'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective

Background
Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective
We sought to understand patient perspectives on physician behaviours during EOL communication.

Design
In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi-structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data.

Setting and Participants
Seriously ill inpatients at three tertiary care hospitals in Canada.

Results
We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness.

Conclusions
Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.

Healthcare Staff Experience of Providing End-of-Life Care to Children: A Mixed Method Review

Background: Staff who provide end-of-life care to children not only have to deal with their own sense of loss, but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges.
Aim: The aim of this review is to explore the experiences of health care professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families.
Data sources: Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO, and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care.
Design: This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data.
Results: The 16 qualitative, six quantitative, and eight mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff’s personal and professional lives, coping strategies, and key approaches to help support staff in their role.
Conclusions: Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing are key strategies for improving healthcare staffs’ experiences, and as such the quality of care they provide.

Message from the President of the United States, transmitting communications from the plenipotentiaries of the United States charged with negotiating peace with Great Britain : showing the conditions on which alone that government is willing to put an end to the war. --

13th Congress, 3d session. House. Doc. 6.

Chart of estimate #6 of work done from the end of February to April, 1856

Chart of estimate #6 of work done from the end of February to April, 1856. This is signed by Fred Holmes, April, 1856.

Managing Profound Suffering at the End-of-Life: Should expanding access to continuous deep sedation be the priority?

Commentaire / Commentary

Changes in the extent of glaciers in the Eastern Terskey Alatoo, the Central Tien-Shan, in response to climatic fluctuations in between the end of the 19th and the beginning of the 21st century

Changes in the extent of glaciers and rates of glacier termini retreat in the eastern Terskey-Alatoo Range, the Tien Shan Mountains, Central Asia have been evaluated using the remote sensing techniques. Changes in the extent of 335 glaciers between the end of the Little Ice Age (LIA; mid-19th century), 1990 and 2003 have been estimated through the delineation of glacier outlines and the LIA moraine positions on the Landsat TM and ASTER imagery for 1990 and 2003 respectively. By 2003, the glacier surface area had decreased by 19% of the LIA value, which constitutes a 76 km(2) reduction in glacier surface area. Mapping of 109 glaciers using the 1965 1:25,000 maps revealed that glacier surface area decreased by 12.6% of the 1965 value between 1965 and 2003. Detailed mapping of 10 glaciers using historical maps and aerial photographs from the 1943-1977 period, has enabled glacier extent variations over the 20th century to be identified with a higher temporal resolution. Glacial retreat was slow in the early 20th century but increased considerably between 1943 and 1956 and then again after 1977. The post-1990 period has been marked by the most rapid glacier retreat since the end of the LIA. The observed changes in the extent of glaciers are in line with the observed climatic warming. The regional weather stations have revealed a strong climatic warming during the ablation season since the 1950s at a rate of 0.02-0.03 degrees Ca-1. At the higher elevations in the study area represented by the Tien Shan meteorological station, the summer warming was accompanied by negative anomalies in annual precipitation in the 1990s enhancing glacier retreat. However, trends in precipitation in the post-1997 period cannot be evaluated due to the change in observational practices at this station. Neither station in the study area exhibits significant long-term trends in precipitation. Crown Copyright (C) 2009 Published by Elsevier B.V. All rights reserved.

Quantitative comparison between the use of 3D vs 2D visualization tools to present building design proposals to non-spatial skilled end users

Information technology in construction (ITC) has been gaining wide acceptance and is being implemented in the construction research domains as a tool to assist decision makers. Most of the research into visualization technologies (VT) has been on the wide range of 3D and simulation applications suitable for construction processes. Despite its development with interoperability and standardization of products, VT usage has remained very low when it comes to communicating and addressing the needs of building end-users (BEU). This paper argues that building end users are a source of experience and expertise that can be brought into the briefing stage for the evaluation of design proposals. It also suggests that the end user is a source of new ideas promoting innovation. In this research a positivistic methodology that includes the comparison of 3D models and the traditional 2D methods is proposed. It will help to identify "how much", if anything, a non-spatial specialist can gain in terms Of "understanding" of a particular design proposal presented, using both methods.

The use of dead-end and cross-flow nanofiltration to purify prebiotic oligosaccharides from reaction mixtures

Nanofiltration (NF) of model sugar solutions and commercial oligosaccharide mixtures were studied in both dead-end and cross-flow modes. Preliminary trials, with a dead-end filtration cell, demonstrated the feasibility of fractionating monosaccharides from disaccharides and oligosaccharides in mixtures, using loose nanofiltration (NF-CA-50, NF-TFC-50) membranes. During the nanofiltration purification of a commercial oligosaccharide mixture, yields of 19% (w w-1) for the monosaccharides and 88% (w w-1) for di, and oligosaccharides were obtained for the NF-TFC-50 membrane after four filtration steps, indicating that removal of the monosaccharides is possible, with only minor losses of the oligosaccharide content of the mixture. The effects of pressure, feed concentration, and filtration temperature were studied in similar experiments carried out in a cross-flow system, in full recycle mode of operation. The rejection rates of the sugar components increased with increasing pressure, and decreased with both increasing total sugar concentration in the feed and increasing temperature. Continuous diafiltration (CD) purification of model sugar solutions and commercial oligosaccharide mixtures using NF-CA-50 (at 25oC) and DS-5-DL (at 60oC) membranes, gave yield values of 14 to 18% for the monosaccharide, 59 to 89% for the disaccharide and 81 to 98% for the trisaccharide present in the feed. The study clearly demonstrates the potential of cross flow nanofiltration in the purification of oligosaccharide mixtures from the contaminant monosaccharides.

How different are GM food accepters and rejecters really? A means-end chains application to yogurt in Germany

The purpose of the paper is to identify and describe differences in cognitive structures between consumer segments with differing levels of acceptance of genetically modified (GM) food. Among a sample of 60 mothers three segments are distinguished with respect to purchase intentions for GM yogurt: non-buyers, maybe-buyers and likely-buyers. A homogeneity test for the elicited laddering data suggests merging maybe- and likely-buyers, yielding two segments termed accepters and rejecters. Still, overlap between the segments’ cognitive structures is considerable, in particular with respect to a health focus in the evaluation of perceived consequences and ambivalence in technology assessment. Distinct differences are found in the assessment of benefits offered by GM food and the importance of values driving product evaluation and thus purchase decisions.