Ethical challenges and decisions at the end-of-life in burn intensive care units. Results from a qualitative interview study

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Experiencing total pain in burn intensive care units: a meta-ethnographic review

Background: Critically burned patients and their families experience unbearable pain and suffering. Working in burn intensive care units (Burn ICUs) is also a major cause of emotional distress for healthcare professionals. Although burn-related pain is part of the acute care provided to burned patients, little is known on how to optimally provide suffering relief. Aim: To understand patients, families, and healthcare professionals’ experiences with total pain and its relief in Burn ICUs. Methods: Meta-ethnography of qualitative evidence following PRISMA. Studies were retrieved from 3 databases (PubMed, ISI and EBSCO host searching CINAHL Complete, MEDLINE Complete, and MedicLatina), combining 3 sets of terms (suffering AND burns AND qualitative). Original qualitative studies exploring experiences of critically burned patients, their families and healthcare teams in BurnICUs were included from inception to October 2022. Results: 305 articles retrieved; 10 selected for analysis and synthesis, with 263 participants. 11 themes emerged from the analysis: Patients’ suffering (changed self, mental anguish, physical pain and its management from onset until discharge when it happened, and divergent opinions about sedation); Families’ suffering (navigating through the experience, managing uncertainty about survival, vicarious suffering, and isolation in their “bubble of trauma”); and Nurses’ suffering (stress, compassion fatigue, and burnout). Discussion/Conclusions: This meta-ethnographic review shows that critically burned patients and their families experience total pain. Nurses caring for these patients and their families express signs of physical and emotional suffering. Timely and targeted palliative care could have a positive impact on these patients, families, and professionals, improving care outcomes. Further research is needed to determine how healthcare systems can best optimise palliative care provision to critically burned patients and their families to address their experience of total pain.info:eu-repo/semantics/acceptedVersio

End-of-life care in burn intensive care units: a systematically conducted scoping review

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Triggers for palliative care referral in burn intensive care units: results from a qualitative interview study based on professionals’ clinical experience and knowledge

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Is it possible to integrate palliative care in burn intensive care units? Results from a qualitative study with healthcare professionals

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Did organizational models and designs of end-of-life care in burn intensive care units change during the COVID-19 pandemic? Professionals’ views and experiences

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Dying with dignity: conceptual and practical similarities and differences among professionals providing end-of-life care

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On the Hamilton-Jacobi Theory for Singular Lagrangian Systems

We develop a Hamilton-Jacobi theory for singular lagrangian systems using the Gotay-Nester-Hinds constraint algorithm. The procedure works even if the system has secondary constraints.Comment: 36 page

Barometric pumping of a fractured porous medium

International audienceBarometric pumping plays a crucial role in the release of trace gases from fractured porous media to the atmosphere, and it requires a rigorous and complete modeling in order to go beyond the approximate schemes available in the literature. Therefore, a coupled set of convection and convection-diffusion equations for a slightly compressible fluid in unsteady conditions should be solved. The numerical methodology is presented, and it is applied to conditions close to the ones of the Roselend Natural Laboratory (France). The precision of the code is assessed and the mechanism of barometric pumping is explained. The usual schematization by simple vertical fractures is shown to be only qualitative. Finally, barometric pumping is shown to be efficient in a narrow range of parameter values; its efficiency is a decreasing function of the matrix porosity and of the fracture density

Pre-multisymplectic constraint algorithm for field theories

We present a geometric algorithm for obtaining consistent solutions to systems of partial differential equations, mainly arising from singular covariant first-order classical field theories. This algorithm gives an intrinsic description of all the constraint submanifolds. The field equations are stated geometrically, either representing their solutions by integrable connections or, what is equivalent, by certain kinds of integrable m-vector fields. First, we consider the problem of finding connections or multivector fields solutions to the field equations in a general framework: a pre-multisymplectic fibre bundle (which will be identified with the first-order jet bundle and the multimomentum bundle when Lagrangian and Hamiltonian field theories are considered). Then, the problem is stated and solved in a linear context, and a pointwise application of the results leads to the algorithm for the general case. In a second step, the integrability of the solutions is also studied. Finally, the method is applied to Lagrangian and Hamiltonian field theories and, for the former, the problem of finding holonomic solutions is also analized.Comment: 30 pp. Presented in the International Workshop on Geometric Methods in Modern Physics (Firenze, April 2005