Medical students writing on death, dying and palliative care : a qualitative analysis of reflective essays

Background: Medical students and doctors are becoming better prepared to care for patients with palliative care needs and support patients at the end of life. This preparation needs to start at medical school. Objective: To assess how medical students learn about death, dying and palliative care during a clinical placement using reflective essays and to provide insights to improve medical education about end of life care and/or palliative care. Methods: Qualitative study in which all reflective essays written by third year medical students in one year from a UK medical school were searched electronically for those that included ‘death’, ‘dying’ and ‘palliative care’. The anonymised data were managed using QSR NVivo 10 software, and a systematic analysis was conducted in three distinct phases: (1) open coding; (2) axial coding and (3) selective coding. Ethical approval was received. Results: Fifty-four essays met the inclusion criteria from 241 essays screened for the terms ‘death’, ‘dying’ or ‘palliative’, 22 students gave consent for participation and their 24 essays were included. Saturation of themes was reached. Three overarching themes were identified: emotions, empathy, and experiential and reflective learning. Students emphasised trying to develop a balance between showing empathy and their emotional state. Students learned a lot from clinical encounters and watching doctors manage difficult situations, as well as from their refection during and after the experience. Conclusions: Reflective essays give insights into the way students learn about death, dying and palliative care and how it affects them personally as well as the preparation that is needed to be better equipped to deal with these kinds of experiences. Analysis of the essays enabled the proposal of new strategies to help make them more effective learning tools and to optimise students’ learning from a palliative care attachment

Communication and support from health-care professionals to families, with dependent children, following the diagnosis of parental life-limiting illness : a systematic review

Background: Communication between parents and their children about parental life-limiting illness is stressful. Parents want support from health-care professionals; however, the extent of this support is not known. Awareness of family’s needs would help ensure appropriate support. Aim: To find the current literature exploring (1) how parents with a life-limiting illness, who have dependent children, perceive health-care professionals’ communication with them about the illness, diagnosis and treatments, including how social, practical and emotional support is offered to them and (2) how this contributes to the parents’ feelings of supporting their children. Design: A systematic literature review and narrative synthesis. Data sources: Embase, MEDLINE, PsycINFO, CINAHL and ASSIA ProQuest were searched in November 2015 for studies assessing communication between health-care professionals and parents about how to talk with their children about the parent’s illness. Results: There were 1342 records identified, five qualitative studies met the inclusion criteria (55 ill parents, 11 spouses/carers, 26 children and 16 health-care professionals). Parents wanted information from health-care professionals about how to talk to their children about the illness; this was not routinely offered. Children also want to talk with a health-care professional about their parents’ illness. Health-care professionals are concerned that conversations with parents and their children will be too difficult and time-consuming. Conclusion: Parents with a life-limiting illness want support from their health-care professionals about how to communicate with their children about the illness. Their children look to health-care professionals for information about their parent’s illness. Health-care professionals, have an important role but appear reluctant to address these concerns because of fears of insufficient time and expertise

Opioids do not influence metastasis in experimental animal cancer models

Correspondenc

ENTREPRENEURIAL RISK-TAKING VERSUS GROWTH MANAGEMENT: THE CASE OF PREMIER TECHNOLOGY, INC.

Agribusiness,

Multivariable control theory applied to hierarchial attitude control for planetary spacecraft

Multivariable control theory is applied to the design of a hierarchial attitude control system for the CARD space vehicle. The system selected uses reaction control jets (RCJ) and control moment gyros (CMG). The RCJ system uses linear signal mixing and a no-fire region similar to that used on the Skylab program; the y-axis and z-axis systems which are coupled use a sum and difference feedback scheme. The CMG system uses the optimum steering law and the same feedback signals as the RCJ system. When both systems are active the design is such that the torques from each system are never in opposition. A state-space analysis was made of the CMG system to determine the general structure of the input matrices (steering law) and feedback matrices that will decouple the axes. It is shown that the optimum steering law and proportional-plus-rate feedback are special cases. A derivation of the disturbing torques on the space vehicle due to the motion of the on-board television camera is presented. A procedure for computing an upper bound on these torques (given the system parameters) is included

MIDWEST GRAIN PRODUCTS: A CHANGE IN STRATEGY DUE TO TRADE ISSUES

Crop Production/Industries, International Relations/Trade,

An Overview of the Wheat Gluten Industry

Production Economics,

Global and U.S. Wheat Gluten Industries: Structure, Competition, and Trade

Industrial Organization,