22 research outputs found

    Barriers to palliative care for children: Perceptions of pediatric health care providers

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    OBJECTIVE. The goal was to explore barriers to palliative care experienced by pediatric health care providers caring for seriously ill children. METHODS. This study explored pediatric provider perceptions of end-of-life care in an academic children's hospital, with the goal of describing perceived barriers to end-of-life care for children and their families. The report focuses on the responses of nurses (n = 117) and physicians (n = 81). RESULTS. Approximately one half of the respondents reported 4 of 26 barriers listed in the study questionnaire as frequently or almost always occurring, that is, uncertain prognosis (55%), family not ready to acknowledge incurable condition (51%), language barriers (47%), and time constraints (47%). Approximately one third of respondents cited another 8 barriers frequently arising from problems with communication and from insufficient education in pain and palliative care. Fourteen barriers were perceived by >75% of staff members as occasionally or never interfering with pediatric end-of-life care. Comparisons between physicians and nurses and between ICU and non-ICU staff members revealed several significant differences between these groups. CONCLUSIONS. Perceived barriers to pediatric end-of-life care differed from those impeding adult end-of-life care. The most-commonly perceived factors that interfered with optimal pediatric end-of-life care involved uncertainties in prognosis and discrepancies in treatment goals between staff members and family members, followed by barriers to communication. Improved staff education in communication skills and palliative care for children may help overcome some of these obstacles, but pediatric providers must realize that uncertainty may be unavoidable and inherent in the care of seriously ill children. An uncertain prognosis should be a signal to initiate, rather than to delay, palliative care

    The geomicrobiology of European mines relevant to radioactive waste disposal

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    SIGLEAvailable from British Library Lending Division - LD:7570.286(FLPU--85-1) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

    Corrosion of steel mediated by sulphate-reducing bacteria with reference to nuclear waste disposal

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    SIGLEAvailable from British Library Document Supply Centre- DSC:D75751/87 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

    Politicised pagodas and veiled resistance : contested urban space in Burma.

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    The urban landscapes of Yangon and Mandalay in Burma (Myanmar) exhibit a rich cultural layering and complex blending of urban forms and architectural styles. But while both cities today are shaped by contemporary economic and political realities, they also clearly reflecttheir historical origins&mdash;Yangon as the British colonial capital and Mandalay as the last seat of the monarchy. Burma&rsquo;s ancient religious monuments, monarchical and colonial heritage on the one hand, and new religious edifices, international standard hotels, commercial enterprises, new public buildings and satellite towns on the other hand, represent the two poles of the dialectic of tradition and modernity. The landscapes, as symbolic representations, have been appropriated bythe authoritarian military regime, the State Peace and Development Council (SPDC) for nation building purposes. But the urban landscapes are also contested and appropriated in symbolic ways and invested with meanings as sites of resistance and struggle by those in opposition, andare thus contested sites where the power relations of domination and resistance intersect. The paper illustrates these themes with examples drawn from Yangon and Mandalay.<br /
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