Dementia and Palliative Care: Sex Differences

Patients who need palliative care have complex physical and psychosocial needs during their illness. The results of previous studies show clear sex inequalities in the occurrence of various symptoms and the need for palliative care. Despite the undoubted sex differences in the creation of palliative care, sex is not a key determinant and is regularly neglected. According to the results of previous studies, women live longer than men, but they live more years with dis- abilities, especially with cognitive impairment. They end up in hospices much more often than men and die more often in institutions (21 % vs. 10 %). The biggest sex differences are present in the domain of caregivers. Most caregivers are women and according to the results of studies it is evident that more than 75 % of all caregivers are women and that women spend 50 % more time providing care than men. The time and effort that women put into caregiving is largely unrecognised and assumed to be a ‘natural’ role for women. In contrast, male caregivers are seen as heroes and numerous studies show that male caregivers receive more support than female caregivers. This is thought to be the reason why female carers have more physical and mental health problems, including anxiety and depression. Health professionals also play a role in the creation of this stereotype. A recent study showed that nurses felt that wives and daughters of patients needed less help than husbands and sons. Overall, all studies show that although women provide most of the care during life, they often lack a reciprocal level of care at the end of their lives. The policy of palliative care is focused on the approach that care at the end of life ‘in the community’ is desirable and achievable for everyone. Unfortunately, the fact that in this context care falls disproportionately on one person - who is most likely a woman - is ignored

An interpretive phenomenological analysis of formative feedback in anesthesia training: the residents' perspective.

BackgroundConsistent formative feedback is cornerstone to competency-by-design programs and evidence-based approaches to teaching and learning processes. There has been no published research investigating feedback from residents' perspectives. We explored the value residents place on feedback in routine operating room settings, their experiences, and understanding of the role of feedback in their training and developing professional identity.MethodsInterpretive phenomenological analysis of residents' experiences with feedback received in clinical settings involved two focus groups with 14 anesthesia residents at two time points. Analysis was completed in the context of a teaching hospital adapting to new practices to align with nationally mandated clinical competencies. Focus group conversations were transcribed and interpreted through the lens of a social constructivist approach to learning as a dynamic inter- and intra-personal process, and evidence-based assessment standards set by the International Test Commission (ITC).ResultsResidents described high quality feedback as consistent, effortful, understanding of residents' thought processes, and containing actionable advice for improvement. These qualities of effective evaluation were equally imperative for informal and formal evaluations. Residents commented that highest quality feedback was received informally, and formal evaluations often lacked what they needed for their professional development.ConclusionResidents have a deep sense of what promotes their learning. Structured feedback tools were seen positively, although the most important determinants of their impact were faculty feedback- and broader evaluation-skills and motivations for both formal and informal feedback loops

Neonatal outcomes of extremely preterm infants exposed to maternal hypertension and cigarette smoking.

Objective To study the outcomes of extremely preterm infants of hypertensive mothers who smoke. Study Design This retrospective cohort study included infants born between 2003 and 2012 at \u3c29 \u3eweeks\u27 gestation and admitted to neonatal intensive care units participating in the Canadian Neonatal Network. Infants were divided into four mutually exclusive groups. Infants of hypertensive mothers who smoked; infants of hypertensive, non-smoking mothers; infants of normotensive mothers who smoked; and infants of normotensive, non-smoking mothers. Using infants of normotensive, non-smoking mothers as the reference group, neonatal outcomes were compared between the groups. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using univariate and multivariate regression analysis. Results Of the 12,307 eligible infants, 172 had hypertensive mothers who smoked, 1689 had hypertensive non-smoking mothers, 1535 had normotensive mothers who smoked, and 8911 had normotensive non-smoking mothers. Compared to infants of normotensive non-smoking mothers, infants of hypertensive mothers, regardless of smoking status, had higher odds of developing bronchopulmonary dysplasia (AORs of smokers 1.62; 95% CI 1.12-2.35 and of non-smokers 1.43; 95% CI 1.24-1.64). There was no difference in the odds of mortality and retinopathy of prematurity stage ≥3 between the groups. Infants of hypertensive, non-smoking mothers had decreased odds of intraventricular hemorrhage \u3egrade 2 and higher odds of necrotizing enterocolitis. There was decreased odds of hypertension if the mother was a smoker (AOR 0.71; 95% CI 0.59-0.85). Conclusion Maternal hypertension is associated with increased rates of bronchopulmonary dysplasia, irrespective of smoking status