Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project

BACKGROUND: The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands. METHODS/DESIGN: We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying. DISCUSSION: With this study we aim to improve the understanding of and attention for patients’ needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses

Dying at home or in an institution: perspectives of Dutch physicians and bereaved relatives

Introduction Previous studies have shown that most people prefer to die at their own home. We investigated whether physicians or bereaved relatives in retrospect differently appreciate the dying of patients in an institution or at home. Materials and methods Of 128 patients with incurable cancer who were followed in the last phase of their lives, 103 passed away during follow-up. After death, physicians filled out a written questionnaire for 102 of these patients, and 63 bereaved relatives were personally interviewed. Results Of 103 patients, 49 died in an institution (mostly a hospital), and 54 died at home (or in two cases in a home-like situation). Patients who had been living with a partner relatively often died at home. Bereaved relatives knew of the patient’s wish to die at home in 25 out of 63 cases; 20 of these patients actually died at home. Thirty-one patients had no known preference concerning their place of dying. Most symptoms and the care provided to address them were equally prevalent in patients dying in an institution and patients dying at home. Bereaved relatives were in general quite satisfied about the provision of medical and nursing care in both settings. Conclusion We conclude that most patients’ preferences concerning the place of dying can be met. In about half of all cases, patients do not seem to have a clear preference concerning their place of dying, which is apparently not a major concern for many people. We found no indication that dying in an institution or at home involves major differences in the process and quality of dying

Do large language models solve verbal analogies like children do?

Analogy-making lies at the heart of human cognition. Adults solve analogies such as \textit{Horse belongs to stable like chicken belongs to ...?} by mapping relations (\textit{kept in}) and answering \textit{chicken coop}. In contrast, children often use association, e.g., answering \textit{egg}. This paper investigates whether large language models (LLMs) solve verbal analogies in A:B::C:? form using associations, similar to what children do. We use verbal analogies extracted from an online adaptive learning environment, where 14,002 7-12 year-olds from the Netherlands solved 622 analogies in Dutch. The six tested Dutch monolingual and multilingual LLMs performed around the same level as children, with MGPT performing worst, around the 7-year-old level, and XLM-V and GPT-3 the best, slightly above the 11-year-old level. However, when we control for associative processes this picture changes and each model's performance level drops 1-2 years. Further experiments demonstrate that associative processes often underlie correctly solved analogies. We conclude that the LLMs we tested indeed tend to solve verbal analogies by association with C like children do

Влияние ледового сжатия на составляющие скорости движения жидкости под ледяным покровом в бегущей периодической изгибно-гравитационной волне конечной амплитуды

Методом многих масштабов с точностью до величин третьего порядка малости получены асимптотические разложения, определяющие составляющие скорости движения жидкости под плавающим ледяным покровом при распространении периодической поверхностной изгибногравитационной волны конечной амплитуды в условиях ледового сжатия. Рассмотрена зависимость распределений составляющих скорости вдоль профиля волны от величины сжимающего усилия и характеристик начальной гармоники. Показано, что с увеличением сжимающего усилия происходит уменьшение амплитудных значений составляющих скорости и отставание фазы колебаний.Методом багатьох масштабів з точністю до величин третього порядку малості отримані асимптотичні розкладання, які визначають складові швидкості руху рідини під плаваючим льодяним покривом при розповсюдженні періодичної поверхневої згинально-гравітаційної хвилі кінцевої амплітуди в умовах льодяного стиснення. Розглянуто залежність розподілів складових швидкості вздовж профілю хвилі від величини стискаючого зусилля та характеристик початкової гармоніки. Показано, що із збільшенням стискаючого зусилля відбувається зменшення амплітудних значень складових швидкості та відставання фази коливань.Using the method of multiple scales, the asymptotic expansions are obtained up to the values of the third order. The expansions condition the components of fluid movement velocity under floating ice cover at propagation of periodic surface flexural-gravity wave of finite amplitude in the condition of ice compression. Dependence of distribution of velocity components along the wave profile upon the compressive force value and the initial harmonic characteristics is considered. It is shown that rise of compressive force is accompanied by decrease of amplitude values of velocity components and lag of oscillations’ phase

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: Sex differences in a representative, population survey

Background: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. Methods: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. Results: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. Conclusions: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner