Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics : A comparative study

INTRODUCTION: The surprise question (SQ) "Would I be surprised if this patient died within the next xx months" can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics. METHODS: This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics. FINDINGS: Proportions of nurses and physicians responding to the SQ with "no, not surprised" was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded "no, not surprised", within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ. DISCUSSION: Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs

Hydrogen Tunneling in a Prokaryotic Lipoxygenase

ABSTRACT: A bacterial lipoxygenase (LOX) shows a deuterium kinetic isotope effect (KIE) that is similar in magnitude and temperature dependence to the very large KIE of eukaryotic LOXs. This occurs despite the evolutionary distance, an ∼25 % smaller catalytic domain, and an increase in Ea of ∼11 kcal/mol. Site-specific mutagenesis leads to a protein variant with an Ea similar to that of the prototypic plant LOX, providing possible insight into the origin of evolutionary differences. These findings, which extend the phenomenon of hydrogen tunneling to a prokaryotic LOX, are discussed in the context of a role for protein size and/or flexibility in enzymatic hydrogen tunneling. Lipoxygenases (LOXs) make up a widespread family ofenzymes that convert unsaturated fatty acids to allyl hydroperoxides and other oxidized products. The first step o

Clinical Implications for Supporting Caregivers at the End-of-Life: Findings and from a Qualitative Study

Despite families providing considerable care at end of life, there are substantial gaps in the provision of supportive care. A qualitative interview study was conducted with 17 caregivers of people supported by an adult hospice to explore the support needs of families. Family members readily identified the ways in which the diagnosis of a life-limiting illness impacted on them and the family as a whole, not just the patient. Implications for practice demonstrate the need to intervene at a family and relational level prior to bereavement, in order to mitigate complicated grief for the surviving family members. Such an approach offers a fruitful prospective alternative to supporting caregivers post-bereavement