Palliative care for the elderly - developing a curriculum for nursing and medical students

<p>Abstract</p> <p>Background</p> <p>Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels.</p> <p>In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper.</p> <p>Methods</p> <p>In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages.</p> <p>We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found.</p> <p>Results</p> <p>The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum.</p> <p>Conclusions</p> <p>The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.</p

Low Frequency Vibrations Disrupt Left-Right Patterning in the Xenopus Embryo

The development of consistent left-right (LR) asymmetry across phyla is a fascinating question in biology. While many pharmacological and molecular approaches have been used to explore molecular mechanisms, it has proven difficult to exert precise temporal control over functional perturbations. Here, we took advantage of acoustical vibration to disrupt LR patterning in Xenopus embryos during tightly-circumscribed periods of development. Exposure to several low frequencies induced specific randomization of three internal organs (heterotaxia). Investigating one frequency (7 Hz), we found two discrete periods of sensitivity to vibration; during the first period, vibration affected the same LR pathway as nocodazole, while during the second period, vibration affected the integrity of the epithelial barrier; both are required for normal LR patterning. Our results indicate that low frequency vibrations disrupt two steps in the early LR pathway: the orientation of the LR axis with the other two axes, and the amplification/restriction of downstream LR signals to asymmetric organs

Epigenetics of human cutaneous melanoma: setting the stage for new therapeutic strategies

Cutaneous melanoma is a very aggressive neoplasia of melanocytic origin with constantly growing incidence and mortality rates world-wide. Epigenetic modifications (i.e., alterations of genomic DNA methylation patterns, of post-translational modifications of histones, and of microRNA profiles) have been recently identified as playing an important role in melanoma development and progression by affecting key cellular pathways such as cell cycle regulation, cell signalling, differentiation, DNA repair, apoptosis, invasion and immune recognition. In this scenario, pharmacologic inhibition of DNA methyltransferases and/or of histone deacetylases were demonstrated to efficiently restore the expression of aberrantly-silenced genes, thus re-establishing pathway functions. In light of the pleiotropic activities of epigenetic drugs, their use alone or in combination therapies is being strongly suggested, and a particular clinical benefit might be expected from their synergistic activities with chemo-, radio-, and immuno-therapeutic approaches in melanoma patients. On this path, an important improvement would possibly derive from the development of new generation epigenetic drugs characterized by much reduced systemic toxicities, higher bioavailability, and more specific epigenetic effects

Quasi-periodic acceleration of electrons by a plasmoid-driven shock in the solar atmosphere

Cosmic rays and solar energetic particles may be accelerated to relativistic energies by shock waves in astrophysical plasmas. On the Sun, shocks and particle acceleration are often associated with the eruption of magnetized plasmoids, called coronal mass ejections (CMEs). However, the physical relationship between CMEs and shock particle acceleration is not well understood. Here, we use extreme ultraviolet, radio and white-light imaging of a solar eruptive event on 22 September 2011 to show that a CME-induced shock (Alfvén Mach number 2:4+0:7 -0:8) was coincident with a coronal wave and an intense metric radio burst generated by intermittent acceleration of electrons to kinetic energies of 2{46 keV (0.1{0.4 c). Our observations show that plasmoid-driven quasi-perpendicular shocks are capable of producing quasi-periodic acceleration of electrons, an effect consistent with a turbulent or rippled plasma shock surface

On the Survival of Butterflies in the Jungle of Urban Systems

As suggested by the title, this contribution is inspired by Gilles Duranton’s and Andrés Rodriguez-Pose’s paper of 2005 entitled “When economists and geographers collide, or the tale of the lions and the butterflies”. Comparing economical (the lions’) and geographical (the butterflies’) scientific approaches, they pointed out their radically different ways of proceeding and the lack of cross-fertilization between these two disciplines. Looking at the geography of cities, our aim is to continue the discussion through pointing out some differences in points of view. First we discuss what seems to be a “necessity” for lions, that of rooting the approach in methodological individualism for understanding the dynamics of a system of cities. Indeed, this seems to be the mainstream position in economy when butterflies explore different ways of flying from one scale to another. We build on philosophers’ tools in order to explore more deeply the meaning of methodological individualism and the relevance of different kinds of “objects” when modelling cities’ dynamics. We then focus on the question of delineation of spatial objects like cities, building on an empirical approach to discuss how proper scale choice associated to a multiscale approach favors comparison. At last, we expose the feedback of an interdisciplinary experience where the city delineation played a crucial role when developing a LUTI model.As a conclusion,we are convinced that more opening and interactions between butterflies, lions (and tigers!), will help the scientific ecosystem to be more resilient