29 research outputs found
Perspectives on advance directives in Japanese society: A population-based questionnaire survey
BACKGROUND: In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. METHOD: A self-administered questionnaire was sent via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. RESULTS: Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. CONCLUSIONS: Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure
Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the incredible years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations
Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions
Detection of Milk Ejection Using Bioimpedance Spectroscopy in Lactating Women during Milk Expression Using an Electric Breast Pump
Simultaneous Breast Expression in Breastfeeding Women Is More Efficacious Than Sequential Breast Expression
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Complementary Measurements of Residual Stresses Before and After Base Plate Removal in an Intricate Additively-Manufactured Stainless-Steel Valve Housing
Residual stress measurements using neutron diffraction and the contour method were performed on a valve housing made from 316 L stainless steel powder with intricate three-dimensional internal features using laser powder-bed fusion additive manufacturing. The measurements captured the evolution of the residual stress fields from a state where the valve housing was attached to the base plate to a state where the housing was cut free from the base plate. Making use of this cut, thus making it a non-destructive measurement in this application, the contour method mapped the residual stress component normal to the cut plane (this stress field is completely relieved by cutting) over the whole cut plane, as well as the change in all stresses in the entire housing due to the cut. The non-destructive nature of the neutron diffraction measurements enabled measurements of residual stress at various points in the build prior to cutting and again after cutting. Good agreement was observed between the two measurement techniques, which showed large, tensile build-direction residual stresses in the outer regions of the housing. The contour results showed large changes in multiple stress components upon removal of the build from the base plate in two distinct regions: near the plane where the build was cut free from the base plate and near the internal features that act as stress concentrators. These observations should be useful in understanding the driving mechanisms for builds cracking near the base plate and to identify regions of concern for structural integrity. Neutron diffraction measurements were also used to show the shear stresses near the base plate were significantly lower than normal stresses, an important assumption for the contour method because of the asymmetric cut
Comparison of maternal milk ejection characteristics during pumping using infant-derived and 2-phase vacuum patterns
Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice
This review integrates pharmaceutical science with routine clinical practice to explain why inhalation manoeuvres through a dry powder inhaler (DPI) should start with a gentle exhalation, away from the inhaler. Place the inhaler in the mouth and ensure the lips form a tight seal. This should be followed by an immediate forceful inhalation that is as fast as possible and continued for as long as the patient can comfortably achieve. Although this is universally accepted, there has been a lot of attention on inhalation flow as an indicator of adequate inspiratory effort. This has led to the wrong assumption that inhalation flows through each DPI should be the same, and that low flows through some DPIs suggest that dose delivery is impaired. Most miss the concept that inhalation flow together with the resistance of the DPI combine to create a turbulent energy which de-aggregates the formulation and provides an effective emitted dose. A low flow through a DPI with high resistance generates the same turbulent energy as fast flow with low resistance. Therefore, depending on the device, different inhalation flows are compatible with potentially effective use. Flow measurements should be a guide to train patients to inhale faster. The focus of inhaler technique training should be the use of the above generic inhalation manoeuvre