Intussusception as a cause of bowel obstruction in adults from a resource limited area, Cameroon

BACKGROUND: Intussusception refers to the telescoping of a proximal segment of bowel into a distal segment. It is a rare cause of intestinal obstruction in adulthood.CASE DETAILS: We report two cases of adult intussusception in a post-operative period following Caesarean Section (with no lead point) and Appendicectomy (due to colonic adenocarcinoma) respectively.CONCLUSION: Though rare in adulthood, intussusception should be considered as a differential diagnosis to bowel obstruction in adults even in the post-operative period.KEYWORDS: Adult intussusception, Aetiology, post-operative intestinal obstruction, colonic adenocarcinoma, Cameroo

Solution blow spinning and obtaining submicrometric fibers of different polymers

Thermoplastic polymers with potential biomedical and electrical applications such as polyethyleneoxide, PEO, polyvinylidene fluoride, PVDF, polyethylene-co-vinyl acetate, EVA were prepared bysolution blow spinning, SBS, looking for the best processing conditions to obtain submicrometricfibers with highest homogeneity in terms of morphology. Fabrication was carried out by a commercialairbrush and a home-made automatic SBS device. The aim of this work was to optimize the SBSprocess for each of the polymer systems to get films in the form of mats formed by submicrometricfibers. In particular, the pressure of the ejecting gas, the feed rate of the polymer solution and theworking distance was considered as the final influencing parameters on the materials morphology.SEM was used as the main technique to evaluate the effect of the processing conditions on the finalmorphology. The different morphologies obtained showed a directly dependence of between themand the processing conditions. Gas pressure, feed rate and working distance have a great influencein the fiber production, fiber diameter, and fiber diameter distribution.Authors gratefully acknowledge financial support from the Projects MAT2014-59116-C2 (Ministerio de Economía y Competitividad); 2012/00130/004 (Fondos de Investigación de Fco. Javier González Benito, política de reinversión de costes generales, Universidad Carlos III de Madrid) and 2011/00287/002 (Acción Estratégica en Materiales Compuestos Poliméricos e Interfases, Universidad Carlos III de Madrid)

Is Care for the Dying Improving in the United States?

Background: Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies. Objective: The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011?2013. Methods: The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent. Results: A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011?2013. Respondents from deaths in 2011?2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95). Conclusions: Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140119/1/jpm.2015.0039.pd

Late Transitions and Bereaved Family Member Perceptions of Quality of End‐of‐Life Care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146458/1/jgs15455.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146458/2/jgs15455_am.pd

Changes in Advance Care Planning in Nursing Homes Before and After the Patient Self‐Determination Act: Report of a 10‐State Survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111179/1/j.1532-5415.1997.tb02963.x.pd

Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel

Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives

Psychometric properties of instruments to measure the quality of end-of-life care and dying for long-term care residents with dementia

Purpose: Quality of care for long-term care (LTC) residents with dementia at the end-of-life is often evaluated using standardized instruments that were not developed for or thoroughly tested in this population. Given the importance of using appropriate instruments to evaluate the quality of care (QOC) and quality of dying (QOD) in LTC, we compared the validity and reliability of ten available instruments commonly used for these purposes. Methods: We performed prospective observations and retrospective interviews and surveys of family (n = 70) and professionals (n = 103) of LTC decedents with dementia in the Netherlands. Results: Instruments within the constructs QOC and QOD were highly correlated, and showed moderate to high correlation with overall assessments of QOC and QOD. Prospective and retrospective ratings using the same instruments differed little. Concordance between family and professional scores was low. Cronbach's alpha was mostly adequate. The EOLD-CAD showed good fit with pre-assumed factor structures. The EOLD-SWC and FPCS appear most valid and reliable for measuring QOC, and the EOLD-CAD and MSSE for measuring QOD. The POS performed worst in this population. Conclusions: Our comparative study of psychometric properties of instruments allows for informed selection of QOC and QOD measures for LTC residents with dementia. © The Author(s) 2011

Design of the Advance Directives Cohort: a study of end-of-life decision-making focusing on Advance Directives

<p>Abstract</p> <p>Background</p> <p>ADs are documents in which one can state one's preferences concerning end-of-life care, aimed at making someone's wishes known in situations where he/she is not able to do so in another manner. There is still a lot unclear about ADs. We designed a study aimed at investigating the whole process from the formulating of an AD to its actual use at the end of life.</p> <p>Methods/Design</p> <p>The study has mixed methods: it's longitudinal, consisting of a quantitative cohort-study which provides a framework for predominantly qualitative sub-studies. The members of the cohort are persons owning an AD, recruited through two Dutch associations who provide the most common standard ADs in the Netherlands, the NVVE (Right to Die-NL), of which 5561 members participate, and the NPV (Dutch Patient Organisation), of which 1263 members participate. Both groups were compared to a sample of the Dutch general public. NVVE-respondents are more often single, higher educated and non-religious, while amongst NPV-respondents there are more Protestants compared to the Dutch public. They are sent a questionnaire every 1,5 year with a follow-up of at least 7,5 years. The response rate after the second round was 88% respectively 90% for the NVVE and NPV. Participants were asked if we were allowed to approach close-ones after their possible death in the future. In this way we can get insight in the actual use of ADs at the end of life, also by comparing our data to that from the Longitudinal Aging Study Amsterdam, whose respondents generally do not have an AD.</p> <p>Discussion</p> <p>The cohort is representative for people with an AD as is required to study the main research questions. The longitudinal nature of the study as well as the use of qualitative methods makes it has a broad scope, focusing on the whole course of decision-making involving ADs. It is possible to compare the end of life between patients with and without an AD with the use of data from another cohort.</p