Retelling Using Different Methods

This study examines different methods of retelling and the effects of these methods on the quality of retelling produced. I claim that different methods of retelling will elicit varying quality of retellings. Data was collected through asking two first graders to retell stories that I had read to them using different methods. The study shows that confidence, memory, and cognitive demand of the retelling task, as well as visual cues and prompting play a role in retelling quality. Retelling is a strategy that is easy to use and can be easily adapted to meet the needs of different types of text

Eine gesetzliche Regulierung des Umgangs mit Opiaten und Sedativa bei medizinischen Entscheidungen am Lebensende?

Zusammenfassung: Der ärztliche Umgang mit Opiaten und Sedativa bei Patienten am Lebensende kann ethische Fragen aufwerfen. Entsprechende Entscheidungen blieben bisher in aller Regel der ärztlichen Berufskunst und -pflicht überantwortet. Heute aber gerät dieser Bereich zunehmend auch in den Blickwinkel des Rechts. Ausdruck davon sind Bestrebungen, die indirekte Sterbehilfe, allenfalls auch die terminale Sedierung gesetzlich zu regeln. Ausgehend von einer Ist-Analyse der ärztlichen Praxis sowie von bereits bestehenden Regulierungen untersucht diese Arbeit die Konsequenzen derartiger Bestrebungen. Es zeigt sich, dass der Versuch, die Thematik der indirekten Sterbehilfe für sich allein, also unter Vermeidung einer Regelung der direkt aktiven Sterbehilfe, zu behandeln, zu großen Schwierigkeiten führen würde. Ernüchternd sind aber auch die Erfahrungen aus den Niederlanden, derartige Fragen im Rahmen eines umfassenden Sterbehilfegesetzes anzugehen. Insgesamt ist somit zu befürchten, dass der Versuch einer detaillierten gesetzlichen Regelung dieses Bereiches mehr neue Grauzonen und Unsicherheiten schafft, als er zu beseitigen verma

Morphine-induced hallucinations - resolution with switching to oxycodone: a case report and review of the literature

Palliation of pain with morphine in cancer patients can be complicated by adverse effects. Tolerance to these effects such as nausea and drowsiness usually occurs within a few days allowing continuation of morphine therapy. However, some patients may develop intolerable adverse effects even after several months on morphine when the dose is increased. A case of morphine-induced hallucinations in a cancer patient who had been on a subcutaneous infusion of diamorphine for several months is discussed. A switch to oxycodone resolved his hallucinations and gave him a new lease of life. The theories behind and evidence for opioid-switching is discussed along with strategies for dealing with intolerable opioid-induced adverse effects

First results from the SafEE project: Safe & Easy Environment for Alzheimer's

International audienc

Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided

Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided

Opioids Switching with Transdermal Systems in Chronic Cancer Pain

<p>Abstract</p> <p>Background</p> <p>Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy</p> <p>Objective</p> <p>To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment.</p> <p>Methods</p> <p>A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks</p> <p>Results</p> <p>Pain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment.</p> <p>Conclusion</p> <p>Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.</p

Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper

The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure