Care and compassion at the end of life

Aim: To examine the provision of the ‘end of life care strategy’ and the perception of provision by patients and carers. Introduction: In determining what constitutes excellence in care at the end of life, one must firstly acknowledge ‘what care and compassion is’. Following this it should be established what one should expect as a minimum standard of care. The end of life care strategy was initiated by the Department of Health in 2008. This guidance was intended to drive forward end of life care provision where patients were seen as the priority and encouraged to engage in all decision making at each point in their journey. Standards suggested by NICE (2011) further support patient empowerment and inclusivity in care planning. Method: A literature search was conducted in order to determine whether there has been a change in provision and to identify whether patients and their carers perceive an excellence in the care that has been delivered. Results: The literature is limited but the underlying issues of pre-end of life care strategy (2008) remain apparent. Patients and their carers continue to lack the autonomy they deserve and decisions are made about them rather than by them. Owing to the lack of direction which should come from the patient, care may be fragmented with numerous members of a multidisciplinary team being involved. Conclusion: Patient involvement is paramount. Early discussions relating to choices at the end of life need to be achieved in a timely manner. This should ensure that the patient and carer experience a high standard of excellent care which has been planned with inclusivity in min

Optical coherence tomography:age estimation of <i>Calliphora vicina</i> pupae <i>in vivo</i>?

Necrophagous blowfly pupae are valuable contributors to the estimation of post-mortem interval, should an accurate age estimate be obtained. At present, this is reliant on a combination of rearing and destructive methods conducted on preserved samples, including morphological observation and gene expression analyses. This study demonstrates the use of optical coherence tomography (OCT) as a tool for in vivo morphological observation and pupal age estimation. Using a Michelson OCT microscope, alive and preserved four and ten-day old Calliphora vicina pupae were scanned in different orientations. Two and three-dimensional images were created. Morphological characteristics such as the brain, mouthparts and legs were identifiable in both living and preserved samples, with distinct differences noted between the two ages. Absorption of light by the puparium results in a vertical resolution of 1-2 mm, preventing observation of deeper tissues. The use of contrast agents or a longer wavelength laser would improve the images obtainable. At present, the data suggests OCT provides a primary view of external and internal morphology, which can be used to distinguish younger and older pupae for further analysis of age and PMI estimation

Chata Sia “I am Choctaw”. Using Images as a Methodology for Cultural and Technological Discourse

Unlike positivist quantitative designs, many qualitative researchers tend to dive right into data collection without benefit of an exploratory study or other pilot study. The purpose of this paper is twofold: (1) to share an image-based methodology adapted from a community strategic planning process and applied to an exploratory study of one native American tribes reaction to cultural images and\ud ICT’s, and (2) to share the many benefits of a pilot study in advance of a larger qualitative research study, including opportunities for discourse around ICT’s in relation to local culture

Targeted therapy for breast cancer prevention.

With a better understanding of the etiology of breast cancer, molecularly targeted drugs have been developed and are being testing for the treatment and prevention of breast cancer. Targeted drugs that inhibit the estrogen receptor (ER) or estrogen-activated pathways include the selective ER modulators (tamoxifen, raloxifene, and lasofoxifene) and aromatase inhibitors (AIs) (anastrozole, letrozole, and exemestane) have been tested in preclinical and clinical studies. Tamoxifen and raloxifene have been shown to reduce the risk of breast cancer and promising results of AIs in breast cancer trials, suggest that AIs might be even more effective in the prevention of ER-positive breast cancer. However, these agents only prevent ER-positive breast cancer. Therefore, current research is focused on identifying preventive therapies for other forms of breast cancer such as human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancer (TNBC, breast cancer that does express ER, progesterone receptor, or HER2). HER2-positive breast cancers are currently treated with anti-HER2 therapies including trastuzumab and lapatinib, and preclinical and clinical studies are now being conducted to test these drugs for the prevention of HER2-positive breast cancers. Several promising agents currently being tested in cancer prevention trials for the prevention of TNBC include poly(ADP-ribose) polymerase inhibitors, vitamin D, and rexinoids, both of which activate nuclear hormone receptors (the vitamin D and retinoid X receptors). This review discusses currently used breast cancer preventive drugs, and describes the progress of research striving to identify and develop more effective preventive agents for all forms of breast cancer

Using Mindfulness Through Doodling in Interactive Notebooking to Increase Student Achievement

The SARS-CoV-2 pandemic, which unfolded from 2019 to 2021, disrupted education systems worldwide, leading to significant learning loss and inequities. The shift to digital learning, necessitated by the pandemic, presented challenges such as learning loss and social-emotional impacts. This study investigates the incorporation of Social Emotional Learning(SEL), with mindfulness, into the school curriculum to address these challenges. The focus of the study is on the implementation of Mindful Doodling as a component of SEL within an interactive notebook in a middle school science curriculum to enhance student achievement. The study aimed to analyze how different amounts of Mindful Doodling in various settings impact achievement in a small, private middle school in the Midwest. The investigator assessed student achievement levels using pre- and post-assessment unit tests and evaluated the effectiveness of Mindful Doodling in different settings, including virtual, hybrid, and in-person learning. The rationale for this study stemmed from the disruptive effects of the pandemic on traditional classroom structures and the resulting impact on student achievement and mental health. The shift to virtual learning created isolation and stress, prompting educators to seek ways to mitigate these effects. Mindful activities, including Mindful Doodling, were introduced into the curriculum to reduce stress. The conceptual framework was grounded in the practice of mindfulness, emphasizing being present in the moment. Mindfulness has been associated with improved physical and mental health, reduced stress, and greater life appreciation. The study focused on the impact of Mindful Doodling on student achievement, exploring whether the frequency of Mindful Doodling and the learning environment (virtual, hybrid, or in-person) played a role in this impact. The study set forth four hypotheses to answer the research questions, exploring the relationship between Mindful Doodling and student achievement in different settings. The independent variables included Mindful Doodling practices, frequency of doodling, and the learning environment, while the dependent variable is student achievement. The study\u27s delimitations included a specific time frame and location, focusing on seventh-grade science students in a suburban private middle school during the 2020-2021 school year. The limitations involved the sample demographics and the use of instructor-created assessments. In summary, this research sought to fill the gap in the understanding of how Mindful Doodling can positively impact student achievement, especially in a post-pandemic learning environment characterized by stress and isolation. The results of this study may provide valuable insights for educators and policymakers looking to enhance SEL practices and improve student outcomes, which includes the incorporation of Mindful Doodling across the curriculum, and expansion of further research, by expanding the study population, as well as expanding the Mindful Doodling practice

Self Management in Heart Failure Education

Heart failure is a growing health problem in the United States, costing the healthcare system billions of dollars and having a significant impact on patients\u27 quality of life. To improve heart failure outcomes and reduce associated costs, we must educate patients to properly manage their disease condition. Traditionally, this patient education takes place during a standard office visit with a provider. However, in a self-management program, the provider, through individualized education, empowers the patient to become an active participant in their care. The purpose of this literature review was to explore the effect of self management programs, in comparison to standard in-office education, on the morbidity and mortality of heart failure patients. A total of 11 articles on self-management programs were reviewed, and it was detennined that heart failure self-management programs show a great potential to improve outcomes such as hospitalizations, quality of life, and mortality. However, more research needs to be done on the topic due to some study results being mixed, or showing results that were not statistically significant. In addition, this review evaluated five studies on the role of the nurse or advanced practice nurse in the self management process. Self-management programs led by a specially trained nurse, or an advanced practice nurse, show great success in improving heart failure patient outcomes. Finally, literature was reviewed to evaluate what components should be included in a heart failure self-management program. These components are described in detail, with relevant practice recommendations directed towards providers caring for heart failure patients. In order to disseminate the impo1iant info1mation from this literature review, a poster of the findings discussed above was created and presented to providers who care for heart failure patients. The presentation included a summary of the literature review findings, as well as practice recommendations based on those findings

Mindfulness Meditation: A Self-Awareness Approach to Weight Management

Obesity is a crucial health care issue that has a global effect on the health care industry. Not only does obesity decrease the patients\u27 quality of life, it also places an astronomical burden on health care delivery systems. The purpose of this quality improvement project was to establish a weight management program derived from evidence-based research. The research question is can the utilization of mindfulness meditations and practices with traditional weight loss methodologies produce sustainable weight loss? Pender\u27s health belief model was the conceptual framework utilized to guide and provides structure for this project. The health belief model has been utilized in numerous health care studies and has provided researchers with tremendous insight on various health care issues. The goal of the project was to provide the inhabitants in a metropolitan city located in the Midwest region of the United States with weight management strategies that would support a declination in the number of patients struggling with obesity in that region. This project developed a turnkey solution to a community health problem consisting of the following strategies: executing mindfulness meditations and practices as part of their daily rituals, reading food labels and making healthier food selections, exercising 30 to 40 minutes a day, and documenting their progression or obstacles in a journal. Since the project consisted of only 20 participants, it is recommended that a larger population and region be utilized for future studies. This project has the potential for societal change by improving the quality of life of and productivity of patients struggling with obesity by decreasing their chances of developing chronic illnesses which can become debilitating