Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care

Background Despite 50 years of modern palliative care (PC), a misunderstanding of its purpose persists. The original message that PC is focused on total care, helping to live until the person dies, is being replaced and linked to feelings of fear, anxiety and death, instead of compassion, support or appropriate care. Society is still afraid to speak its name, and specialized units are identified as “places of death” as opposed to “places of life” meant to treat suffering. This issue is prohibitive to the implementation and development of PC policies worldwide. It is imperative to identify what message PC professionals are relaying to patients and other health care specialists and how that message may condition understandings of the right to access PC. Methods A qualitative study, employing focused ethnography and participant observation (PO) of the daily interaction of PC professionals with patients and family members in three different PC services. Two researchers independently conducted a thematic analysis, followed by member checking with participants. Results A total of 242 h of participant observation revealed the following messages sent by PC professionals in their daily interaction with patients and families: i) We are focused on your wellbeing; ii) You matter: we want to get to know you; iii) Your family is important to us. Conclusion The complexity of PC discourses contributes to the difficulty of identifying a clear universal message between PC professionals, patients and families. The PC professionals observed transmit a simple message focused on their actions rather than their identity, which may perpetuate some social/cultural misunderstandings of PC. It seems there is a common culture, based on the same values and attitudes, within the messages that PC professionals transmit to patients and their families. PC teams are characterised by their availability

Palliative care professionals’ message to others: an ethnographic approach

Introduction: Palliative care continues to be misunderstood within the world of healthcare. Palliative care professionals are key agents for promoting a greater understanding of their field. This study aims to examine the messages, both implicit and explicit, that palliative care professionals transmit about themselves and their work within their teams and to other health professionals. Methods: Focused ethnographic secondary analysis, exploring the interactions of palliative care professionals as it happens at everyday work. An inductive thematic analysis was developed from 242 h of observation of the daily work practices of palliative care professionals, focusing on their interactions with others. The data was coded without predefined categories, and the analysis was performed independently by two researchers. Results: Palliative professionals communicate that they are part of an active team working in an organized manner. They value and feel proud of their work. Despite the intensity of their work, these professionals are always available to others, to whom they demonstrate a clear professional identity. They convey their expertise in alleviating suffering, respectful behavior and collaborative ability. Conclusion: Professionals, in their daily work, communicate through their messages the essence of palliative care. It is essential that palliative care professionals perceive themselves as potential influencers and explicitly transmit the reasons for their intervention. Otherwise, others will perpetuate the myths, misunderstandings, and lack of a positive reputation for palliative car

The significance of gratitude for palliative care professionals: a mixed method protocol

Background: In palliative care (PC) patients and relatives (P/R) often show their gratitude to the healthcare professionals (HP) who care for them. HP appreciate these displays of gratitude, although the impact of the same has not been examined in detail. Publications analysed tell personal experiences in which HP say that displays of gratitude create sensations of well-being, pride and increased motivation to carry on caring. No systematic examination in PC was found. These aspects related to gratitude may be important in the field of PC, where there is constant exposure to suffering and the preoccupation which arises from wanting to help HP to go on with their work, but it needs closer study and systemisation. The purpose of this study is to understand the significance and the role of the gratitude received from P/R for palliative care health professionals (PCHP). Methods: A suitable mixed method will be used. The first phase will be quantitative and will consist of a survey, piloted by experts, whose goal is to explore the current situation in Spain as regards displays of gratitude received by HP at PC services. It will be sent by e-mail. The results from this part will be incorporated into the second part which will be qualitative and whose goal is to understand the significance of the experience of receiving displays of gratitude from the perspective of PCHP, using a phenomenological approach. Interviews will be undertaken amongst PCHP. The interview guide will be designed after taking the survey results into account. The project has been granted ethical approval. Discussion: These results are set to provide a key contribution within the context of the growing preoccupation on how to care for HP, how to ensure retention and keep them from resigning, as well as preventing burnout, emotional fatigue and boosting their resilience. In order to do this, it is both interesting and ground breaking, to analyse the repercussion of spontaneous gratitude shown by P/R towards PCHP, to see if this is a useful resource to reduce these problems and to encourage the greater presence of dignity and humanisation, for both those receiving care and for those providing it. This gratitude may be one of these strategies

Arsenic distribution in a pasture area impacted by past mining activities

[EN]Former mine exploitations entail a serious threat to surrounding ecosystems as after closure of mining activities their unmanaged wastes can be a continuous source of toxic trace elements. Quite often these mine sites are found within agricultural farming areas, involving serious hazards as regards product (feed/food) quality. In this work a grazing land impacted by the abandoned mine exploitation of an arsenical deposit was studied so as to evaluate the fate of arsenic (As) and other trace elements and the potential risks involved. With this aim, profile soil samples (0–50 cm) and pasture plant species (Agrostis truncatula, Holcus annus and Leontodon longirostris) were collected at different distances (0–100 m) from the mine waste dump and analyzed for their trace element content and distribution. Likewise, plant trace element accumulation from impacted grazing soils and plant trace element translocation were assessed. The exposure of livestock grazing animals to As was also evaluated, establishing its acceptability regarding food safety and animal health. International soil guideline values for As in grazing land soils (50 mg kg−1) resulted greatly exceeded (up to about 20-fold) in the studied mining-affected soils. Moreover, As showed a high mobilization potential under circumstances such as phosphate application or establishment of reducing conditions. Arsenic exhibited relatively high translocation factor (TF) values (up to 0.32–0.89) in pasture plant species, reaching unsafe concentrations in their above-ground tissues (up to 32.9, 16.9 and 9.0 mg kg−1 in Agrostis truncatula, Leontodon longirostris and Holcus annus, respectively). Such concentrations represent an elevated risk of As transfer to the high trophic-chain levels as established by international legislation. The limited fraction of arsenite found in plant roots should play an important role in the relatively high As root-to-shoot translocation shown by these plant species. Both soil ingestion and pasture intake resulted important entrance pathways of As into livestock animals, showing quite close contribution levels. The cow acceptable daily intake (ADI) of As regarding food safety was surpassed in some locations of the study area when the species Agrostis truncatula was considered as the only pasture feed. Restrictions in the grazing use of lands with considerable As contents where this plant was the predominant pasture species should be established in order to preserve food quality. Therefore, the exposure of livestock animals to As via both soil ingestion and pasture consumption should be taken into account to establish the suitability of mining-impacted areas for gazing

Palliative professionals' experiences of receiving gratitude: a transformative and protective resource

Providing palliative care can be both challenging and rewarding. It involves emotionally demanding work and yet research shows that burnout is lower than in other fields of healthcare. Spontaneous expressions of gratitude from patients and family members are not uncommon and are highly valued. This study explored the experience of Spanish palliative professionals who received expressions of gratitude from their patients and families. A phenomenological approach was used to better understand the role of receiving gratitude in participants¿ lives. Interviews were transcribed verbatim and a phenomenological approach to analysis was undertaken using macro-thematic and micro-thematic reflection. Two team members independently engaged in this reflection with an inductive approach. The analysis was shared and discussed at periodic meetings to identify the key themes and sub-themes of the gratitude experience. Ten palliative professionals were interviewed. Participants engaged in a process of recognizing, internalizing and treasuring the expressions of gratitude which they then used for reflection and growth. These expressions were a powerful and deeply meaningful resource that the palliative professionals revisited over time. Receiving expressions of gratitude invited a stronger sense of the value of one¿s self and one¿s work that was motivational and protective, particularly during challenging times

On the manufacturing of highly-customized near net-shape medical implants using magnesium alloy sheet

Incluída en Procedia Manufacturing 50The purpose of this work is defining a global methodology framework for the manufacturing of medical implants using Mg alloys by Incremental Forming process from the results attained by the authors in this field. The methodology proposed considers two main steps, an indispensable related to material characterization that includes from the classical and mechanical to spifability testing and it includes numerical simulations. And another one related mainly to implant forming taking into account the best process parameters from the analysis carried out in the previous step. As newness, two variants of the incremental forming process, Single (SPIF) and Two-Point (TPIF) Incremental Forming, are used for the same magnesium implant geometry. Different outputs variables, mainly: Ra, Shape accuracy and Thicknesses, besides Force and Temperature were analysed for comparison purposes.Universidad de Girona MPCUdG2016 / 036Ministerio de Educación, Universidad e Investigación (Italia) CUP - D94I18000260001Ministerio de Educación (España) DPI2016-77156-

New cytotoxic neolignans from the cobalt crust fungus

Terana coerulea (Phanerochaetaceae family) is known as the cobalt crust fungus and it is used for its antibiotic properties at the Irati’s Forest (Navarra, Spain). Previous mycochemical investigations reported the isolation of corticins A-C,[1] p-terphenyl neolignans related to the antitumoural telephoric acid.[2] In this job, from powdered dry fungi, six extracts of increasing polarity were obtained and tested for cytotoxicity against four human tumour cell lines and one non-tumour primary cell culture with the sulforhodamine B assay. From the most cytotoxic one, the EtOAc extract, we isolated and identified three p-terphenyl neolignans. One of them was previously described as corticin A by Briggs et al.,[1] whose earlier structure has been revised in this work using one- and two-dimensional NMR, HRMS, positive and negative MS/MS and its peracetyl derivative in comparison with 4’’-deoxy and 4,5-dimethoxy candidusines A.[3] The other two neolignans are new natural products, named corticins D and E. These neolignans were less cytotoxic than the EtOAc extract itself, maybe due to an aerial oxidation and degradation produced when these neolignans, with catechol moieties, are definitively purified.info:eu-repo/semantics/publishedVersio

Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences

Objective Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context. Methods A cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2 and analysis of variance. Results 201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12). Conclusions One in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the ‘wish’ or ‘desire’ to die, with or without HD ideation

What are families most grateful for after receiving palliative care? Content analysis of written documents received: a chance to improve the quality of care

ICS. Family members are involved in the care of palliative patients at home and therefore, should be viewed as important sources of information to help clinicians better understand the quality palliative care service patients receive. The objective of the study was to analyse what is valued most by family carers undergoing bereavement of a palliative care home service in order to identify factors of quality of care. Qualitative exploratory study based on documentary analysis. Content analysis of 77 gratitude documents received over 8 years by a palliative home service in Odivelas, near Lisbon (Portugal) was undertaken, through an inductive approach and using investigator triangulation. Frequency of distinct categories was quantitatively defined. Results: Three different content categories emerged from the analysis: a) Recognition of the care received and the value of particular aspects of care within recognised difficult situations included aspects such as kindness, listening, relationships established (63/77 documents)¿ b) Family recognition of the achievements of the palliative care team (29/77) indicated as relief from suffering for the patient and family, opportunity of dying at home, help in facing difficult situations, improvement in quality of life and wellbeing, and feeling of serenity during bereavement¿ c) Messages of support (45/77) related to the need of resources provided