 2001–2013. Research data comprehended long-term intensive care patient handover documents (N = 250). Data was gathered from one university hospital intensive care unit and subjected to a content analysis of technical implementation, structure and content at five different time points. In addition to this, the nursing handover documents were analysed from a nursing decision-making standpoint. Sub-data (n = 5 x 50) from the years 2001, 2002, 2004, 2006 and 2013 was gathered. The first sub-data was manual, written on paper with a pen. The rest of the sub-data obtained was entered in a dedicated intensive care information system. The study developed an intensive care patient nursing handover document analysis framework, which was used to deductively analyse the research data. The results indicated that the transitioning to electronic records reinforced structure and identification improving the reusability of data was increased. Although intensive care nursing was recorded on nursing handover documents more comprehensively in more recent sub-data, it was done selectively with regard to overall patient care, e.g. there are no entries concerning the psychological support and counselling of patients or family members. Nursing handover documents do not contain a systematic description of the patient's communication and functional capacity at the moment of transfer. The patient's condition at the moment of transfer is not clearly indicated on the handover documents. Plans for follow-up treatment are not recorded at all. Nursing decision-making is difficult to find on the nursing handover documents used as research data. The study developed a handover document model for intensive care nursing that supports nursing decision-making and the continuity of care. Developmental recommendations focus on the management of co-operation within organisations for ensuring the continuity of care and enhancing each area of nursing in recording nursing handover documents by planning nursing for the patient, taking follow-up treatment resources into consideration. Keywords: Intensive care nursing, nursing decision-making, nursing records, information flow, nursing handover document, continuity of care

Yrityksen raportointitehtävien keskittäminen palvelukeskukseen, case-tutkimus

Pro Gradu –tutkielman tarkoituksena on ollut selvittää tämän hetken yritysmaailman yhtä keskeisintä aihetta, tehtävien keskittämistä palvelukeskukseen. Yrityksen tekemään päätökseen ovat vaikuttaneet useat eri tekijät, joista kiristyvä kilpailu ja toimintaympäristön muutokset ovat olleet merkittävimmät. Muutosprosessin läpivieminen vie aikaa ja siihen tulisi valmistautua huolella, sillä prosessiin liittyy useita eri vaiheita. Toimintojen organisointi ja muutosjohtaminen muodostavat tutkimuksen teoriapohjan. Tutkimus on laadullinen tutkimus, jonka aineisto on kerätty haastatteluiden ja havainnoinnin avulla. Tutkimus tehtiin eräässä kansainvälisessä yrityksessä, sen yhden liiketoiminta-alueen ja yhden toimintayksikön osalta. Tutkimustuloksista voitiin havaita, että tehtävien keskittäminen palvelukeskukseen koostui useasta vaiheesta. Se koettiin hyväksi ja onnistuneeksi toimintatavaksi. Tehtävien keskittämisprosessiin liittyy hyötyjä ja haasteita, näiden osalta tutkimustuloksissa löytyi yhteneviä tekijöitä aiempien tutkimusten ja kirjallisuusmateriaalin kanssa. Tutkimustulokset osoittivat, että muutosjohtaminen noudatteli tunnettua vaiheistusmallia. Muutosjohtamiseen liittyy merkittävästi ihmisten ja organisaation käyttäytyminen, joka vaikuttaa muutosprosessin onnistuneeseen läpiviemiseen. Ihmiset kokevat muutoksen eri tavoin ja aluksi vastustavat uutta tilannetta.

Legal education in crisis: healing and humanizing Canadian law schools /

Western law schools are suffering from an identity and moral crisis. Many of the legal profession's problems can be traced to the law school environment, where students are taught to reason and practice in ways that are often at odds with their own personalities and values and even with generally accepted psychologically healthy practices. The idealism, ethic of care, and personal moral compasses of many students become eroded and even lost in the present legal education system. Formalism, rationalism, elitism, and big business values have become paramount. In such a moment of historical crisis, there exists the opportunity to create a new legal education story. This paper is a conceptual study of both my own Canadian legal education and the general legal education experience. It examines core problems and critiques of the existing Western legal education organizational and pedagogical paradigm to which Canadian law schools adhere. New approaches with the potential to enrich, humanize, and heal the Canadian law school experience are explored. Ultimately, the paper proposes a legal education system that is more interdisciplinary, theoretically and practically integrated, emotionally intelligent, technologically connected, morally accountable, spiritual, and humane. Specific pedagogical and curricular strategies are suggested, and recommendations for the future are offered. The dehumanizing aspects of the law school experience in Canada have rarely been studied. It is hoped that this thesis will fill a gap in the research and provide some insight into an issue that is of both academic and public importance, since the well-being of law students and lawyers affects the interests of their clients, the general public, and the integrity and future of the entire legal system.

Surface effect ferromagnetism in pure and reduced strontium titanate

A room temperature ferromagnetic hysteresis is observed in single crystal strontium titanate substrates as purchased from several manufacturers. It was found that polishing all sides of the substrates removed this observed hysteresis, suggesting that the origin of the ferromagnetic behavior resides on the surface of the substrates. X-ray diffraction and energy dispersive x-ray spectra were measured however they were unable to detect any impurity phases. In similar semiconducting oxides it was previously suggested that ferromagnetism could originate in oxygen vacancies or from disorder within the single crystal. To this end substrates were annealed in both air and vacuum in a range of temperatures (600°C to 1100°G) to both create bulk oxygen vacancies and to heal surface damage. Annealing in vacuum was found to create a measureable number of oxygen vacancies however their creation could not be correlated to the ferromagnetic signal of the substrate. Annealing in air was found to effect the remnant moment of the substrate as well as the width of the x-ray diffraction peaks on the unpolished face, weakly suggesting a relation between surface based disorder and ferromagnetism. Argon ion bombardment was employed to create a layer of surface disorder in the polished crystal, however it was not found to induce ferromagnetism. It was found that acid etching was sufficient to remove the ferromagnetism from as purchased samples and similarly simulated handling with stainless steel tweezers was sufficient to re-create the ferromagnetism. It is suggested that the origin of this ferromagnetism in SrTi03 is surface contaminants (mainly iron).

LEISURE CONNECTIONS AND HEALING FOLLOWING TRAUMA: CONSTRUCTIVIST AND EXISTENTIAL REFLECTIONS AND THEORIZING

Trauma can have lasting effects on health (CAMH, 2010; DSM-IV, 1994; Lazarus, 1966), negatively influencing meanings and experiences of leisure in relation to health (Griffin, 2002, 2005; Meister & Pedlar, 1996). This interpretive grounded theory explored understandings of leisure during Leisure Connections and how Leisure Connections provides a context for healing from trauma. Data included observations, interviews with six participants, and reflection cards. Nine themes emerged: responding to trauma in leisure, letting go of familiar coping patterns and opening to joy, being in the moment of small steps and simple things, changing understandings of self, reconnecting with the body, shifting to internal motivation, choosing, reconnecting with others in leisure, balancing life with leisure, and growth and connections. Leisure Connections supported participants to explore leisure and its benefits as issues arise, to understand and respond differently. Leisure Connections provides boundary situations critical for existential growth and opportunity to change coping patterns.

L'intérêt d'assurance comme élément constitutif de la déclaration initiale de risque en assurance de dommages

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de maîtrise en droit (LL.M.)"

Le processus suivi par les pairs aidants lors de leur expérience auprès d’adolescents suicidaires

Depuis plusieurs années, on assiste à la création de programmes en prévention du suicide à l’adolescence. L’un de ces programmes repose sur le principe des pairs aidants. Il consiste à former des jeunes dont le rôle est d’apporter du soutien à des camarades qui vivent des difficultés. Or, à notre connaissance, aucune étude n’a comme préoccupation spécifique l’aide apportée par un pair aidant à un élève suicidaire. C’est pourquoi le but de notre étude est de comprendre et d’interpréter le processus suivi par les pairs aidants lors de leur expérience auprès d’un adolescent suicidaire. Nous avons effectué des entrevues auprès de cinq anciens pairs aidants qui avaient joué ce rôle entre une et trois années auparavant. À cause de sa pertinence pour ce type d’étude, l’approche méthodologique choisie a été la théorisation ancrée. La proposition qui a émergé de l’analyse des données est que l’expérience de pairs aidants auprès d’adolescents suicidaires est une mission héroïque à la fois stimulante, « confrontante » et enrichissante. Pour rendre compte de la globalité de cette expérience, vécue comme une mission invitant le pair aidant à prendre un rôle de « héros », trois étapes ont été distinguées. La première étape commence par l’accès au statut de pair aidant. Après être entré en contact avec un camarade suicidaire, le pair aidant s’engage dans la mission de le sauver. Le pair aidant est alors « tout feu tout flamme » dans son rôle de héros sauveur. Au cours de la seconde étape seront considérés les faits entourant la mission. L’aide s’engage comme un combat pour « sauver » l’élève suicidaire. L’enthousiasme « tout feu tout flamme » du début se tempère dans l’ambivalence du combat que représente l’aide concrète. C’est la période d’une certaine désillusion. La dernière étape s’amorce après que soit terminée l’aide qu’a fournie le pair aidant. Il fait le point sur les victoires et les défaites qu’a comportées cette mission. C’est alors le moment de la sagesse. Au cours de l’analyse, certaines données ont suscité la réflexion. Nous avons donc effectué une seconde recension des écrits reliés au processus de venir en aide à un adolescent suicidaire en tant que pair aidant. À la fin de cette étude, nous pensons que le programme de pairs aidants a des répercussions positives pour l’adolescent impliqué.