23 research outputs found

    Phase of Illness in palliative care: Cross-sectional analysis of clinical data from community, hospital and hospice patients

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    © 2017, © The Author(s) 2017. Background: Phase of Illness describes stages of advanced illness according to care needs of the individual, family and suitability of care plan. There is limited evidence on its association with other measures of symptoms, and health-related needs, in palliative care. Aims: The aims of the study are as follows. (1) Describe function, pain, other physical problems, psycho-spiritual problems and family and carer support needs by Phase of Illness. (2) Consider strength of associations between these measures and Phase of Illness. Design and setting: Secondary analysis of patient-level data; a total of 1317 patients in three settings. Function measured using Australia-modified Karnofsky Performance Scale. Pain, other physical problems, psycho-spiritual problems and family and carer support needs measured using items on Palliative Care Problem Severity Scale. Results: Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale items varied significantly by Phase of Illness. Mean function was highest in stable phase (65.9, 95% confidence interval = 63.4–68.3) and lowest in dying phase (16.6, 95% confidence interval = 15.3–17.8). Mean pain was highest in unstable phase (1.43, 95% confidence interval = 1.36–1.51). Multinomial regression: psycho-spiritual problems were not associated with Phase of Illness (χ 2 = 2.940, df = 3, p = 0.401). Family and carer support needs were greater in deteriorating phase than unstable phase (odds ratio (deteriorating vs unstable) = 1.23, 95% confidence interval = 1.01–1.49). Forty-nine percent of the variance in Phase of Illness is explained by Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale. Conclusion: Phase of Illness has value as a clinical measure of overall palliative need, capturing additional information beyond Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale. Lack of significant association between psycho-spiritual problems and Phase of Illness warrants further investigation

    Synchronisation of sedimentary records using tephra : a postglacial tephrochronological model for the Chilean Lake District

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    Well-characterised tephra horizons deposited in various sedimentary environments provide a means of synchronising sedimentary archives. The use of tephra as a chronological tool is however still widely underutilised in southern Chile and Argentina. In this study we develop a postglacial tephrochronological model for the Chilean Lake District (ca. 38 to 42 degrees S) by integrating terrestrial and lacustrine records. Tephra deposits preserved in lake sediments record discrete events even if they do not correspond to primary fallout. By combining terrestrial with lacustrine records we obtain the most complete tephrostratigraphic record for the area to date. We present glass geochemical and chronological data for key marker horizons that may be used to synchronise sedimentary archives used for palaeoenvironmental, palaeoclimatological and palaeoseismological purposes. Most volcanoes in the studied segment of the Southern Volcanic Zone, between Llaima and Calbuco, have produced at least one regional marker deposit resulting from a large explosive eruption (magnitude >= 4), some of which now have a significantly improved age estimate (e.g., the 10.5 ka Llaima Pumice eruption from Llaima volcano). Others, including several units from Puyehue-Cordon Caulle, are newly described here. We also find tephra related to the Cha1 eruption from Chaiten volcano in lake sediments up to 400 km north from source. Several clear marker horizons are now identified that should help refine age model reconstructions for various sedimentary archives. Our chronological model suggests three distinct phases of eruptive activity impacting the area, with an early-to-mid-Holocene period of relative quiescence. Extending our tephrochronological framework further south into Patagonia will allow a more detailed evaluation of the controls on the occurrence and magnitude of explosive eruptions throughout the postglacial

    Compositional variability in mafic arc magmas over short spatial and temporal scales: evidence for the signature of mantle reactive melt channels

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    Understanding arc magma genesis is critical to deciphering the construction of continental crust, understanding the relationship between plutonic and volcanic rocks, and for assessing volcanic hazards. Arc magma genesis is complex. Interpreting the underlying causes of major and trace element diversity in erupted magmas is challenging and often non-unique. To navigate this complexity mafic magma diversity is investigated using sample suites that span short temporal and spatial scales. These constraints allow us to evaluate models of arc magma genesis and their geochemical implications based on physical arguments and recent model results. Young volcanic deposits (≲18 kyr) are analysed from the Southern Volcanic Zone (SVZ), Chile, in particular suites of scoria cones on the flanks of arc stratovolcanoes that have erupted relatively primitive magmas of diverse compositions. Our study is centred on the high-resolution post-glacial tephrochronological record for Mocho-Choshuenco volcano where tight age constraints and a high density of scoria cones provide a spatially well-resolved mafic magma dataset. Two compositional trends emerge from the data. Firstly, magmas from cones on the flanks of the main edifice become more mafic with distance from the central vent. This is attributed to fractional crystallisation processes within the crust, with distal cones sampling less differentiated magmas. Secondly, there is a set of cones with distinct major and trace element compositions that are more primitive but enriched in incompatible elements relative to the central system and other ‘normal SVZ’ magmas. This distinct signature – termed the ‘Kangechi’ signature – is observed at three further clusters of cones within the SVZ. This is attributed to greater preservation of the enriched melt signature arising from reactive melt transport within the mantle wedge. Our model has important implications for arc magma genesis in general, and in particular for the spatial and temporal scales over which compositional variations are preserved in erupted magmas

    Post-glacial eruptive history of Volcán Mocho-Choshuenco, Chile; large dataset of glass, Fe-Ti oxide analyses, Radiocarbon dates and isopach data

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    <p>Dataset from H. Rawson, J. Naranjo, V. Smith, K. Fontijn, D. Pyle, T. A. Mather, H. Moreno. (2015) The frequency and magnitude of post-glacial explosive eruptions at Volcán Mocho-Choshuenco, southern Chile, <em>Journal of Volcanology and Geothermal Research </em></p> <p>doi:10.1016/j.jvolgeores.2015.04.003</p> <p> </p> <p>We have reconstructed a high resolution, post-glacial eruption history of Volcán Mocho-Choshuenco (39°55’S 72°2’W). In the dataset attached:</p> <p>SD1: GPS localities of key outcrops</p> <p>SD2: ~2150 major element glass analyses from 22 tephra units (eruptions); analysed on EMP</p> <p>SD3: ~2700 Fe-Ti oxide analyses from 19 tephra units (eruptions); analysed on EMP</p> <p>SD4: Secondary standard data; analysed on EMP</p> <p>SD5: 48 Radiocarbon samples; uncalibrated 14C ages, calibrated ages (using OxCal4.2 (Bronk Ramsey, 2009) and SHCal13 calibration curve (Hogg et al., 2013)).</p> <p>SD6: Maximum pumice, maximum lithic and thickness measurements for three Plinian and two sub-Plinian eruptions.</p> <p> </p> <p> </p> <p> </p> <p> </p

    Post-glacial eruptive history of Chile

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    <p>Dataset from K Fontijn, SM Lachowycz, H Rawson, DM Pyle, TA Mather, JA Naranjo, H Moreno-Roa, Late Quaternary tephrostratigraphy of southern Chile and Argentina, Quaternary Science Reviews 89, 70 - 84. [Open Access] doi: 10.1016/j.quascirev.2014.02.007</p> <p>Post-glacial eruptive history of SVZ and AVZ volcanoes, as known from the historical and geological record. Calendar age is given in years before 1950 AD (historical eruptions or varve-dated), ka (Ar-Ar or stratigraphically constrained), or ka cal BP for14C ages. Uncalibrated 14C ages are given where available, and were calibrated in OxCal4.2 (Bronk Ramsey, 2009) using the SHCal13 calibration curve (Hogg et al., 2013). The most important eruptions are highlighted in blue; the large (V > 1 km3) eruptions for which dispersal data are available are highlighted in red. These eruptions are thought to have left significant regional marker horizons which should be readily identifiable in sediment sections. Numbered references can be found in Supplementary Information.</p

    Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure

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    BackgroundPrognostic awareness (PA)-the understanding of limited life expectancy-is critical for effective goals of care discussions (GOCD) in which patients discuss their goals and values in the context of their illness. Yet little is known about PA and GOCD in patients with advanced heart failure (HF). This study aims to determine the prevalence of PA among patients with advanced HF and patient characteristics associated with PA and GOCD.MethodsWe assessed the prevalence of self-reported PA and GOCD using data from a multisite communication intervention trial among patients with advanced HF with an implantable cardiac defibrillator at high risk of death.ResultsOf 377 patients (mean age 62 years, 30% female, 42% nonwhite), 78% had PA. Increasing age was a negative predictor of PA (odds ratio, 0.95 [95% CI, 0.92-0.97]; P&lt;0.01). No other patient characteristics were associated with PA. Of those with PA, 26% had a GOCD. Higher comorbidities and prior advance directives were associated with GOCD but were of only borderline statistical significance in a fully adjusted model. Symptom severity (odds ratio, 1.77 [95% CI, 1.19-2.64]; P=0.005) remained a robust and statistically significant positive predictor of having a GOCD in the fully adjusted model.ConclusionsIn a sample of patients with advanced HF, the frequency of PA was high, but fewer patients with PA discussed their end-of-life care preferences with their physician. Improved efforts are needed to ensure all patients with advanced HF have an opportunity to have GOCD with their doctors. Clinicians may need to target older patients with HF and continue to focus on those with signs of worsening illness (higher symptoms). Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01459744

    Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure

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    Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (−1.16, p = 0.252) and skill (−0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF
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