Death anxiety in patients with metastatic non-small cell lung cancer with and without brain metastases

Context: Death anxiety is common in patients with metastatic cancer, but its relationship to brain metastases and cognitive decline is unknown. Early identification of death anxiety and its determinants allows proactive interventions to be offered to those in need. Objectives: To identify psychological, physical, and disease-related (including brain metastases and cognitive impairment) factors associated with death anxiety in metastatic non-small cell lung cancer (mNSCLC) patients. Methods: A cross-sectional pilot study with mNSCLC outpatients completing standardized neuropsychological tests and validated questionnaires measuring death anxiety, cognitive concerns, illness intrusiveness, depression, demoralization, self-esteem, and common cancer symptoms. We constructed a composite for objective cognitive function (mean neuropsychological tests z-scores). Results: Study measures were completed by 78 patients (50% females; median age 62 years [range 37–82]). Median time since mNSCLC diagnosis was 11 months (range 0–89); 53% had brain metastases. At least moderate death anxiety was reported by 43% (n = 33). Objective cognitive impairment was present in 41% (n = 32) and perceived cognitive impairment in 27% (n = 21). Death anxiety, objective, and perceived cognitive impairment did not significantly differ between patients with and without brain metastases. In univariate analysis, death anxiety was associated with demoralization, depression, self-esteem, illness intrusiveness, common physical cancer symptoms, and perceived cognitive impairment. In multivariate analysis, demoralization (P < 0.001) and illness intrusiveness (P = 0.001) were associated with death anxiety. Conclusion: Death anxiety and brain metastases are common in patients with mNSCLC but not necessarily linked. The association of death anxiety with both demoralization and illness intrusiveness highlights the importance of integrated psychological and symptom management. Further research is needed on the psychological impact of brain metastases

The attitudes of brain cancer patients and their caregivers towards death and dying: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Much money and energy has been spent on the study of the molecular biology of malignant brain tumours. However, little attention has been paid to the wishes of patients afflicted with these incurable tumours, and how this might influence treatment considerations.</p> <p>Methods</p> <p>We interviewed 29 individuals – 7 patients dying of a malignant brain tumor and 22 loved ones. One-on-one interviews were conducted according to a pre-designed interview guide. A combination of open-ended questions, as well as clinical scenarios was presented to participants in order to understand what is meaningful and valuable to them when determining treatment options and management approaches. The results were analyzed, coded, and interpreted using qualitative analytic techniques in order to arrive at several common overarching themes.</p> <p>Results</p> <p>Seven major themes were identified. In general, respondents were united in viewing brain cancer as unique amongst malignancies, due in large part to the premium placed on mental competence and cognitive functioning. Importantly, participants found their experiences, however difficult, led to the discovery of inner strength and resilience. Responses were usually framed within an interpersonal context, and participants were generally grateful for the opportunity to speak about their experiences. Attitudes towards religion, spirituality, and euthanasia were also probed.</p> <p>Conclusion</p> <p>Several important themes underlie the experiences of brain cancer patients and their caregivers. It is important to consider these when managing these patients and to respect not only their autonomy but also the complex interpersonal toll that a malignant diagnosis can have.</p

Elevstyrets påverkan på gymnasieelevers lärandemiljö - en fallstudie på Ale gymnasium.

Under åren 1997-006 genomförde ett 40-tal gymnasieskolor, däribland Ale gymnasium, en försöksverksamhet med elevmajoritet i skolornas lokala styrelse. Den nuvarande regeringen valde att inte förlänga tiden för försöksverksamheten. Genom en fallstudie ämnar denna studie att utifrån ett sociokulturellt perspektiv undersöka hur elevstyret på Ale gymnasium påverkade lärandemiljön för elever. Data kommer att samlas in i form av intervjuer från elever, rektor och lärare som fanns på Ale gymnasium under perioden med elevstyre. Under elevstyrets påverkan fick de redan aktivt engagerade eleverna en mer gynnsam lärandemiljö, men övriga elever påverkades ej nämnvärt. Studien ger en insikt i hur elevstyret påverkar elevernas lärandemiljö, vilket har en stor betydelse för lärare inom gymnasieskolan

MDD vs. traditional software development: a practitioner’s subjective perspective

Context: Today’s project managers have a myriad of methods to choose from for the development of software applications. However, they lack empirical data about the character of these methods in terms of usefulness, ease of use or compatibility, all of these being relevant variables to assess the developer’s intention to use them. Objective: To compare three methods, each following a different paradigm (Model-Driven, Model-Based and Code-Centric) with respect to their adoption potential by junior software developers engaged in the development of the business layer of a Web 2.0 application. Method: We have conducted a quasi-experiment with 26 graduate students of the University of Alicante. The application developed was a Social Network, which was organized around a fixed set of modules. Three of them, similar in complexity, were used for the experiment. Subjects were asked to use a different method for each module, and then to answer a questionnaire that gathered their perceptions during such use. Results: The results show that the Model-Driven method is regarded as the most useful, although it is also considered the least compatible with previous developers’ experiences. They also show that junior software developers feel comfortable with the use of models, and that they are likely to use them if the models are accompanied by a Model-Driven development environment. Conclusions: Despite their relatively low level of compatibility, Model-Driven development methods seem to show a great potential for adoption. That said, however, further experimentation is needed to make it possible to generalize the results to a different population, different methods, other languages and tools, different domains or different application sizes.This paper has been co-supported by the Spanish Ministry of Education, and the University of Alicante under contracts TIN2010-15789 (SONRIA) and GRE10-23 (DISEMRIA)