A Qualitative Study of the Meaning for Older People of Living Alone at Home in Rural Ghana

Many people live alone in old age, often with significant health and other challenges. Living alone may contribute to social isolation, with this concept understood as loneliness that has negative influences on health and wellbeing. Alternatively, living alone could be salutogenic (or positive). An interpretive-descriptive study explored the meaning for older adults of living alone at home in rural Ghana, a developing African country. After purposive sampling, multi-day observations and repeated interviews of 10 individuals occurred until data saturation was achieved. Three themes emerged: (a) how they came to be living alone, (b) their variable ability to competently and comfortably live at home alone in old age, and (c) fears associated with living alone in old age. Most of the participants interviewed indicated that living alone was not a choice. Many difficulties with living alone were present, including fears about personal safety and the need to cope with health and income issues. As such, new considerations for old age social isolation were identified. With accelerating population aging, more older people will be living alone, making it essential for health and social policies to be designed in rural and urban areas of each country that address local cultural and economic realities.   &nbsp

Moral Distress Experienced by Nurses in Relation to Organ Donation and Transplantation

With a shortage of organs for transplantation purposes, many ethical issues confront registered nurses, particularly those involved in making difficult allocation and rejection decisions and those who interact with people who are not successful in gaining a needed organ for survival. This is a theoretical paper aimed at justifying the need for research investigations on moral distress in relation to organ donation and transplantation. Given the caring nature of nurses and the widespread impact of the shortage of organs for transplantation purposes, moral distress is likely to be present and growing in both incidence and severity

Age-based Considerations in Educating Children About Organ Transplantation

This study sought undergraduate nursing student views on the best method for educating children of different ages about organ transplantation when they are candidates for the procedure. This was a cross-sectional survey of volunteers who completed a questionnaire. For children under age 6, the students indicated most often that the best method to teach them was “Parents talk to the child.” For children aged 6-11, two answers were commonly provided: “One-on-one teaching by a transplant nurse” and “Group classes of children own age by transplantation team.” For children aged 12-17, the most common answer was “One-on-one teaching by transplant nurse.” As such, the child’s age greatly influenced their answers, an understandable and expected finding. However, it is important to consider that chronically-ill children who have had frequent healthcare experiences are likely to have different learning needs and abilities as compared to well children their own age, and so research is needed now to determine if conventional views about the way to teach them (and particularly those under the age of 6) are correct

How is Death Hastening Done? A Review of Existing Sanctioned Death Hastening Decision-Making Processes and Practices

Death hastening is a controversial terminal care option that is currently carried out in only four countries and some US states, with Canada posed to allow it on June 6, 2016. This article focuses on how assisted suicide and euthanasia have been managed in the four countries and US states where it has been sanctioned and practiced. A systematic literature review and additional searches were employed to gain information on the methods, recipients, procedures, regulations, outcomes, and other information available on state-sanctioned death hastening. The findings reveal many different possible models and thus considerations required for planning in advance of death hastening actually occurring.  &nbsp

Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8%) and urbanite (79.5%), and cancer was the most common diagnosis (36.2%). Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3%) had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital

An Examination of Palliative or End-of-Life Care Education in Introductory Nursing Programs across Canada

An investigation was done to assess for and describe the end-of-life education provided in Canadian nursing programs to prepare students for practice. All 35 university nursing schools/faculties were surveyed in 2004; 29 (82.9%) responded. At that time, all but one routinely provided this education, with that school developing a course (implemented the next year). As compared to past surveys, this survey revealed more class time, practicum hours, and topics covered, with this content and experiences deliberately planned and placed in curriculums. A check in 2010 revealed that all of these schools were providing death education similar to that described in 2004. These findings indicate that nurse educators recognize the need for all nurses to be prepared to care for dying persons and their families. Regardless, more needs to be done to ensure novice nurses feel capable of providing end-of-life care. Death education developments will be needed as deaths increase with population aging

Molecular Subtypes and Personalized Therapy in Metastatic Colorectal Cancer

Development of colorectal cancer occurs via a number of key pathways, with the clinicopathological features of specific subgroups being driven by underlying molecular changes. Mutations in key genes within the network of signalling pathways have been identified; however, therapeutic strategies to target these aberrations remain limited. As understanding of the biology of colorectal cancer has improved, this has led to a move toward broader genomic testing, collaborative research and innovative, adaptive clinical trial design. Recent developments in therapy include the routine adoption of wider mutational spectrum testing prior to use of targeted therapies and the first promise of effective immunotherapy for colorectal cancer patients. This review details current biomarkers in colorectal cancer for molecular stratification and for treatment allocation purposes, including open and planned precision medicine trials. Advances in our understanding, therapeutic strategy and technology will also be outlined

THE ROLE OF PRODUCT ATTRIBUTES IN THE AGRICULTURAL NEGOTIATIONS

Marketing, International Relations/Trade,

Respiratory muscle deoxygenation during exercise in patients with heart failure demonstrated with near-infrared spectroscopy

AbstractExertional dyspnea in patients with heart failure may be due, in part, to respiratory muscle underperfusion. Near-infrared spectroscopy is a new technique that permits noninvasive assessment of skeletal muscle oxygenation by monitoring changes in nearinfrared light absorption. With use of near-infrared spectroscopy, serratus anterior muscle oxygenation during maximal bicycle exercise was compared in 10 patients with heart failure (ejection fraction 16 ± 5%) and 7 age-matched normal subjects. Oxygen consumption (VO2), minute ventilation (VE) and arterial saturation were also measured. Changes in difference in absorption between 760 and 800 nm, expressed in arbitrary units, were used to detect muscle deoxygenation.Minimal change in this difference in absorption occurred in normal subjects during exercise, whereas patients with heart failure exhibited progressive changes throughout exercise consistent with respiratory muscle deoxygenation (peak exercise: normal 3 ± 6, heart failure 12 ± 4 near-infrared arbitrary units, p < 0.001). At comparable work loads patiente with heart failure had significantly greater minute ventilation and respiratory rate but similar tidal volume when contrasted with normal subjects. However, at peak exercise normal subjects achieved significantly greater minute ventilation and tidal volume with a comparable respiratory rate. No significant arterial desaturation occurred during exercise in either group.These findings indicate that respiratory muscle deoxygenation occurs in patients with heart failure during exercise. This deoxygenation may contribute to the exertional dyspnea experienced by such patients