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in favour of cpr predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit dnar decisions.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

Microseismic Monitoring of the Mounds Drill Cuttings Injection Tests

This paper describes the microseismic mapping of repeated injections of drill cuttings into two separate formations at a test site near Mounds, OK. Injections were performed in sandstone and shale formations at depths of 830 and 595 m, respectively. Typical injection disposal was simulated using multiple small-volume injections over a three-day period, with long shut-in periods interspersed between the injections. Microseismic monitoring was achieved using a 5-level array of wireline-run, triaxial- accelerometer receivers in a monitor well 76 m from the disposed well. Results of the mapped microseismic locations showed that the disposal domti W= generally aligns with the major horizontal stress with some variations in azimuth and that wide variations in height and length growth occurred with continued injections. These experiments show that the cuttings injection process cm be adequately monitored from a downhole, wireline-run receiver array, thus providing process control and environmental assurance

Health-related quality of life change in patients treated at a multidisciplinary pain clinic

Background Multidisciplinary pain management (MPM) is a generally accepted method for treating chronic pain, but heterogeneous outcome measures provide only limited conclusions concerning its effectiveness. Therefore, further studies on the effectiveness of MPM are needed to identify subgroups of patients who benefit, or do not benefit, from these interventions. Our aim was to analyse health-related quality of life (HRQoL) changes after MPM and to identify factors associated with treatment outcomes. Methods We carried out a real world observational follow-up study of chronic pain patients referred to a tertiary multidisciplinary outpatient pain clinic to describe, using the validated HRQoL instrument 15D, the HRQoL change after MPM and to identify factors associated with this change. 1,043 patients responded to the 15D HRQoL questionnaire at baseline and 12 months after the start of treatment. Background data were collected from the pre-admission questionnaire of the pain clinic. Results Fifty-three percent of the patients reported a clinically important improvement and, of these, 81% had a major improvement. Thirty-five percent reported a clinically important deterioration, and 12% had no change in HRQoL. Binary logistic regression analysis revealed that major improvement was positively associated with shorter duration of pain (Peer reviewe

Humanistic psychotherapy research 1990-2015 : from methodological innovation to evidence-supported treatment outcomes and beyond

Over the past twenty five years, humanistic psychotherapy (HP) researchers have actively contributed to the development and implementation of innovative practice-informed research measures and coding systems. Qualitative and quantitative research findings, including meta-analyses, support the identification of HP approaches as evidence-based treatments for a variety of psychological conditions. Implications for future psychotherapy research, training and practice are discussed in terms of addressing the persistent disjunction between significant HP research productivity and relatively low support for HP approaches in university-based clinical training programs, funding agencies and government-supported clinical guidelines. Finally, specific recommendations are provided to further enhance and expand the impact of humanistic psychotherapy research for clinical training programs and the development of treatment guidelines

Effects of school-based interventions on mental health stigmatization: a systematic review

Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others