End-of-life care in the intensive care unit : a systematic review of qualitative studies investigating the experiences and perceptions of the patient's family

Review question/objective The review objective is to synthesise the best available evidence on experiences and perceptions of family members of intensive care unit patients on the adequacy of end-of-life care, where life-support modalities have been withheld or withdrawn. Inclusion criteria Types of participants This review will consider studies that report on the experiences and perceptions of patients’ families on EOLC in the ICU, where life-support modalities have been withheld or withdrawn. The family is defined as “those who are closest to the patient... the family may include the biological family, family by acquisition, and the family of choice and friends”. Phenomena of interest The phenomena of interest for this review are the patients’ families experiences, perceptions or views on the adequacy of EOLC delivered in the ICU, where life-support modalities were withheld or withdrawn. These experiences may refer to the following views on domains of care considered important at the end-of-life in the ICU, which have been described already in the existing literature: timely, consistent, and compassionate communication, clinician availability, clinical decision making based on patients’ preferences, goals and values, physical care implemented to maintain patient comfort, holistic interdisciplinary care and bereavement care for families of patients who died.

The uber-assumption family

We offer an exposition of Boneh, Boyen, and Goh’s “uber-assumption” family for analyzing the validity and strength of pairing assumptions in the generic-group model, and augment the original BBG framework with a few simple but useful extensions.

The impact of funding deadlines on personal workloads, stress and family relationships : a qualitative study of Australian researchers

Objective To examine the impact of applying for funding on personal workloads, stress and family relationships. Design Qualitative study of researchers preparing grant proposals. Setting Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. Participants Australian researchers (n=215). Results Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. Conclusions The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.

Internet teaching foundation for the Remote Sensing Core Curriculum program

The Remote Sensing Core Curriculum (RSCC) was initiated in 1993 to meet the demands for a college-level set of resources to enhance the quality of education across national and international campuses. The American Society of Photogrammetry and Remote Sensing adopted the RSCC in 1996 to sustain support of this educational initiative for its membership and collegiate community. A series of volumes, containing lectures, exercises, and data, is being created by expert contributors to address the different technical fields of remote sensing. The RSCC program is designed to operate on the Internet taking full advantage of the World Wide Web (WWW) technology for distance learning. The issues of curriculum development related to the educational setting, with demands on faculty, students, and facilities, is considered to understand the new paradigms for WWW-influenced computer-aided learning. The WWW is shown to be especially appropriate for facilitating remote sensing education with requirements for addressing image data sets and multimedia learning tools. The RSCC is located at http://www.umbc.edu/rscc. The Remote Sensing Core Curriculum (RSCC) was initiated in 1993 to meet the demands for a college-level set of resources to enhance the quality of education across national and international campuses. The American Society of Photogrammetry and Remote Sensing adopted the RSCC in 1996 to sustain support of this educational initiative for its membership and collegiate community. A series of volumes, containing lectures, exercises, and data, is being created by expert contributors to address the different technical fields of remote sensing. The RSCC program is designed to operate on the Internet taking full advantage of the World Wide Web (WWW) technology for distance learning. The issues of curriculum development related to the educational setting, with demands on faculty, students, and facilities, is considered to understand the new paradigms for WWW-influenced computer-aided learning. The WWW is shown to be especially appropriate for facilitating remote sensing education with requirements for addressing image data sets and multimedia learning tools. The RSCC is located at http://www.umbc.edu/rscc.

Partial mediation role of self-efficacy between positive social interaction and mental health in family caregivers for dementia patients in Shanghai

We explored the mediation effect of caregiver self-efficacy on the influences of behavioral and psychological symptoms (BPSD) of dementia care recipients (CRs) or family caregivers’ (CGs) social supports (informational, tangible and affectionate support and positive social interaction) on CGs’ mental health. We interviewed 196 CGs, using a battery of measures including demographic data of the dyads, CRs’ dementia-related impairments, and CGs’ social support, self-efficacy and the Medical Outcome Study (MOS) Short-Form (SF-36) Health Survey. Multiple regression analyses showed that gathering information on self-efficacy and managing CG distress self-efficacy were the partial mediators of the relationship between positive social interaction and CG mental health. Managing caregiving distress self-efficacy also partial mediated the impact of BPSD on CG mental health. We discuss implications of the results for improving mental health of the target population in mainland China.

Cryptanalysis of the LAKE hash family

We analyse the security of the cryptographic hash function LAKE-256 proposed at FSE 2008 by Aumasson, Meier and Phan. By exploiting non-injectivity of some of the building primitives of LAKE, we show three different collision and near-collision attacks on the compression function. The first attack uses differences in the chaining values and the block counter and finds collisions with complexity 233. The second attack utilizes differences in the chaining values and salt and yields collisions with complexity 242. The final attack uses differences only in the chaining values to yield near-collisions with complexity 299. All our attacks are independent of the number of rounds in the compression function. We illustrate the first two attacks by showing examples of collisions and near-collisions.

Symbiotic relationships : saviour siblings, family rights and biomedicine

It is now possible to combine the use of preimplantation genetic diagnosis (PGD) and tissue matching to select an IVF embryo that will, after birth, be a compatible tissue donor for an existing individual. This article analyses the ethical issues and the regulatory frameworks that intersect around the creation of tissue compatible children.

Mindfulness-meditation on the move : implementation of an ACT-based mindfulness practice intervention and training within a University Dance program

As part of the introduction of a broader dance medicine and science related health and wellbeing program, a 9 week mindfulness-meditation ACT-based program was delivered to all students undertaking full-time University dance training (N = 106). The aim of the program was to assist students in the further development of performance psychology skills that could be applied in both performance and non-performance settings. Participant groups were comprised of both male (N = 12) and female (N = 94) students from across all three year levels of two undergraduate dance courses, divided into three groups by mixed year levels due to timetable scheduling requirements. Pre- and post-testing was undertaken utilising the Mindful Attention Awareness Scale (MAAS-15), a uni-dimensional measure of mindfulness, in addition to qualitative questions checking the current level of awareness and understanding of mindfulness practice and its application. Weekly sessions were conducted by qualified sport and exercise psychologists and covered key practices such as: Mindfulness of Body, Mindfulness of Breathing, Mindfulness of Sounds, ACT-based and general Imagery exercises, Developing Open Awareness, Mindfulness of Emotions, and Developing Inner Stillness. Students were required to maintain a reflective journal that was utilised at the end of each weekly session, in addition to completion of a mid-Semester reflective debrief. Teaching staff additionally attended the weekly sessions and linked the mindfulness practice learnings into the student’s practical dance and academic classes where appropriate. Anecdotal feedback indicates that participation in the mindfulness-meditation sessions and the development of these mental skills has resulted in positive performance and personal outcomes. Observations collated from staff and students, results from the data collection phases and recommendations regarding future applications within dance training settings will be discussed within the presentation.

How do you ‘teach’ sustainability to engineers? introducing the engineering sustainable solutions program

Environmental engineers are increasingly being required to have knowledge about sustainability in their professional careers. Accreditation mechanisms for including sustainability in degree program requirements exist and are gradually being implemented by Engineers Australia. However, true integration of sustainability material into higher and vocational education curricula is still low, particularly outside the environmental engineering degree programs. In addition to environmental engineering, it is crucial for engineering across the specialisations, to be exposed to sustainability concepts and theories. This paper will demonstrate how sustainability as a ‘critical literacy’ can be designed for teaching within mainstream engineering education, using a current Australian project as a case study. The project demonstrates that sustainability education for all engineers is not only possible, but that there is international interest in collaborating in such an educational initiative. A pilot trial of the Introductory Module was undertaken in Semester 1 2004 and Version 2 trials are now proceeding with a number of universities and organisations nationally and internationally. Further modules are currently being developed in collaboration with Engineers Australia and UNESCO. The program is a finalist in the 2005 Banksia Awards (Category 11, Environmental Leadership Education and Training).

Genetic secrets and the family

The issue of how individual patients and their doctors should act in relation to the knowledge that the patient has a genetic condition— specifically, whether the patient and/or the doctor should or must inform relevant members of the patient’s family—is a looming area of medicolegal controversy. Over the last fifteen years or so, the issue of confidentiality versus disclosure has been particularly controversial in relation to HIV/AIDS patients.1 It has been argued that medical information about genetic disease gives rise to special problems vis-à-vis blood relatives. Because genetic disease is transmitted only by way of procreation, information about genetic disease is unique in that there is a propensity (which is highly variable and depends upon a variety of factors) for the condition to be shared by members of a family who are biologically related. Thus, genetic information about an individual may reveal information about relatives of that individual which is ‘specific (that the person has or will develop a genetic disease); or predictive (that the person has an unspecified risk of developing the disease)’

Physical activity levels among children attending family day care

Objective To objectively measure the physical activity (PA) levels of children attending family day care programs. Methods A total of 114 children from 47 family day care centers wore an accelerometer for the duration of their time in care. Time in moderate-to-vigorous PA (MVPA) and total PA was calculated using previously validated cut points. Results Children accumulated 5.8 ± 3.2 minutes of MVPA and 10.4 ± 4.4 minutes of total PA per hour of attendance. Boys exhibited significantly higher levels of PA than girls. Among healthy weight children, 4- and 5-year-olds exhibited significantly higher levels of PA than 2- and 3-year-olds. Overweight and obese 4- and 5-year-olds exhibited significantly lower levels of PA than their healthy weight counterparts. Conclusions and Implications Children attending family day care participate in low levels of PA during the child care day. The results highlight the need for effective programs to promote PA in family day care.

Validity of family child care providers' proxy reports on children's physical activity

Background Interventions to promote physical activity (PA) in children attending family child care homes (FCCHs) require valid, yet practical, measurement tools. The aim of this study was to assess the validity of two proxy report instruments designed to measure PA in children attending FCCHs. Methods A sample of 37 FCCH providers completed the Burdette parent proxy report, modified for the family child care setting for 107 children 3.4±1.2 years of age. A second sample of 42 FCCH providers completed the Harro parent and teacher proxy report, modified for the family child care setting, for 131 children 3.8±1.3 years of age. Both proxy reports were assessed for validity using accelerometry as a criterion measure. Results Significant positive correlations were observed between provider-reported PA scores from the modified Burdette proxy report and objectively measured total PA (r=0.30; p<0.01) and moderate-to-vigorous PA (MVPA; r=0.34; p<0.01). Across levels of provider-reported PA, both total PA and MVPA increased significantly in a linear dose-response fashion. The modified Harro proxy report was not associated with objectively measured PA. Conclusion Proxy PA reports completed by family child care providers may be a valid assessment option in studies where more burdensome objective measures are not feasible.

An outcome evaluation of the ‘Skipper’ designated driver program

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drink drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs appear to be quite widespread around the world, however a limited number have been subject to rigorous evaluation. This paper reports results from an outcome evaluation of a designated driver program called ‘Skipper’, which was trialled in a provincial city in Queensland, Australia. The outcome evaluation included surveys three weeks prior to (baseline), four months following (1st follow-up), and 16 months following (2nd follow-up) the commencement of the trial in both the ‘intervention area’ (baseline, n = 202; 1st follow-up, n = 211; 2nd follow-up, n = 200) and a ‘comparison area’(baseline, n = 203; 1st follow-up, n = 199; 2nd follow-up, n = 201); and a comparison of random breath testing and crash data before and after the trial. The survey results indicate that awareness of the program in the intervention area was quite high four months following its introduction and that this was maintained at 16 months. The results also suggest that the ‘Skipper’ program and the related publicity had positive impacts on behaviour with an increase in the proportion of people participating in designated driver as a passenger. It is less clear, however, whether the ‘Skipper’ program impacted on other behaviours of interest, such as drink driving or involvement in alcohol-related crashes. Suggestions for further research and program improvement are discussed as well as limitations of the research.