Reflection of illness and strategies for handling advanced lung cancer - a qualitative analysis in patients and their relatives

Background: Lung cancer patients are often diagnosed in an advanced stage of disease. In a situation of palliative treatment, both patients and their relatives experience existential burden. Evidence suggests that multi-professional teams should deal with them as dyads. However, little is known about differences in their individual situation. The purpose of this study is to explore and compare reflections that arise out of the context of diagnosis and to compare how patients and their relatives try to handle advanced lung cancer. Methods: Data was collected by qualitative interviews. A total of 18 participants, 9 patients diagnosed with advanced lung cancer (ICD- 10 C-34, stage IV) starting or receiving palliative treatment and 9 relatives were interviewed. Data was interpreted using qualitative content analysis. Results: Reflection aspects were “thoughts about the cause”, “meaning of belief” and “experience of inequity”. Patients often experienced the diagnosis as inequity and were more receptive for believing in treatment success. The main strategies found were “repression”, “positive attitude”, “strong focus on the present” and “adjustment of life terms”. Patient and relative dyads used the same strategies, but with different emphasis. That life time is limited was more frequently realized by relatives than by patients. Conclusion: While strategies used by relatives are similar to those of patients’, they are less reflective and more pragmatic in terms of handling daily life and organizing care. The interviewed patients were mostly not able to takeover these tasks. To strong was their belief in treatment success, their repression of the future and the focus on the present. This implicates, that in terms of end-of-life care, relatives are important to reach patients who are often not receptive to this topic

Food Insecurity at the University of Denver: A Qualitative Exploratory Study to Identify Challenges and Opportunities for Improvements Around Food Insecurity on DU’s Campus

The purpose of this course-based research project was to understand students’ perceptions and opinions about student food insecurity on the University of Denver campus, identifying challenges and opportunities for improvement, with the hope that the results will support the DU community’s efforts to prevent and address food insecurity on DU’s campus

Untersuchung von Kohleveredelungsanlagen unter besonderer Berücksichtigung der Trennaufgaben

Eine aus der Urananreicherung bekannte Theorie zur Beurteilung der Trennung von Zwei-Komponenten-Gemischen konnte für die Anwendung auf Mehr-Komponenten-Gemische erweitert werden. Damit eröffnet sich die Möglichkeit, Energie- und Investitionsaufwand einer Trennoperation relativ einfach und schnell aus den Vorgaben der Mengen- und Stoffbilanz zu ermitteln. Parameter, die für diese Berechnung erforderlich sind, müssen für jede Trennöperation einmal ermittelt werden, lassen sich dann jedoch beliebig oft für verschiedene Reinheitsgrade benutzen. Eine wesentliche Erkenntnis der bisherigen Entwicklung nuklearerKohleveredelungsverfahren "Wasserdampf-Kohle-Vergasung" und "Hydrierende Kohle-Vergasung" ist, daß neben der eigentlichen Vergasung vor allem die Trennung von Stoffen von großer Bedeutung für die Gesamtprozesse ist. Dies ist auch die Abtrennung von Schadstoffen und Begleitstoffen, die zweckmäßige Einstellung der Reaktionsgemische und die Behandlung der abzugebenden Stoffe. Wendet man die Stofftrennungstheorie auf diese Verfahrensvorschläge an, so lassen sich aus deren Simulation wichtige Schlußfolgerungen ziehen

A macro approach to software resource estimation of life cycle control.

http://archive.org/details/macroapproachtos00vorgNANAN

Untersuchung von Kohleveredelungsanlagen unter besonderer Beruecksichtigung der Trennaufgaben

Copy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Individual difficulties and resources – a qualitative analysis in patients with advanced lung cancer and their relatives

Anika Sparla,1 Sebastian Flach-Vorgang,1 Matthias Villalobos,2 Katja Krug,1 Martina Kamradt,1 Kadiatou Coulibaly,1 Joachim Szecsenyi,1 Michael Thomas,2 Sinikka Gusset-Bährer,2 Dominik Ose1,3 1Department of General Practice and Health Services Research, Heidelberg University Hospital, 2Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; 3University of Utah, Department of Population Health Sciences, Health System Innovation and Research, Salt Lake City, UT, USA Purpose: Lung cancer is a disease with a high percentage of patients diagnosed in an advanced stage. In a situation of palliative treatment, both patients and their relatives experience diverse types of distress and burden. Little research has been done to identify the individual difficulties and resources for patients with advanced lung cancer and their relatives. Especially, standardized questionnaire-based exploration may not assess the specific distressing issues that pertain to each individual on a personal level. The purpose of this qualitative study is to explore and compare individual difficulties and resources for lung cancer patients and their relatives within the palliative care context.Methods: Data were collected by qualitative interviews. A total of 18 participants, nine patients diagnosed with advanced lung cancer (International Classification of Diseases, tenth edition, diagnosis C-34, stage IV) starting or receiving palliative treatment and nine relatives, were interviewed. Data were interpreted through qualitative content analysis.Results: We identified four main categories of difficulties: communication and conflicts, home and everyday life, thinking about cancer, and treatment trajectory. In general, difficulties were related to interpersonal relationships as well as to impact of chemotherapy. Family, professional caregivers, and social life were significant resources and offered support to both patients and relatives.Conclusion: Results suggest that patient and relative education could reduce difficulties in several areas. Patients seem to struggle with the fear of not having any perspective in therapy. Relatives seem to experience helplessness regarding their partner’s deterioration and have to handle their own life and the care work simultaneously. The most important resource for both patients and relatives is their family. In addition, professional lung cancer nurses support relatives in an emotional and organizational way. Intense supportive care for relatives should be standardized. Keywords: inoperable lung cancer, palliative care, difficulties, resources, health services research, qualitative researc