Content of health status reports of people seeking assisted suicide: a qualitative analysis

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue

Content of health status reports of people seeking assisted suicide: a qualitative analysis

Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursu

Modell evidenzbasierter Rehabilitationspflege

Rehabilitation ist ein junger Fachbereich in der Schweiz. Die gesetzlichen Grundlagen für die Rehabilitationsmedizin wurden 1996 im Krankenversicherungsgesetz (KVG) gelegt. Rehabilitation befasst sich mit den Folgen von Krankheiten und Unfällen und richtet sich an alle Menschen, die in ihrer Funktion oder Partizipation eingeschränkt sind. Rehabilitation ist der koordinierte Einsatz medizinischer, pflegerischer, sozialer, beruflicher, technischer und pädagogischer Maßnahmen zur Funktionsverbesserung, zum Erreichen einer größtmöglichen Eigenaktivität und Partizipation in allen Lebensbereichen (AG Leistungserbringer-Versicherer für wirtschaftliche und qualitätsgerechte Rehabilitation (ALVR), 1999). In den letzten Jahren fand ein Übergang von traditionellen Bäderkliniken zu eigentlichen Rehabilitationskliniken statt; es entstanden Kliniken für neurologische, kardiologische, pneumologische und traumatologische Rehabilitation (Knüsel & Bachmann, 2010). Heute entfallen 4232 (10,6%) der Krankenhausbetten in der Schweiz auf Rehabilitationsklinken. Pro 1000 Einwohner wurden im Jahre 2007 6,8 Patientinnen während durchschnittlich 25,3 Tage in Rehabilitationskliniken mit dem Ziel der Wiedereingliederung in das angestammte Umfeld stationär behandelt. Die meisten von ihnen waren über 70-jährige Frauen (BFS – Statistisches Lexikon der Schweiz, 2009)

Wie Menschen mit Multipler Sklerose die mobilitätsfördernde Pflegeintervention erleben

In der Schweiz leben rund 10.000 Menschen mit Multipler Sklerose (MS). MS ist eine Autoimmunerkrankung des zentralen Nervensystems (ZNS). Durch die nachfolgende Demyelinisierung und Axondegeneration im ZNS treten unterschiedliche Behinderungen auf. Menschen mit MS leiden neben Symptomen wie Müdigkeit und Schwäche an Beeinträchtigungen ihrer Koordination und Bewegung. MS-Betroffenen, die in ihrer Bewegung eingeschränkt sind, wurde während des Rehabilitationsaufenthaltes die Intervention der Mobilitätsfördernden Pflege (MfP) angeboten. Dabei schlafen die Betroffenen auf einem Matratzenlager auf dem Boden, werden über verschiedene Stufen und Positionen vom Boden in den Rollstuhl und umgekehrt, mobilisiert und angeleitet, ihre Bewegungsfähigkeiten einzusetzen. Im Rahmen einer randomisiert kontrollierten Studie, die die Intervention MfP auf den Rehabilitationseffekt hin überprüft, wurde untersucht, wie Patienten mit MS die Intervention der MfP erleben. Dazu wurden 16 Teilnehmende der Interventionsgruppe interviewt und ihre Aussagen mittels interpretierender Phänomenologie analysiert. Die Teilnehmenden litten zwischen 3 und 31 Jahren an MS. Es wurden vier unterschiedliche Muster des Erlebens beschrieben. Je nach Persönlichkeit, Krankheitsverlauf und Kontext sprachen die Patienten über andere Phänomene ihres Erlebens. Dabei ging es um das Erleben eines Trainingseffektes, um Anstrengung, um Vertrauen in den eigenen Körper und den Prozess von »Heilwerden«. Die Aussagen eröffnen Pflegenden einen Zugang zur Welt dieser Menschen, damit sie besser auf deren Bedürfnisse eingehen können

Do not attempt resuscitation : the importance of consensual decisions

Aims: To describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (cpr / do not attempt resuscitation (dnar) decisions; to analyse decision patterns; and understand the practical implications. Design: A qualitative grounded theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in German-speaking Switzerland. Results: Establishing dnar orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of cpr predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit dnar decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. Conclusion: Establishing dnar orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education

Handling EEG artifacts and searching individually optimal experimental parameter in real time: a system development and demonstration

Abstract: Objective. Neuroadaptive paradigms that systematically assess event-related potential (ERP) features across many different experimental parameters have the potential to improve the generalizability of ERP findings and may help to accelerate ERP-based biomarker discovery by identifying the exact experimental conditions for which ERPs differ most for a certain clinical population. Obtaining robust and reliable ERPs online is a prerequisite for ERP-based neuroadaptive research. One of the key steps involved is to correctly isolate electroencephalography artifacts in real time because they contribute a large amount of variance that, if not removed, will greatly distort the ERP obtained. Another key factor of concern is the computational cost of the online artifact handling method. This work aims to develop and validate a cost-efficient system to support ERP-based neuroadaptive research. Approach. We developed a simple online artifact handling method, single trial PCA-based artifact removal (SPA), based on variance distribution dichotomies to distinguish between artifacts and neural activity. We then applied this method in an ERP-based neuroadaptive paradigm in which Bayesian optimization was used to search individually optimal inter-stimulus-interval (ISI) that generates ERP with the highest signal-to-noise ratio. Main results. SPA was compared to other offline and online algorithms. The results showed that SPA exhibited good performance in both computational efficiency and preservation of ERP pattern. Based on SPA, the Bayesian optimization procedure was able to quickly find individually optimal ISI. Significance. The current work presents a simple yet highly cost-efficient method that has been validated in its ability to extract ERP, preserve ERP effects, and better support ERP-based neuroadaptive paradigm

Handling EEG artifacts and searching individually optimal experimental parameter in real time: a system development and demonstration.

Objective.Neuroadaptive paradigms that systematically assess event-related potential (ERP) features across many different experimental parameters have the potential to improve the generalizability of ERP findings and may help to accelerate ERP-based biomarker discovery by identifying the exact experimental conditions for which ERPs differ most for a certain clinical population. Obtaining robust and reliable ERPs online is a prerequisite for ERP-based neuroadaptive research. One of the key steps involved is to correctly isolate electroencephalography artifacts in real time because they contribute a large amount of variance that, if not removed, will greatly distort the ERP obtained. Another key factor of concern is the computational cost of the online artifact handling method. This work aims to develop and validate a cost-efficient system to support ERP-based neuroadaptive research.Approach.We developed a simple online artifact handling method, single trial PCA-based artifact removal (SPA), based on variance distribution dichotomies to distinguish between artifacts and neural activity. We then applied this method in an ERP-based neuroadaptive paradigm in which Bayesian optimization was used to search individually optimal inter-stimulus-interval (ISI) that generates ERP with the highest signal-to-noise ratio.Main results.SPA was compared to other offline and online algorithms. The results showed that SPA exhibited good performance in both computational efficiency and preservation of ERP pattern. Based on SPA, the Bayesian optimization procedure was able to quickly find individually optimal ISI.Significance.The current work presents a simple yet highly cost-efficient method that has been validated in its ability to extract ERP, preserve ERP effects, and better support ERP-based neuroadaptive paradigm