21 research outputs found

    Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians.

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    Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions. Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents. We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis. We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender. The decisions about medical indication were based on considerations relating to the individual patient, to the family, and to other patients. Individual patient factors included clinical aspects and benefit-burden considerations. Physicians' individual views and feelings influenced their decision-making. Different factors were applied or weighed differently in the two cases. In case of conflict with parents, physicians preferred solutions aimed at establishing consensus. The pediatricians defined medical indication on a case-by-case basis and were influenced by emotional reasoning. In contrast to prevailing ethico-legal principles, they included the interests of other persons in their decisions. Decision-making strategies should incorporate explicit discussions of social aspects and physicians' feelings to improve the transparency of the decision-making process and reduce bias

    A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

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    <p>Abstract</p> <p>Background</p> <p>Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described.</p> <p>Methods/Design</p> <p>In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs], altogether 421 residents) with 2 control regions (10 n/hs, altogether 985 residents). Inclusion went from 01.02.09 to 30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12) months after the first (last) possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The regional multifaceted intervention on the basis of the US program Respecting Choices<sup>® </sup>comprises training of n/h staff as facilitators, training of General Practitioners, education of hospital and ambulance staff, and development of eligible tools, including Physician Orders for Life-Sustaining Treatment in case of Emergency (POLST-E).</p> <p><it>Participation data: </it>Of 1406 residents reported to live in the 14 n/hs plus an estimated turnover of 176 residents until the last possible inclusion date, 645 (41%) were willing to participate. Response rates were 38% in the intervention region and 42% in the control region. Non-responder analysis shows an equal distribution of sex and age but a bias towards dependency on nursing care in the responder group. <it>Outcome analysis </it>of this study will become available in the course of 2011.</p> <p>Discussion</p> <p>Implementing an ACP program for the n/hs and related health care providers of a region requires a complex community intervention with the effect of nothing less than a cultural shift in this health care sector. This study is to our knowledge the first to develop a strategy for regional implementation of ACP, and to evaluate its feasibility in a controlled design.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN99887420">ISRCTN99887420</a></p

    The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

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    Objective To investigate the impact of advance care planning on end of life care in elderly patients

    BotSitter

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    As society progresses into an era where both parents work, whether it is online or in person, children in the home may be put in dangerous situations if they are not given the attention they need. The BotSitter is an automated system that follows the child around and makes an audio alarm to alert both the child and the nearby guardian. Using RSSI trilateration, predetermined danger areas, and embedded controls, the BotSitter will be able to follow the child. The device can manage to keep track of the child for the guardian while being almost completely automated outside of setup

    Eastern Washington University Commencement Program, 2009

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    Program for Eastern Washington University\u27s spring commencement in 2009https://dc.ewu.edu/commencement_prog/1030/thumbnail.jp

    Analysis of Persian Wikipedia Articles in the Field of Library and Information Science

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    Objective: Wikipedia is a social multilingual encyclopedia that integrates all information about a particular topic on its platform. The present study aims to analyze the thematic content of Persian articles contributed in the field of library and information science (LIS) in Wikipedia and to identify the thematic gaps in this field. Materials and Methods: The data were collected using two different methods: document analysis and observation. In the first and second phases of the study, 591 Persian articles written in the categories of Library and Information Science and other related sub-categories were identified and analyzed. Then, their thematic content and gaps were investigated using a checklist developed based on the JITA Classification System of LIS. The collected data were analyzed using Microsoft Excel. Findings: The results revealed the following thematic content distribution of Persian articles written in the field of Library and Information Science in Wikipedia based on the JITA Classification System: “I. Information treatment for information services” class with 134 articles (22.69% out of 591 articles), “H. Information sources, supports, channels” class with 126 articles (21.32%), “L. Information technology and library technology” class with 84 articles (14.24%), “E. Publishing and legal issues” class with 58 articles (9.82%), “B. Information use and sociology of information” class with 57 articles (9.65%), “G. Industry, profession and education” class with 51 articles (8.64%), “D. Libraries as physical collections” class with 40 articles (6.78%), “A. Theoretical and general aspects of libraries and information” class with 16 articles (2.72%), “J. Technical services in libraries, archives, museum” class with 10 articles (1.7%), “F. Management” class with 9 articles (1.52%), “C. Users, literacy and reading” class with 4 articles (0.68%), and “K. Housing technologies” class with 2 articles (0.34%). Conclusion: Due to the thematic dispersion of Persian Wikipedia articles, Iranian LIS professionals should improve the quantity and quality of Persian articles on Wikipedia, especially on topics with thematic gaps. While reviewing the articles, it was observed that some articles were weak in terms of content and scope. It is suggested that librarians, information specialists, and information professionals help Wikipedia to strengthen and improve its articles, which in turn benefits the millions of users around the world

    Suffolk Journal, vol. 74, no. 8, 10/30/2013

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    https://dc.suffolk.edu/journal/1570/thumbnail.jp

    Advance care planning for cancer patients: A systematic review of perceptions and experiences of patients, families and healthcare providers

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    Background Patients with advanced cancer may benefit from end of life (EOL) planning, but there is evidence that their willingness and desire to engage in advance care planning (ACP) varies. The reasons for this remain poorly understood. Previous reviews on ACP most commonly report outcome measures related to medical interventions and type of care. Synthesis of the literature, which aims to illuminate the salient characteristics of ACP and investigates the psychological and social features of preparation for the EOL, is required. Methods We searched Medline, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials for studies on perceptions or experiences regarding ACP of adults with cancer, family, friends, or professionals caring for this group. Databases were searched from earliest records to 19 November 2014. A thematic analysis of the literature generated conceptual themes. Results Of the 2483 studies identified, 40 were eligible for inclusion. Studies addressed the relational nature of ACP, fear surrounding ACP, the conceptual complexity of autonomy, and the influence of institutional culture and previous healthcare experiences on ACP. Conclusions The complex social and emotional environments within which EOL planning is initiated and actioned are not sufficiently embedded within standardized ACP. The notion that ACP is concerned principally with the ‘right’ to self-determination through control over treatment choices at the EOL may misrepresent the way that ACP actually occurs in cancer care and ultimately conflict with the deeper concerns and needs of patients, who experience ACP as relational, emotional, and social

    Eastern Washington University Commencement Program, 2008

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    Program for Eastern Washington University\u27s spring commencement in 2008https://dc.ewu.edu/commencement_prog/1029/thumbnail.jp

    Eastern Washington University Commencement Program, 2003

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    Program for Eastern Washington University\u27s spring commencement in 2003https://dc.ewu.edu/commencement_prog/1024/thumbnail.jp
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