Redefining the patient-carer model at end of life.

CONTEXT: While the patient-carer dyad has been broadly described, there is little exploration of patient-carer models in use. AIM: To explore types of patient-carer models in use for those with advanced and progressive disease. METHODS: Qualitative interviews were undertaken with patients at risk of dying in the next year and their carers across three sites (residential care home, medical assessment unit, general medical unit). Thematic analysis was undertaken. RESULTS: Four patient-carer models were identified. In these, the provision of care and of coordination of care services were important areas and organised differently across the patient, the carer, and alternative sources of support. CONCLUSION: A 'one size fits all' patient-carer model is outdated and a new understanding of different types of patient-carer models are required to fully inform care delivered at end of life

An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive care

AIM: To conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care. BACKGROUND: End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process. DESIGN: Integrative literature review. DATA SOURCES: MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000 - May 2015. REVIEW METHODS: A five stage review process, informed by Whittemore and Knafl\u27s methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organised and analysed. Convergent qualitative thematic synthesis was used. RESULTS: From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n=15); quantitative (n=4); mixed methods (n=2); case study (n=2); and discourse analysis (n=1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories. CONCLUSION: Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualisation of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family centred end-of-life care is required making the nursing contribution at this time more visible

A national survey exploring views and experience of health professionals about transferring patients from critical care home to die.

BACKGROUND: Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals' (HCP) experience and views. OBJECTIVES: To examine (1) HCPs' experience of transferring patients home to die from critical care, (2) HCPs' views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. DESIGN: A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. SETTING/PARTICIPANTS: Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. RESULTS: In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. CONCLUSION: While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held

A temperature-dependent multilayer model for direct current carrying HTS coated-conductors under perpendicular AC magnetic fields

Abstract When a type II superconductor carrying a direct current is subjected to a perpendicular oscillating magnetic field, a direct current (DC) voltage will appear. This voltage can either result from dynamic resistance effect or from flux flow effect, or both. The temperature variation in the superconductor plays an important role in the nature of the voltage, and there has been little study of this so far. This paper presents and experimentally verifies a 2D temperature-dependent multilayer model of the second generation (2G) high temperature superconducting (HTS) coated conductors (CC), which is based on H-formulation and a general heat transfer equation. The model has coupled the electromagnetic and thermal physics, and it can simulate the behavior of 2G HTS coated conductors in various working conditions where the temperature rise has a significant impact. Representative electromagnetic phenomena such as the dynamic resistance effect and the flux flow effect, and thermal behavior like quench and recovery have been simulated. This thermal-coupled model is a powerful tool to study the thermal-electromagnetic behaviors of 2G HTS coated conductors in different working conditions, especially when the impact of temperature rise is important. This multilayer model is also very useful in analyzing the impact of different layers in the 2G HTS CCs, especially the metal stabilizer layers. It has been proven to be a very powerful tool to help understand more complicated characteristics in the CCs which could not be accurately measured or simulated by previous numerical models. The work is indicative and very useful in designing ac magnetic field controlled persistent current switches and flux pumps, in terms of increasing the off-state resistance, analyzing different sources of losses, minimizing detrimental losses, and enhancing the safety and stability.</jats:p

Flux pumping for non-insulated and metal-insulated HTS coils

High-temperature superconducting (HTS) coils wound from coated conductors without turn-to-turn insulation (non-insulated (NI) coils) have been proven with excellent electrical and thermal performances. However, the slow charging of NI coils has been a long-lasting problem. In this work, we explore using a transformer-rectifier HTS flux pump to charge an NI coil and a metal-insulated coil. The charging performance comparison is made between different coils. Comprehensive study is done to thoroughly understand the electrical-magnetic transience in charging these coils. We will show that the low-voltage high-current flux pump is especially suitable for charging NI coils with very low characteristic resistance