Neurologists' lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis

BACKGROUND Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals' experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors' experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists' lived experience of delivering an MNDC diagnosis. METHODS Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews. RESULTS Two themes were constructed from the data: 'Meeting patients' emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors', and 'Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news'. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process. CONCLUSIONS Based on the study's findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed

Neurologists' current practice and perspectives on communicating the diagnosis of a motor neurodegenerative condition: a UK survey

Background The communication of a life-changing diagnosis can be a difficult task for doctors with potential long-term effects on patient outcomes. Although several studies have addressed the experiences of individuals with motor neurodegenerative diseases in receiving this diagnosis, a significant research gap exists regarding professionals’ perspectives, especially in the UK. This study aimed to assess UK neurologists’ current practice and perspectives on delivering the diagnosis of a motor neurodegenerative disease, explore different aspects of the process and detail the potential challenges professionals might face. Methods We conducted an anonymised online survey with 44 questions, grouped into four sections; basic demographic information, current practice, the experience of breaking bad news and education and training needs. Results Forty-nine professionals completed the survey. Overall, participants seemed to meet the setting-related standards of good practice; however, they also acknowledged the difficulty of this aspect of their clinical work, with about half of participants (46.5%) reporting moderate levels of stress while breaking bad news. Patients’ relatives were not always included in diagnostic consultations and participants were more reluctant to promote a sense of optimism to patients with poorer prognosis. Although professionals reported spending a mean of around 30–40 min for the communication of these diagnoses, a significant proportion of participants (21–39%) reported significantly shorter consultation times, highlighting organisational issues related to lack of capacity. Finally, the majority of participants (75.5%) reported not following any specific guidelines or protocols but indicated their interest in receiving further training in breaking bad news (78.5%). Conclusions This was the first UK survey to address neurologists’ practice and experiences in communicating these diagnoses. Although meeting basic standards of good practice was reported by most professionals, we identified several areas of improvement. These included spending enough time to deliver the diagnosis appropriately, including patients’ relatives as a standard, promoting a sense of hope and responding to professionals’ training needs regarding breaking bad news

Healthcare professionals’ involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study

Purpose Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals’ involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. Materials and methods 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson’s disease or Huntington’s disease took part in individual, semi-structured interviews which were analysed using thematic analysis. Results Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. Conclusions BBN was a critical and challenging aspect of healthcare professionals’ clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future

Life history of Colpomenia sinuosa (Scytosiphonaceae, Phaeophyceae) in the Azores.

Copyright © 2003 Phycological Society of America.Colpomenia sinuosa (Mertens ex Roth) Derbès and Solier (Scytosiphonaceae, Phaeophyceae) is a common species on the rocky intertidal shores of the Azores, where reproductive gametophytes occur throughout the year. Life-history studies of this species were carried out in culture, and both sexual and asexual reproduction were observed. Anisogamous gametes fused to form zygotes. The zygotes gave rise to a filamentous prostrate sporophyte generation bearing unilocular sporangia, under both short-day and long-day conditions at 15 and 22° C, and to both unilocular and plurilocular sporangia, under the lower temperature condition. Unispores developed into gametophytes, and plurispores gave rise to filamentous sporophytes. Asexual reproduction was carried out by unfused female gametes and asexual plurispores produced from the same gametophyte. Unfused gametes developed into filamentous prostrate sporophytes producing unilocular sporangia in both culture conditions, and unispores released from the sporangia gave rise to gametophytes. Asexual plurispores from field gametophytes, under both culture conditions, developed directly into new gametophytes. The species exhibited three types of life history: a heteromorphic, diplohaplontic; a heteromorphic, monophasic (both with alternation between the erect and filamentous prostrate thalli); and a monomorphic, monophasic

Multi-train trajectory optimisation to maximise rail network energy efficiency under travel-time constraints

Optimising the trajectories of multiple interacting trains to maximise energy efficiency is a difficult, but highly desirable, problem to solve. A bespoke genetic algorithm has been developed for the multi-train trajectory optimisation problem and used to seek a near-optimal set of control point distances for multiple trains, such that a weighted sum of the time and energy objectives is minimised. Genetic operators tailored to the problem are developed including a new mutation operation and the insertion and deletion pairs of control points during the reproduction process. Compared with published results, the new GA was shown to increase the quality of solutions found by an average of 27.6% and increase consistency by a factor of 28. This allows more precise control over the relative priority given to achieving time targets or increasing energy efficiency

Ionization of Rydberg atoms by blackbody radiation

We have studied an ionization of alkali-metal Rydberg atoms by blackbody radiation (BBR). The results of the theoretical calculations of ionization rates of Li, Na, K, Rb and Cs Rydberg atoms are presented. Calculations have been performed for nS, nP and nD states which are commonly used in a variety of experiments, at principal quantum numbers n=8-65 and at the three ambient temperatures of 77, 300 and 600 K. A peculiarity of our calculations is that we take into account the contributions of BBR-induced redistribution of population between Rydberg states prior to photoionization and field ionization by extraction electric field pulses. The obtained results show that these phenomena affect both the magnitude of measured ionization rates and shapes of their dependences on n. A Cooper minimum for BBR-induced transitions between bound Rydberg states of Li has been found. The calculated ionization rates are compared with our earlier measurements of BBR-induced ionization rates of Na nS and nD Rydberg states with n=8-20 at 300 K. A good agreement for all states except nS with n>15 is observed. Useful analytical formulas for quick estimation of BBR ionization rates of Rydberg atoms are presented. Application of BBR-induced ionization signal to measurements of collisional ionization rates is demonstrated.Comment: 36 pages, 16 figures. Paper is revised following NJP referees' comments and suggestion

Helicopter tail rotor thrust and main rotor wake coupling in crosswind flight

The tail rotor of a helicopter with a single main rotor configuration can experience a significant reduction in thrust when the aircraft operates in crosswind flight. Brown’s vorticity transport model has been used to simulate a main rotor and tail rotor system translating at a sideslip angle that causes the tail rotor to interact with the main rotor tip vortices as they propagate downstream at the lateral extremities of the wake. The tail rotor is shown to exhibit a distinct directionally dependent mode during which tail rotors that are configured so that the blades travel forward at the top of the disk develop less thrust than tail rotors with the reverse sense of rotation. The range of flight speeds over which this mode exists is shown to vary considerably with the vertical location of the tail rotor. At low flight speeds, the directionally dependent mode occurs because the tail rotor is immersed within not only the downwash from the main rotor but also the rotational flow associated with clusters of largely disorganized vorticity within the main rotor wake. At higher flight speeds, however, the tail rotor is immersed within a coherent supervortex that strongly influences the velocity field surrounding the tail rotor

Electrical excitation of shock and soliton-like waves in two-dimensional electron channels

We study electrical excitation of nonlinear plasma waves in heterostructures with two-dimensional electron channels and with split gates, and the propagation of these waves using hydrodynamic equations for electron transport coupled with two-dimensional Poisson equation for self-consistent electric potential. The term related to electron collisions with impurities and phonons as well as the term associated with viscosity are included into the hydrodynamic equations. We demonstrate the formation of shock and soliton-like waves as a result of the evolution of strongly nonuniform initial electron density distribution. It is shown that the shock wave front and the shape of soliton-like pulses pronouncedly depend on the coefficient of viscosity, the thickness of the gate layer and the nonuniformity of the donor distribution along the channel. The electron collisions result in damping of the shock and soliton-like waves, while they do not markedly affect the thickness of the shock wave front.Comment: 9 pages, 11 figure

Modeling the Near-Infrared Luminosity Functions of Young Stellar Clusters

We present the results of numerical experiments designed to evaluate the usefulness of near-infrared luminosity functions for constraining the Initial Mass Function (IMF) of young stellar populations. From this numerical modeling, we find that the luminosity function of a young stellar population is considerably more sensitive to variations in the underlying initial mass function than to either variations in the star forming history or assumed pre-main-sequence (PMS) mass-to-luminosity relation. To illustrate the potential effectiveness of using the KLF of a young cluster to constrain its IMF, we model the observed K band luminosity function of the nearby Trapezium cluster. Our derived mass function for the Trapezium spans two orders of magnitude in stellar mass (5 Msun to 0.02 Msun), has a peak near the hydrogen burning limit, and has an IMF for Brown Dwarfs which steadily decreases with decreasing mass.Comment: To appear in ApJ (1 April 2000). 37 pages including 11 figures, AAS: ver 5.

New records of brown algae (Phaeophyta) from the Azores

Copyright © 2000 Kluwer Academic Publishers. Printed in the Netherlands.The following five species of microscopic tuft-forming/encrusting brown algae (Phaeophyta) are newly recorded for the Island of São Miguel (Azores): Nemoderma tingitana Schousboe ex Bornet. Pseudolithoderma roscoffense Loiseaux (Lithodermataceae), Hecatonema terminalis (Kutzing) Kylin (Punctariaceae), Compsonema saxicolum (Kuckuck) Kuckuck, and Microspongium gelatinosum Reinke (Scytosiphonaceae). The species are described, and information is presented on their ecology and distribution around the island