Philological Approaches

As a mode of study, philology has a long history, yet the way the term has been used, and the attitude of scholars to both the study of orthography and the meaning of orthographic variation, has changed substantially over time. This chapter outlines the origins and history of philology, from its roots in the Classical period to the present day, and discusses how far philological approaches pertain to the study of historical orthography. Philology’s focus on material, historical and manuscript contexts makes it an especially fruitful way of interrogating historical texts, and philological methods have long been viewed as a particularly apt way of dealing with (among other features) the wide orthographic variation naturally present in medieval works. To illustrate the concerns and approaches of present-day philologists to the study of historical orthography, the chapter presents two case studies. The first focuses on scribal practices in Old English and provides an example of a manuscript-centered analysis of orthography. The second focuses on the scripting of Old English and Old High German and illustrates how historical orthographies can be analyzed by mapping spelling onto an etymological sound reference system

Translating Middle English (Im)politeness: The Case of Geoffrey Chaucer’s Miller’s Tale

Some of the bawdy details of Chaucer’s Canterbury Tales continue to pose challenges to translators, who must find renderings that are both descriptively and stylistically adequate. The Miller’s Tale provides an illustrative case study, in which the drunken narrator describes Nicholas’s rather physical wooing of the carpenter’s wife Alisoun in graphic detail. Existing translations of the key term queynte range from the flowery euphemism to the straightforward vulgarism. An appropriate translation into present-day English needs to be based not only on sound philological analysis, but also on a careful evaluation of the register of the original Middle English expression. This article offers a corpus-based assessment of relevant candidate expressions in order to propose a translation that captures the appropriate level of (im)politeness, both of the narrator towards his fellow pilgrims and of Chaucer towards his readers

Psychological adjustment to lung transplantation

Lung transplantation (LTx) is an effective treatment for end-stage lung failure. Despite great advances in transplant medicine over the last few decades, LTx does not result in complete recovery of health, as transplant recipients continue to be confronted by various health problems that must be psychologically processed and overcome. Many suffer from frequent emotional distress and psychological disorders that can negatively influence their ability to cope with their new organ, negatively impacting both their adherence to immunosuppressive therapy and health-related quality of life (HRQoL). Therefore, it is both clinically and scientifically relevant to assess the postoperative HRQoL and mental health of LTx recipients to identify those at risk for poor post-transplant outcomes and to improve patients’ symptom experience. This manuscript consists of three studies that review psychological adjustment to lung transplantation in terms of HRQoL and psychosocial outcomes via three different approaches. Study 1 is a systematic review of the literature to compile and interpret the evidence on measures to assess HRQoL and psychological outcomes following LTx, summarizing psychological outcomes in studies published between 1994 and 2013. Of 371 articles, 63 studies were selected for final review. Considerable heterogeneity was found in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, eligible studies generally point to significant improvements in both mental health and HRQoL post-transplant. A huge opportunity for future research lies in the development of guidelines to aid in the selection of outcome measures to assess psychological outcomes of lung transplant recipients. The second study investigated the psychosocial outcome trajectories of 40 lung transplant recipients related to psychological distress and HRQoL over their first six months posttransplant. Three distinctive clusters were identified: (1) patients with optimal postoperative trajectories (35%); (2) patients with good postoperative trajectories (42%); and (3) patients with poor postoperative trajectories (23%). The last group tended to be older, to suffer from more severe disease, to have more co-morbid conditions, and to have had a prolonged ICU and/or hospital stay. Disease severity, length of stay, and HRQoL two weeks post-transplant were strong predictors of psychological distress and impaired HRQoL at six months of follow-up. The results underscore the psychosocial needs of patients with poor post-transplant trajectories. The third study qualitatively analyzed patient experiences with transplantation and their adjustment to normal life within the first six months post-transplant. ‘Physical benefits’, ‘fear of rejection’, ‘gratitude towards the donor’, and ‘side effects’ were the most frequently named themes with respect to the transplantation process, new lungs, donor and medication regimen. Most themes remained unchanged over time. While comments about ‘intensive care unit delirium’ and ‘worries regarding donated organ quality’ diminished significantly over time, mentions of ‘restrictions in everyday life’ increased significantly. Gender comparison revealed only marginal differences in the response categories. Improvements in physical function during the early postoperative phase may be limited by the onset of clinical complications, fear of rejection and infections, medication side effects, and restrictions in everyday life. Generally, studies on HRQoL and psychological outcomes after lung transplantation have been limited by lost to follow-up, cross-sectional designs, small sample sizes and, great variability in the use of validated and non-validated outcome measures, such that comparisons between different studies are difficult. One area of future research is the development of consensus guidelines to aid in the selection of outcome measures to assess HRQoL and psychological outcomes among LTx patients. In addition, longitudinal studies, including pre- vs. post-transplant assessment with adequately-sized samples are needed to further investigate outcome profiles and identify additional outcome predictors in these patients

Resilience in Cancer Patients

Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual’s ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events.Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer.Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress.Results: Biological, personal, and most importantly social factors contribute to cancer patients’ resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed.Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care

The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions

Healthcare is presently experiencing a global workforce crisis, marked by the inability of hospitals to retain qualified healthcare workers. Indeed, poor working conditions and staff shortages have contributed to structural collapse and placed a heavy toll on healthcare workers' (HCWs) well-being, with many suffering from stress, exhaustion, demoralization, and burnout. An additional factor driving qualified HCWs away is the repeated experience of moral distress, or the inability to act according to internally held moral values and perceived ethical obligations due to internal and external constraints. Despite general awareness of this crisis, we currently lack an organized understanding of how stress leads to poor health, wellbeing, and performance in healthcare workers. To address this critical issue, we first review the literature on moral distress, stress, and health in HCWs. Second, we summarize the biobehavioral pathways linking occupational and interpersonal stressors to health in this population, focusing on neuroendocrine, immune, genetic, and epigenetic processes. Third, we propose a novel Psychoneuroimmunological Model of Moral Distress and Health in HCWs based on this literature. Finally, we discuss evidence-based individual- and system-level interventions for preventing stress and promoting resilience at work. Throughout this review, we underscore that stress levels in HCWs are a major public health concern, and that a combination of system-level and individual-level interventions are necessary to address preventable health care harm and foster resilience in this population, including new health policies, mental health initiatives, and additional translational research

Prevalence and predictors for 72-h mortality after transfer to acute palliative care unit

PURPOSE Accurate prediction of survival is important to facilitate clinical decision-making and improve quality of care at the end of life. While it is well documented that survival prediction poses a challenge for treating physicians, the need for clinically valuable predictive factors has not been met. This study aims to quantify the prevalence of patient transfer 72 h before death onto the acute palliative care unit in a tertiary care center in Switzerland, and to identify factors predictive of 72-h mortality. METHODS All patients hospitalized between January and December 2020 on the acute palliative care unit of the Competence Center Palliative Care of the Department of Radiation Oncology at the University Hospital Zurich were assessed. Variables were retrieved from the electronic medical records. Univariable and multivariable logistic regressions were used to identify predictors of mortality. RESULTS A total of 398 patients were screened, of which 188 were assessed. Every fifth patient spent less than 72 h on the acute palliative care unit before death. In multivariable logistic regression analysis, predictors for 72-h mortality after transfer were no prior palliative care consult (p = 0.011), no advance care directive (p = 0.044), lower performance status (p = 0.035), lower self-care index (p = 0.003), and lower blood albumin level (p = 0.026). CONCLUSION Late transfer to the acute palliative care unit is not uncommon, which can cause additional distress to patients and caretakers. Though clinically practical short-term survival predictors remain largely unidentified, early integration of palliative care should be practiced more regularly in patients with life-limiting illness

Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy

Background Treatment of metastatic cancer patients with multiple repeat courses of radiotherapy has become more frequent due to their improved overall survival. However, very little is known about their long-term outcome. This analysis reports on the quality-of-life, hematologic toxicity, patient-reported experiences and satisfaction, and psychological distress of cancer patients treated with multiple repeat radiotherapy. Methods All patients treated with ≥5 courses of radiotherapy between 2011 and 2019 at the Department of Radiation Oncology, University Hospital Zurich (USZ) were screened for this study. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. All patients completed two questionnaires: EORTC QLQ-C30 questionnaire for quality-of-life and a questionnaire evaluating psychological distress and patient-reported experiences. Hematologic toxicities were assessed via a recent blood sample. Results Of n = 33 patients treated with ≥5 radiotherapy courses and being alive, 20 (60.6%) participated in this study. The most common primary tumor was non-small cell lung cancer (n = 14, 42.4%). The most common sites of irradiation were brain (n = 78, 37.1%) and bone metastases (n = 59, 28.1%). All participating patients reported that they had experienced a subjective benefit from multiple repeat radiotherapy and denied increased side effects in later radiotherapy courses. Yet, 45% (n = 9) of the patients reported an increase of psychological distress with increasing numbers of radiotherapy treatments. While global health status was stable, patients having received multiple repeat radiotherapy reported increased fatigue (p = <0.006). Blood analysis showed significantly reduced hemoglobin and lymphocyte levels compared to the healthy population (p = <0.03). Discussion and conclusion Patient-reported experiences and satisfaction of long-term cancer patients treated with multiple repeat radiotherapy are positive. However, increased levels of fatigue and significantly reduced hemoglobin and lymphocyte levels were observed. These data indicate the need to further investigate the effects of multiple courses of radiotherapy in chronic cancer patients

Ist eine Handlungsempfehlung für den Einsatz von Ketamin / Esketamin zur Behandlung von Depression und Angst in der Palliative Care möglich?

Aufgrund der oft limitierten Lebenserwartung von Patientinnen und Patienten in der Palliative Care stellt sich insbesondere in Bezug auf die Behandlung möglicher psychischer Störungen wie Depression oder Angst die Herausforderung rasch wirksamer und möglichst einfach zu applizierender Medikamente. Ziel dieser Arbeit ist es, die aktuelle Literatur und ausgewählte Leitlinien in Hinblick auf Evidenz bezüglich Einsatz von Ketamin und Esketamin als Medikamente zur Behandlung von Depression und Angststörung bei palliativen Patientinnen und Patienten zu untersuchen