Development of improved structural adhesives Annual summary report, 1 Jul. 1967 - 3 Dec. 1968

Improved structural adhesives for bonding aluminum over low temperature

False dichotomy versus genuine choice the argument over physician-assisted dying

Journal ArticleDespite a growing consensus that palliative care should be a core part of the treatment offered to all severely ill patients who potentially face death,1 challenging questions remain. How broad a choice should patients have in guiding the course of their own dying? What limitations should be placed on the physician's obligation to address patients' suffering? Physician-assisted death (also called physician-assisted suicide or physician aid in dying) has long been the focal point of ethical and political debate-a divisive, hot button issue in a domain in which there is otherwise considerable agreement

Excellent palliative care as the standard, physician-assisted dying as a last resort

Journal ArticleTo understand the role of physician-assisted death as a last-resort option restricted to dying patients for whom palliative care or hospice has become ineffective or unacceptable, one must understand how frequently and under what circumstances that occurs. If all such cases are the result of inadequately delivered palliative care, then the best answer would be to improve the standard of care and make the problem disappear. Most experts in pain management believe that 95 to 98 percent of pain among those who are terminally ill can be adequately relieved using modern pain management,1 which is a remarkable track record?unless you are unfortunate enough to be in the 2 to 5 percent for whom it is unsuccessful. However, among hospice patients who were asked about their pain level one week before their death, 5 to 35 percent rated their pain as "severe" or "unbearable."2 An additional 25 percent reported their shortness of breath to be "unbearable" one week before death.3 This says nothing of the physical symptoms that are harder to relieve, such as nausea, vomiting, confusion, and open wounds, including pressure sores, which many patients experience.

Thermally Resistant Polymers for Use as Fuel Tanks Sealants Annual Summary Report, 1 Jul. 1968 - 30 Jun. 1969

Siloxane and perfluoroalkylenic polymers for elastomeric fuel tank sealant material

Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses

Consensus guidelines on analgesia and sedation in dying intensive care unit patients

BACKGROUND: Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. METHODS: Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). RESULTS: After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. CONCLUSION: Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia

Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

Background: decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.Methods: the Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.Results: conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.Conclusion: the model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacte