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Journal articles on the topic 'Aided Dying'
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Capron, Alexander M. "Legalizing Physician-Aided Death." Cambridge Quarterly of Healthcare Ethics 5, no. 1 (1996): 10–23. http://dx.doi.org/10.1017/s096318010000668x.
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Physician aid in dying is a broader topic than euthanasia in that the latter usually refers to active euthanasia, while physician assistance also encompasses the issue of assisted suicide. Volumes could be and have been written on physician-assisted death. But my purpose here is to address a specific aspect of the topic: the policy implications with regard to proposed legislation on physician-aided death.Although the title's reference to physician assistance suggests a focus on the role of the professional, what people often take to be most important and at the heart of the topic is the issue of the patient's rights, usually seen as being manifested in four different ways. First is the right to a dignified death, as free from pain and suffering as possible. In crossing national boundaries and preceding the organization of the professions and the creation of societies, this right is viewed as one that ought to be recognized.
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Hannig, Anita. "Author(iz)ing Death: Medical Aid-in-Dying and the Morality of Suicide." Cultural Anthropology 34, no. 1 (February 22, 2019): 53–77. http://dx.doi.org/10.14506/ca34.1.08.
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In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.
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Thomasma, David C. "When Physicians Choose to Participate in the Death of Their Patients: Ethics and Physician-Assisted Suicide." Journal of Law, Medicine & Ethics 24, no. 3 (1996): 183–97. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01852.x.
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Physicians have long aided their patients in dying in an effort to ease human suffering. It is only in the nineteenth and twentieth centuries that the prolongation of life has taken on new meaning due to the powers now available to physicians, through new drugs and high technology interventions. Whereas earlier physicians and patients could readily acknowledge that nothing further could be done, today that judgment is problematic.Most often, aiding the dying took the form of not doing anything further to prolong life. Morally, this act of restraint was not difficult, because few options could have been considered. However, some physicians, rarely, would help patients die either by hastening death directly or by increasing pain control with the risk of hastening death, the so-called double effect. When directly hastening death, physicians either directly caused the death of the patient through euthansia, or supplied the means to the patient to bring about death with or without encouragement to use these means. The latter is physician-assisted suicide (PAS).
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Silvagni, P. A., L. J. Lowenstine, T. Spraker, T. P. Lipscomb, and F. M. D. Gulland. "Pathology of Domoic Acid Toxicity in California Sea Lions (Zalophus californianus)." Veterinary Pathology 42, no. 2 (March 2005): 184–91. http://dx.doi.org/10.1354/vp.42-2-184.
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Over 100 free-ranging adult California sea lions ( Zalophus californianus) and one Northern fur seal ( Callorhinus ursinus), predominantly adult females, were intoxicated by domoic acid (DA) during three harmful algal blooms between 1998 and 2000 in central and northern California coastal waters. The vector prey item was Northern anchovy ( Engraulis mordax) and the primary DA-producing algal diatom was Psuedonitzschia australis. Postmortem examination revealed gross and histologic findings that were distinctive and aided in diagnosis. A total of 109 sea lions were examined, dying between 1 day and 10 months after admission to a marine mammal rehabilitation center. Persistent seizures with obtundation were the main clinical findings. Frequent gross findings in animals dying acutely consisted of piriform lobe malacia, myocardial pallor, bronchopneumonia, and complications related to pregnancy. Gross findings in animals dying months after intoxication included bilateral hippocampal atrophy. Histologic observations implicated limbic system seizure injury consistent with excitotoxin exposure. Peracutely, there was microvesicular hydropic degeneration within the neuropil of the hippocampus, amygdala, pyriform lobe, and other limbic structures. Acutely, there was ischemic neuronal necrosis, particularly apparent in the granular cells of the dentate gyrus and the pyramidal cells within the hippocampus cornu ammonis (CA) sectors CA4, CA3, and CA1. Dentate granular cell necrosis has not been reported in human or experimental animal DA toxicity and may be unique to sea lions. Chronically, there was gliosis, mild nonsuppurative inflammation, and loss of laminar organization in affected areas.
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Azotam, Adaorah NU. "Pediatric consent." Nursing Ethics 19, no. 4 (June 29, 2012): 581–85. http://dx.doi.org/10.1177/0969733012448348.
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This article will explore pediatric consent through the analysis of a clinical case study using the principles of biomedical ethics approach. Application of the principles of autonomy, nonmaleficence, beneficence, and justice will be dissected in order to attempt to establish resolution of the ethical dilemma. The main conflict in this case study deals with whether the wishes of an adolescent for end-of-life care should be followed or should the desire of his parents outweigh this request. In terminal cancer, the hope of early palliative care and dignity in dying serve as priorities in therapy. Application of the moral principles to both sides of the dilemma aided in providing an objective resolution to uphold pediatric consent.
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Wiegand, Debra L., Jooyoung Cheon, and Giora Netzer. "Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU." American Journal of Hospice and Palliative Medicine® 36, no. 1 (September 24, 2018): 13–23. http://dx.doi.org/10.1177/1049909118801011.
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Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.
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MAHLBERG, GABY. "LES JUGES JUGEZ, SE JUSTIFIANTS(1663) AND EDMUND LUDLOW‘S PROTESTANT NETWORK IN SEVENTEENTH-CENTURY SWITZERLAND." Historical Journal 57, no. 2 (May 8, 2014): 369–96. http://dx.doi.org/10.1017/s0018246x13000447.
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ABSTRACTThis article aims to locate English republican thought and writing in a wider European context and to understand the personal connections that aided the distribution and reception of English republican ideas abroad. It does so through the case-study of a little-known pamphlet published by the English regicide Edmund Ludlow during his exile in Switzerland after the restoration of the Stuart monarchy in 1660.Les juges jugez, se justifiants(1663) was a French translation of the dying speeches and other miscellaneous texts of some of the English regicides, produced in Geneva and subsequently printed in Yverdon with the help of Ludlow's local Protestant network. Rather than propagating a secular republican ideology, Ludlow offered his work to a European Protestant audience in the language of Geneva, promoting a primarily religious cause in an attempt to make martyrs out of political activists. It is therefore to Ludlow's Protestant networks that we need to turn to find out more about the transmission of English republican ideas in francophone Europe and beyond.
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Faisal, Muhammad, Donald Richardson, Andy Scally, Robin Howes, Kevin Beatson, and Mohammed Mohammed. "Performance of externally validated enhanced computer-aided versions of the National Early Warning Score in predicting mortality following an emergency admission to hospital in England: a cross-sectional study." BMJ Open 9, no. 11 (November 2019): e031596. http://dx.doi.org/10.1136/bmjopen-2019-031596.
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ObjectivesIn the English National Health Service, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient’s risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS).DesignLogistic regression model development and external validation study.SettingTwo acute hospitals (YH—York Hospital for model development; NH—Northern Lincolnshire and Goole Hospital for external model validation).ParticipantsAdult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2).ResultsThe risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups.ConclusionsAn externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.
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Hanson, Chad T., and Malcolm P. North. "Post-fire epicormic branching in Sierra Nevada Abies concolor (white fir)." International Journal of Wildland Fire 15, no. 1 (2006): 31. http://dx.doi.org/10.1071/wf05019.
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In California’s mixed-conifer forest, which historically had a regime of frequent fires, two conifers, Sequoiadendron giganteum and Pseudotsuga menziesii, were previously known to produce epicormic sprouts from branches. We found epicormic branching in a third mixed-conifer species, Abies concolor, 3 and 4 years after a wildfire in the central Sierra Nevada Mountains of California. Sprouting occurred only from the boles. We investigated (1) whether the degree of crown loss and the extent of epicormic branching were independent; and (2) whether epicormic branching differed by tree size. The vertical extent of epicormic foliage increased with increasing severity of crown loss. There was a significantly greater proportion of large diameter-class (>50 cm diameter at breast height [dbh]) trees with epicormic branching than small/medium diameter-class (25–50 cm dbh) trees. These results suggest large diameter Abies concolor may survive high levels of crown loss, aided by crown replacement through epicormic branching, but that reiterative green foliage may not appear for up to 3 years after fire damage. If this response is widespread, it would suggest some ‘dying’ trees logged under current salvage guidelines could survive, and that higher-intensity fire may substantially reduce the density of small post-fire suppression white fir, while retaining many larger overstory trees.
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Siagian, Yuli Yanthi, Rizal Sinaga, Christoper Sinaga, and Yosef Manik. "Life cycle assessment and eco-efficiency Indicator for ulos weaving using loom machine in Toba Samosir Regency of North Sumatra." E3S Web of Conferences 74 (2018): 05002. http://dx.doi.org/10.1051/e3sconf/20187405002.
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Toba Samosir Regency is one of the centers of ulos weaving in North Sumatera. Most of the weaving processes are carried out traditionally by small-size enterprises. However, it is identified that there are 8 ulos weaving industries that utilize loom machine. To date, no holistic environmental impact assessment has yet been conducted on weaving industry in Toba Samosir. This study aims to assess potential environmental impact caused by weaving industry in Toba Samosir. The scope of this study covers gate-to-gate stages in ulos production, consisting mangiran, washing, dipping, drying, dying, boiling, sun-drying, weaving, and manirat. The functional unit of this study is 182 kg of ulos, representing one batch of production. The assessments are conducted by two approaches; these are Life Cycle Assessment and Eco-efficiency Index measurement. The LCA modeling and computation of environmental impacts are aided by openLCA software. From LCA, it is revealed that the potential environmental impacts associated with ulos weaving are Eutrophication Potential (5.28E+01 kg PO4 eq - 8.41E+01 kg PO4 eq), Climate Change Potential (7.17E+02 kg CO2 eq - 5.74E+02 kg CO2 eq), and Photochemical Oxidation Potential (3.40E+00 kg CFC-11 eq - 4.68E+01 kg CFC-11 eq). The major stressors causing these impacts are using firewood. The calculation result of Eco-Efficiency Index (EEI) for weaving industry in Toba Samosir Regency falls between 0,1 and 0,4, which indicates the product is affordable but not sustainable..
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Ferrero, Franco, Raffaella Mossotti, Riccardo Innocenti, Franco Coppa, and Monica Periolatto. "Enzyme-aided wool dyeing: Influence of internal lipids." Fibers and Polymers 16, no. 2 (February 2015): 363–69. http://dx.doi.org/10.1007/s12221-015-0363-8.
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Chaimowitz, Gary, Alison Freeland, Grainne E. Neilson, Nickie Mathew, Raj Rasasingham, Natasha Snelgrove, and Melanie Wong. "Medical Assistance In Dying: Aide médicale à mourir." Canadian Journal of Psychiatry 65, no. 9 (March 31, 2020): 664–67. http://dx.doi.org/10.1177/0706743720919299.
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Perkins, Gavin D., Frances Griffiths, Anne-Marie Slowther, Robert George, Zoe Fritz, Philip Satherley, Barry Williams, et al. "Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis." Health Services and Delivery Research 4, no. 11 (April 2016): 1–154. http://dx.doi.org/10.3310/hsdr04110.
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BackgroundCardiac arrest is the final common step in the dying process. In the right context, resuscitation can reverse the dying process, yet success rates are low. However, cardiopulmonary resuscitation (CPR) is a highly invasive medical treatment, which, if applied in the wrong setting, can deprive the patient of dignified death. Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decisions provide a mechanism to withhold CPR. Recent scientific and lay press reports suggest that the implementation of DNACPR decisions in NHS practice is problematic.Aims and objectivesThis project sought to identify reasons why conflict and complaints arise, identify inconsistencies in NHS trusts’ implementation of national guidelines, understand health professionals’ experience in relation to DNACPR, its process and ethical challenges, and explore the literature for evidence to improve DNACPR policy and practice.MethodsA systematic review synthesised evidence of processes, barriers and facilitators related to DNACPR decision-making and implementation. Reports from NHS trusts, the National Reporting and Learning System, the Parliamentary and Health Service Ombudsman, the Office of the Chief Coroner, trust resuscitation policies and telephone calls to a patient information line were reviewed. Multiple focus groups explored service-provider perspectives on DNACPR decisions. A stakeholder group discussed the research findings and identified priorities for future research.ResultsThe literature review found evidence that structured discussions at admission to hospital or following deterioration improved patient involvement and decision-making. Linking DNACPR to overall treatment plans improved clarity about goals of care, aided communication and reduced harms. Standardised documentation improved the frequency and quality of recording decisions. Approximately 1500 DNACPR incidents are reported annually. One-third of these report harms, including some instances of death. Problems with communication and variation in trusts’ implementation of national guidelines were common. Members of the public were concerned that their wishes with regard to resuscitation would not be respected. Clinicians felt that DNACPR decisions should be considered within the overall care of individual patients. Some clinicians avoid raising discussions about CPR for fear of conflict or complaint. A key theme across all focus groups, and reinforced by the literature review, was the negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’.LimitationsThe variable quality of some data sources allows potential overstatement or understatement of findings. However, data source triangulation identified common issues.ConclusionThere is evidence of variation and suboptimal practice in relation to DNACPR decisions across health-care settings. There were deficiencies in considering, discussing and implementing the decision, as well as unintended consequences of DNACPR decisions being made on other aspects of patient care.Future workRecommendations supported by the stakeholder group are standardising NHS policies and forms, ensuring cross-boundary recognition of DNACPR decisions, integrating decisions with overall treatment plans and developing tools and training strategies to support clinician and patient decision-making, including improving communication.Study registrationThis study is registered as PROSPERO CRD42012002669.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Peng, Linghui, Ronghui Guo, Shouxiang Jiang, Jianwu Lan, Yongfeng He, and Xuemei Huang. "Ultrasound-aided dyeing of cotton fabric with spirooxazines and photochromic properties." Fibers and Polymers 16, no. 6 (June 2015): 1312–18. http://dx.doi.org/10.1007/s12221-015-1312-2.
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Periolatto, Monica, Franco Ferrero, Mirco Giansetti, Raffaella Mossotti, and Riccardo Innocenti. "Enzyme-aided wool dyeing with a neutral protease at reduced temperatures." Engineering in Life Sciences 10, no. 5 (September 16, 2010): 474–79. http://dx.doi.org/10.1002/elsc.201000089.
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Murray, B. "Liverpool care pathway: doctors have always aimed to ease distress in dying." BMJ 345, no. 14 1 (November 14, 2012): e7606-e7606. http://dx.doi.org/10.1136/bmj.e7606.
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Parisi, Luca, Amir Zaernia, Renfei Ma, and Mansour Youseffi. "Ηyper-sinh-Convolutional Neural Network for Early Detection of Parkinson’s Disease from Spiral Drawings." WSEAS TRANSACTIONS ON COMPUTER RESEARCH 9 (March 31, 2021): 1–7. http://dx.doi.org/10.37394/232018.2021.9.1.
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Modern developments in the state-of-the-art open-source activation functions for Convolutional Neural Networks (CNNs) have broadened the selection of benchmark activations for Deep Learning (DL)-aided classification. Nevertheless, achieving discrimination of non-linear input image data in CNN is still not straightforward and it is unclear how such novel activation functions can have translational applications with tangible impact. hyper-sinh, made freely available in TensorFlow and Keras, was demonstrated as a benchmark activation function on five (N=5) datasets in its ground-breaking paper. Measuring the value from deploying this activation in a specific application is pivotal to supply the required evidence of its performance on real-life supervised DL-based image classification tasks. In this study, a CNN was for the first time combined with hypersinh to aid early detection of Parkinson’s Disease (PD) from discriminating pathophysiological patterns extracted from spiral drawings. Thus, the hyper-sinh activation was deployed to maximise the separability of the input features from spiral drawings via automated pattern recognition. We demonstrate the accuracy and reliability of hyper-sinh-CNN to aid early diagnosis of PD, evaluated against other gold standard activation functions, including the recent Quantum ReLU (QReLU) and the modified Quantum ReLU (m-QReLU) that solved the ‘dying ReLU’ problem for the first time in the literature of DL. Two (N=2) benchmark datasets from the database of the Botucatu Medical School, São Paulo State University in Brazil, scaled to be in 28 by 28 pixels as the MNIST benchmark data, were used to discriminate between input image patterns of 158 subjects (53 healthy controls and 105 patients with PD) from spirals drawn on graphics tablets. Overtraining was avoided via early stopping and the models were developed and tested in TensorFlow and Keras (Python 3.6). The supervised model (hyper-sinh-CNN) could detect early Parkinson’s Disease with 81% and 91% classification accuracy from the two datasets respectively (F1-scores: 73% and 91% correspondingly). Furthermore, the model achieved high sensitivity (81% and 91%). Thus, this study validates the application of hyper-sinh to aid real-life supervised DL-based image classification, in particular early diagnosis of PD from spiral drawings.
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Fringer, André, Sabrina Stängle, Iren Bischofberger, Daniel Büche, Renate Praxmarer, Stefan Ch. Ott, and Wilfried Schnepp. "Experiences of relatives with outpatient palliative care: a cross-sectional study." International Journal of Palliative Nursing 26, no. 5 (June 2, 2020): 230–37. http://dx.doi.org/10.12968/ijpn.2020.26.5.230.
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Aim: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. Design: A cross-sectional survey. Methods: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. Findings: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.
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Zambrano, Sofia C., Anna Chur-Hansen, and Gregory B. Crawford. "The experiences, coping mechanisms, and impact of death and dying on palliative medicine specialists." Palliative and Supportive Care 12, no. 4 (June 11, 2013): 309–16. http://dx.doi.org/10.1017/s1478951513000138.
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AbstractObjectives:Research on the experiences, coping mechanisms, and impact of death and dying on the lives of palliative medicine specialists is limited. Most research focuses on the multidisciplinary team or on nurses who work with the dying. Fewer studies consider medical professionals trained in palliative medicine. This study aimed to explore the experiences, coping mechanisms, and impact of death and dying on palliative medicine specialists when dealing with their patients at the end of life.Methods:A qualitative research approach guided the study, one-on-one interview data were analyzed thematically. A purposeful sampling technique was employed for participant recruitment. Seven palliative medicine specialists practicing in one city participated in open-ended, in-depth interviews.Results:The analysis of participants' accounts identified three distinct themes. These were Being with the dying, Being affected by death, and dying and Adjusting to the impact of death and dying.Significance of results:This study further contributes to the understanding of the impact of death and dying on professionals who care for dying patients and their families. Despite the stressors and the potential for burnout and compassion fatigue, these participants employed strategies that enhanced meaning-making and emphasized the rewards of their work. However, the consequences of work stressors cannot be underestimated in the practice of palliative care.
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Zhang, Xinqing, Kuanjun Fang, Jianfei Zhang, Dawu Shu, Jixian Gong, and Xiuming Liu. "A vacuum-dehydration aided pad-steam process for improving reactive dyeing of cotton fabric." Journal of Cleaner Production 168 (December 2017): 1193–200. http://dx.doi.org/10.1016/j.jclepro.2017.09.112.
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Richard, Nicholas, Nicholas Emma, and Koffman Jonathan. "288 Challenges in reducing hospital deaths in multiple sclerosis." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A44.2—A44. http://dx.doi.org/10.1136/jnnp-2018-abn.152.
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IntroductionFifty-five percent of people with multiple sclerosis (pwMS) will die in hospital, above the national average. This study aimed to determine factors that impact place of death for pwMS.MethodsRetrospective sequential notes review from the UK MS Tissue Bank.ResultsThirty notes were reviewed from 18/06/12% to 08/09/16. 53% died in hospital, 23% in nursing homes, 13% at home and 10% in hospices. Health interventions increased in year of death versus year prior to death in community (p=0.0369) and primary care (p=0.002) but not in secondary care but were not associated with a non-hospital death (NHD). Recognition of dying (73%, p=0.0024) and having an advanced care plan (ACP) (67%, p=0.0003) were associated with NHD. Family involvement was associated with recognition of dying (p=0.0146) but not with NHD. Multivariable analysis found recognition a person is dying and having an ACP were independently predictive of NHD (R2=0.52, p=0.034). The mean time prior to death of having an ACP (9.6±8.1 months) was months prior from when dying was recognised (17.4±27 days, p=0.0004).ConclusionHaving an ACP and recognition a pwMS is dying are key factors to achieving a NHD. This study highlights the challenges to reducing hospital deaths in MS.
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Seo, Kawoun. "Moderating Effect of Nurse’s Character on the Relationship between Attitudes toward Nursing Care of the Dying and Performance of Terminal Care in South Korea." Healthcare 9, no. 9 (September 10, 2021): 1195. http://dx.doi.org/10.3390/healthcare9091195.
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This study aimed to investigate the moderating effect of nurses’ characteristics on the relationship between attitudes toward nursing care and terminal care performance of hospice nurses. The participants included nurses working in hospice care units in general hospitals in South Korea. Data collected from August 1 to 31, 2020 were analyzed using t-test, ANOVA, Pearson′s correlation coefficients, and hierarchical multiple regression. The performance of terminal care was positively correlated with attitudes toward nursing care of the dying (r = 0.45, p < 0.001) and nurses’ characteristics (r = 0.60, p < 0.001). There was also a positive correlation (r = 0.58, p < 0.001) between attitudes toward nursing care for dying patients and nurses′ characteristics. Nurses’ characteristics had a significant moderating effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care. This means that the nurses’ character had a buffering effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care in hospice care units. These findings suggest that continuous and repetitive educational programs on terminal care need to be enhanced, and strategies to strengthen attitudes toward nursing care of the dying and nurses’ character need to be included in these programs.
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Saunders, Sue. "A Methodological Study to Develop and Validate a Death Attitude Scale: Buddhists and Medical Students Compared." OMEGA - Journal of Death and Dying 38, no. 3 (May 1999): 211–34. http://dx.doi.org/10.2190/3q0v-e9fq-e55l-uh7r.
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This study aimed to develop and validate a death attitude scale which would be applicable to Christians, non-Christians, and atheists alike. A sample of 147 medical students and a sample of 115 Buddhists completed a fifty-six-item questionnaire in order to empirically test generality across samples. Four conceptual aspects of death and dying were investigated. The results of three principle components analyses provided evidence for three of the a priori labeled factors: Fear and anxiety about death and dying; Fear and anxiety about personal extinction; and Positive attitude to death and dying. Seventeen items which loaded satisfactorily across both samples were retained for the orthogonal three factor solution. Construct validity was considered to be high and reliability was found to be good. This study provided empirical support for at least two orthogonal factors requiring further attention from thanatological researchers. Results highlighted the importance of sampling non-Christian populations; of sampling populations who have experience of aspects of death and dying and of using questionnaire items which have no religious bias.
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Carr, Michelle, and Melanie Pratt Merriman. "Comparison of Death Attitudes among Hospice Workers and Health Care Professionals in other Settings." OMEGA - Journal of Death and Dying 32, no. 4 (June 1996): 287–301. http://dx.doi.org/10.2190/r4t6-d1kv-m37d-1p47.
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Since most health care professionals are trained in acute care settings where all efforts are employed to prolong life, they may not be comfortable caring for dying patients. Hospice professionals have a lot of experience dealing with dying patients. The purpose of this study was to compare and contrast the death attitudes of hospice and hospital-based health care professionals. The construct theory for the study was that comfort in dealing with dying patients is based on 1) personal beliefs about death and 2) experience dealing with dying patients. Seventy-six hospital and 106 hospice workers participated in the study and completed the thirty-four-item Death Attitude Index (DAI) and the fifteen-item Death Anxiety Scale [1]. The results showed that hospice employees had higher DAI scores (greater comfort caring for the terminally ill), as predicted. Social workers had the highest mean DAI scores and the lowest scores on the DAS (low death anxiety). Nurses aides exhibited high death anxiety and low comfort in dealing with terminal clients. For all disciplines, DAI and DAS scores were highly correlated (coefficient = −0.91). Independent variables that correlated with high DAI scores were educational level and a sacred (versus secular) value system.
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Ross, Margaret M., Michael J. MacLean, Roy Cain, Scott Sellick, and Rory Fisher. "End of Life Care: The Experience of Seniors and Informal Caregivers." Canadian Journal on Aging / La Revue canadienne du vieillissement 21, no. 1 (2002): 137–46. http://dx.doi.org/10.1017/s0714980800000702.
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ABSTRACTAs Canada's elderly population grows, an increasing number of seniors will require care as they face the end of life. Relatively little research attention, however, has been given to end-of-life issues, including those related to treatment and care for persons who are both old and dying. Families and health care providers have little direction and guidance to ensure an optimum quality of life for seniors prior to death and during the period of bereavement. This article presents an abbreviated summary of the literature regarding end-of-life issues and challenges for seniors who face a life threatening illness and are at, or near, the end of their lives. The article is also informed by a series of focus groups with elderly and other informal caregivers regarding the giving of help and getting support while caring for persons who are dying. It concludes with a response to this evidence by making a series of recommendations aimed at ensuring optimal end-of-life care for seniors who are dying and their families.
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Simpson, Nikita, Michael Angland, Jaskiran K. Bhogal, Rebecca E. Bowers, Fenella Cannell, Katy Gardner, Anishka Gheewala Lohiya, et al. "‘Good’ and ‘Bad’ deaths during the COVID-19 pandemic: insights from a rapid qualitative study." BMJ Global Health 6, no. 6 (June 2021): e005509. http://dx.doi.org/10.1136/bmjgh-2021-005509.
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Dealing with excess death in the context of the COVID-19 pandemic has thrown the question of a ‘good or bad death’ into sharp relief as countries across the globe have grappled with multiple peaks of cases and mortality; and communities mourn those lost. In the UK, these challenges have included the fact that mortality has adversely affected minority communities. Corpse disposal and social distancing guidelines do not allow a process of mourning in which families and communities can be involved in the dying process. This study aimed to examine the main concerns of faith and non-faith communities across the UK in relation to death in the context of the COVID-19 pandemic. The research team used rapid ethnographic methods to examine the adaptations to the dying process prior to hospital admission, during admission, during the disposal and release of the body, during funerals and mourning. The study revealed that communities were experiencing collective loss, were making necessary adaptations to rituals that surrounded death, dying and mourning and would benefit from clear and compassionate communication and consultation with authorities.
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Rodenbach, Rachel, Andrew Althouse, Thomas J. Smith, Douglas B. White, Edward Chu, Marie Bakitas, Yael Schenker, and Robert M. Arnold. "Relationships between worry about dying in patients with advanced cancer and their illness understanding, treatment preferences, and advance care planning." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 12080. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.12080.
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12080 Background: Patients with advanced cancer often worry about dying, yet little is known about the role their fears play regarding future care. We aimed to explore relationships between patients’ worry about dying and their illness understanding, treatment preference, and advance care planning. Methods: This cross-sectional study uses baseline data from a community-based, primary palliative care intervention trial. Patients had metastatic solid tumors, an Eastern Cooperative Oncology Group performance status of 0-2, and their oncologist “would not be surprised” if they died in the next year. Using patients’ response to “I worry about dying” (not at all, a little bit, somewhat, quite a bit, or very much) from the Functional Assessment of Chronic Illness - Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding (report of being terminally ill or not), treatment preference (life-extending vs. symptom-focused), and advance care planning (completion of an advance directive or not). We also performed sensitivity analyses substituting “I feel scared about my future” (strongly disagree, disagree, agree, or strongly agree) from the Herth Hope Index for “I worry about dying.” Results: Of 672 patients, 54% were female, 94% white, and 69% currently receiving chemotherapy. 47% reported worrying about dying “not at all,” while 9.7% worried “quite a bit” or “very much.” In regression analysis, those who worried “quite a bit” or “very much” were more likely to describe themselves as terminally ill (adjusted odds ratio (AOR)=1.98, 95% CI=1.10-3.54, p=0.021) and more likely to prefer life-extending treatment over symptom-focused care (AOR=2.61, 95% CI=1.30-5.22, p=0.007) compared with patients who reported not worrying about dying. They also were less likely to have completed an advance directive (AOR=0.49, 95% CI=0.25-0.94, p=0.032). The same relationships were observed using patients’ response to “I feel scared about my future.” Conclusions: Patients with advanced cancer who worry more about dying can affirm they are terminally ill and are more likely to want life-extending treatment over symptom care while less likely to engage in advance care planning. Understanding these patients’ decision making is critical to ensuring that their values are known and understood near the end of life.
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Yavas, Arzu, Ozan Avinc, and Görkem Gedik. "Ultrasound and Microwave Aided Natural Dyeing of Nettle Biofibre (Urtica dioica L.) with Madder (Rubia tinctorum L.)." Fibres and Textiles in Eastern Europe 25 (August 31, 2017): 111–20. http://dx.doi.org/10.5604/01.3001.0010.2855.
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The success of suture yarn depends upon its tensile and bending properties. As sutures pass through the tissue, it should possess enough strength to hold the tissue together and should be flexible so as to be knotted. The aim of the present work was to improve the strength of silk suture without affecting its bending properties. Silk sutures were fabricated using a circular braiding machine. Structural variations were made by varying the diameter and by producing core sheath suture yarn. The resulting suture yarn is coated with chitosan – a biopolymer. The mechanical performances of suture materials coated with and without chitosan were studied and compared with commercial suture. It was observed that the suture with a core-sheath structure performed well during tensile and knot testing. The coarser yarns exhibited higher bending rigidity and lower knot strength than the finer suture yarns.
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Sivakumar, Venkatasubramanian, Gopalaraman Swaminathan, Paruchuri Gangadhar Rao, and Thirumalachari Ramasami. "Ultrasound-aided leather dyeing: a preliminary investigation on process parameters influencing ultrasonic technology for large-scale production." International Journal of Advanced Manufacturing Technology 45, no. 1-2 (February 17, 2009): 41–54. http://dx.doi.org/10.1007/s00170-009-1956-4.
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Bonner, Joseph, Brandon Stange, Mindy Kjar, Margaret Reynolds, Eric Hartz, Donald Bignotti, Miriam Halimi, et al. "Interdisciplinary Plans of Care, Electronic Medical Record Systems, and Inpatient Mortality." ACI Open 02, no. 01 (January 2018): e21-e29. http://dx.doi.org/10.1055/s-0038-1653970.
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Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes. Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality. Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital. Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50). Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital.
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Huriah, Titih, Nurul Hidayah, and Akichika Mikami. "Attitudes and Associated Factors towards Care for Dying Patients among Non-Palliative Care Nurses, Yogyakarta, Indonesia." IJNP (Indonesian Journal of Nursing Practices) 5, no. 1 (June 2, 2021): 9–16. http://dx.doi.org/10.18196/ijnp.v5i1.10131.
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Background: The increment of terminal health problems causes the demand for palliative care to increase. Nurses’ attitudes toward palliative care have critical implications on the quality of care for terminally ill patients. This study aimed to investigate non-palliative care nurses’ attitudes towards death and dying patients in palliative care in Indonesia.Method: A cross-sectional design was performed in four general hospitals, five primary health centers, and three nursing homes in Yogyakarta. Systematic random sampling was the method employed. The research instrument used Frommelt Attitudes towards Care of the Dying (FATCOD). FATCOD is a 30-item tool using a five-point Likert scale to indicate respondents' attitudes toward caring for dying patients. Attitudes had two categories, namely favorable (≥ mean score of the total score of (FATCOD) Scale) and unfavorable ( mean score of the total score of (FATCOD) Scale). Two hundred seventeen (217) non-palliative care nurses completed the FATCOD and a ten-item demographic questionnaire. The data analysis used descriptive statistics, chi-square, and linear regression.Results: The total FATCOD score achieved in this study was 111.29±9.44 (range 30–150). Concerning nurses’ attitudes towards the family members of terminally ill dying patients, the score was 39.85 (±4.12) out of a possible 50. Besides attitudes towards patient care provision, the score was 71.43 (±6.39) out of a possible 100. The nurses' attitudes towards the dying patients showed that the favorable and unfavorable attitudes had almost the same percentage. Of significance, working experience variables were associated with attitudes in the total FATCOD and patient FATCOD. Working experience and level of education were related to attitudes towards the family FATCOD.Conclusion: Non-palliative care nurses had a favorable attitude towards palliative care. The ministry of health should give awareness by providing various training, workshop, formal and informal education about PC for nurses.
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Bandeira, Danieli, Silvana Bastos Cogo, Leila Mariza Hildebrandt, and Marcio Rossato Badke. "Death and dying in the formation process of nurses from the perspective of nursing professors." Texto & Contexto - Enfermagem 23, no. 2 (June 2014): 400–407. http://dx.doi.org/10.1590/0104-07072014000660013.
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This qualitative and descriptive study aimed to identify how nursing course professors approach death and dying in the university and what the implications are on the formation process. Ten professors of the undergraduate nursing course were intentionally selected and underwent semi-structured interviews, which were recorded. The thematic analysis of the data revealed that the presence of the fact caused insecurity in the interviewees and portrayed the lack of preparation in the undergraduate course, which could indicate a certain difficulty working with this theme. Furthermore, the interviewees highlighted the importance of working with death and dying. It is essential to understand the university to be a transforming agent of reflective subjects and a promoter of conditions for the student to experience the aspects involved in the care when faced with death.
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Kondo, Rieko, and Makiko Kondo. "Strategies for caring for the peaceful death of cancer patients at home in Japan – A meta-synthesis of the literature." Clinical Nursing Studies 6, no. 4 (April 28, 2018): 23. http://dx.doi.org/10.5430/cns.v6n4p23.
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This study aimed to identify strategies that enable the provision of high quality home care for dying patients with cancer. We searched the NPO Japan Medical Abstracts Society database through Ichushi-Web and selected literature that focused on home care for dying patients with cancer of Japanese origin. In particular, we chose research papers published between 2005 and 2015 that used the qualitative research methodology. The research subjects comprised patients (excluding children), family members of patients, and medical staff who were primary caregivers. We identified the following four research questions by reviewing 13 articles: “A. What enables patients to live at home until they die?”, “B. What difficulties does a dying patient encounter while living at home until death?”, “C. What represents effective support for patients living at home until they die?”, and “D. What represents ineffective support for patients who live at home until they die?”. All results were grouped depending on their relevance to these research questions. We identified 4 categories each pertaining to Research Question A (RQ-A) and RQ-D, and 3 each pertaining to RQ-B and RQ-C. We identified the following five factors that can promote the peaceful death of patients with cancer at home: 1) strong family bonds; 2) caring for the dying patient by the family, according to a framework provided by the medical staff; 3) a guaranteed unconstrained daily life; 4) support for the family’s range of emotions; and 5) systematic support from visiting medical staff and the hospital.
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Loera, Barbara, Giorgia Molinengo, Marco Miniotti, and Paolo Leombruni. "Refining the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD–B) for medical students: A confirmatory factor analysis and Rasch validation study." Palliative and Supportive Care 16, no. 1 (May 15, 2017): 50–59. http://dx.doi.org/10.1017/s147895151700030x.
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ABSTRACTObjective:Given the increasing number of patients requiring palliative care and the need for more professionals who are able to provide care for the dying comfortably, assessment of medical attitudes toward end-of-life care is becoming a key aspect of medical education. The present study aimed to establish whether the Frommelt Attitude Toward the Care Of the Dying, Form B (FATCOD–B) meets current psychometric standards of validity for an assessment tool in medical education.Method:The participants were 200 undergraduate medical students. Since in a previous study the FATCOD–B was found to have a weak structure due to poor item validity, a refined version was proposed and tested in the present study. Confirmatory factor analysis and the Rasch model were employed to assess its dimensionality and psychometric properties.Results:The construct measured by the FATCOD–B continues to be misspecified. The tool has a two-dimensional structure. The first is well-structured and demonstrates appreciable measurement and discriminant capabilities. The second has low validity because its measurement capabilities are based on weakly correlated items.Significance of results:Our results suggest that the FATCOD–B measures a two-dimensional construct and that only its first dimension is a robust measurement tool for use in medical education to evaluate undergraduates' attitudes about caring for the dying.
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Harris, Denise Andrea, Kirsten Jack, and Christopher Wibberley. "Making her end of life her own: further reflections on supporting a loved one with motor neurone disease." International Journal of Palliative Nursing 25, no. 6 (June 2, 2019): 284–92. http://dx.doi.org/10.12968/ijpn.2019.25.6.284.
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Background: People can live for many months without knowing why their body is failing prematurely before being diagnosed with motor neurone disease (MND); a terminal neurodegenerative disease which can be experienced as ‘devastating’ for the person and their family. Aim: This study aimed to explore the meaning of supporting a loved one with MND to die. Methods: This study uses reflection and autobiographical story to connect with broader cultural, political and social meaning and understandings of dying. Findings: Four themes were identified relating to the end-of-life trajectory of MND. Loss of person (lived body experienced in silence); loss of relationships (lived relations are challenged); loss of home and loss of time (lived space and lived time take on new meaning); loss of future (dying—facing it alone). Conclusion: Dying with MND is a complex phenomenon. When a person can no longer move and communicate, relationships between those involved in end-of-life care are challenging. A person with MND needs the support from those acting as power of attorney to make their end of life their own, and they themselves need support to find meaning in their suffering. This autoethnographic reflection provides vicarious experiences for nurses and other healthcare professionals working with people with MND and similar conditions.
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Wibisono, Muhammad Arif, I. G. B. Budi Dharma, Mega Inayati Rif’ah, and Pramudi Arsiwi. "Computer Aided Stamped Batik Design and Manufacturing for Batik Machine with Wax Moving Module." Applied Mechanics and Materials 842 (June 2016): 388–94. http://dx.doi.org/10.4028/www.scientific.net/amm.842.388.
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Batik is one of the Indonesian heritage culture that needs to be preserved, especially for traditional batik using wax to form batik pattern and resist dyeing color. One way to draw batik on fabric is by using a stamp. Nowadays, most of traditional batiks are still produced manually with limited capacity. On other hand, the number of batik craftsman is decreased due to lack of regeneration of young craftsman. This study aimed to develop software for designing stamped batik, along with its production steps, and information used to execute the design on batik machine with moving module. The software required a batik stamp design, size of fabric (maximum 12 m), pattern of stamping, and color. Digital image of the batik design and its colour will be generate along with the G-Code for executing the design on batik machine with moving module. Batik machine with moving module consists of 13 meters working table and a bridge runs along the table by carrying stamp and wax module. For each step of the bridge, stamp module will stamp wax on fabric along its width. These movements are controlled by programmable computer with G-Code from batik design system. Batik design system and the machine have been tested and is able to give information about size of fabric used, kind of dye used, and G-Code for controlling the machine.
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Surugiu, Roxana, Bogdan Catalin, Danut Dumbrava, Andrei Gresita, Denisa Greta Olaru, Dirk M. Hermann, and Aurel Popa-Wagner. "Intracortical Administration of the Complement C3 Receptor Antagonist Trifluoroacetate Modulates Microglia Reaction after Brain Injury." Neural Plasticity 2019 (November 14, 2019): 1–9. http://dx.doi.org/10.1155/2019/1071036.
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Worldwide, millions of individuals suffer an ischemic stroke each year, causing major disability, especially in the elderly, where stroke is the number one cause of disability. However, to date, no effective therapy exists that targets the functional recovery after stroke. After necrosis, neuroinflammation is a common feature of the acute stroke and a major obstacle to tissue restoration. In the lesioned area, the dying neurons release chemotactic signals, such as fractalkine/CX3CL1, which evoke “eat-me” signals that are recognized by microglia expressing complement C3a receptor (C3aR), resulting in phagocytosis of the dying but still viable neurons, known as secondary phagocytosis. Using a mouse model of stroke and two-photon microscopy, we aimed to attenuate poststroke phagocytosis of the dying but still viable neurons by using SB 290157, an antagonist of C3aR. We found that intracortical administration of SB 290157 reduced the number of inflammatory microglial cells expressing ED1 and Iba1 antigens at the lesion site. We could show, in vivo, that two days after a needle-induced cortical lesion there were less microglial cells present around the injury site, displaying less high-order branches and an increase in the lower order ones, suggesting an attenuated phagocytic phenotype in treated animals as compared with controls. We conclude that the C3aR antagonist, SB 290157, may be used in the future to limit the neuronal death by limiting secondary phagocytosis after stroke.
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Erickson, Karla A. "Knowing Death Well: Intimate and Contextual Death Competence among End-of-Life Laborers." Journal of Contemporary Ethnography 46, no. 6 (June 22, 2016): 647–72. http://dx.doi.org/10.1177/0891241616652218.
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End-of-life workers, regardless of occupational status, work against a transformed culture of death and dying. Against that backdrop of technological brinkmanship, segregation of aging and dying from other aspects of life, and a cultural denial of death’s inevitability, end-of-life workers develop competence and expertise; however, that competence varies, shaped by the training and occupational status of its purveyors. Based on three years of participant observation and interviews with end-of-life laborers, I identify two types of death competence—intimate and contextual—that develop at different levels of the occupational hierarchy. One situates death philosophically and morally, the other garners insight from the body to sustain elders’ personhood in the face of diminishing capacities. These ways of knowing are valuable in a death-denying culture. Surfacing the less apparent expertise of nurse’s aides also contributes to existing social theory about death competence and raises questions about occupational knowledge more generally.
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Martí-García, Celia, Manuel Fernández-Alcántara, Laura Ruiz-Martín, Rafael Montoya-Juárez, Cesar Hueso-Montoro, and M. Paz García-Caro. "La muerte ante uno mismo. Respuestas de jóvenes estudiantes ante el pensamiento de la propia muerte." Anales de Psicología 33, no. 3 (July 21, 2017): 630. http://dx.doi.org/10.6018/analesps.33.3.248351.
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<p>Narratives produced by thinking and reflecting about death and dying may be themselves a source of new knowledge in the study of anxiety and attitudes toward death. A qualitative descriptive study aimed to explore the features of thoughts, emotions and feelings about young people's own death, (nursing students) was conducted. 85 students voluntarily answered a self-administered questionnaire with open questions based on Mortality Salience, used in the Terror Management Theory. Content analysis using Atlas.ti software was performed. When reflecting upon their own death, participants reported substantive emotions such as fear, pain, distress, sadness or loneliness. The fear of their own death was specified as the inability to achieve goals in life, to leave the family and the dying process itself. When reflecting upon been physically dead, attributes of the decomposition of the body, spiritual attributes, beliefs, denial and preferences were identified. Cultural worldview, values and beliefs of each person were remarkably present when thinking about their own death.</p>
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Wang, Xue Chuan, Pei Yi Wang, Tao Tao Qiang, and Long Fang Ren. "Surface Modification of Acid Activated Polyamide Fiber by Immobilizing Collagen." Advanced Materials Research 393-395 (November 2011): 1501–5. http://dx.doi.org/10.4028/www.scientific.net/amr.393-395.1501.
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Collagen was immobilized onto moderate acid activated polyamide fibers with glutaraldehyde (cross-linking agent) aimed to improve its sanitary property. The immobilization of collagen onto polyamide fiber was estimated by dyeing collagen modified fabrics with a cationic brilliant red 5GN, and determining the dyeing properties of the dyed fabrics. The modification also confirmed technically by Differential scanning calorimetry (DSC), Scanning electron microscopy (SEM) and Atomic force microscope (AFM). Cationic dyeing showed brighter and more even dyeing properties of the collagen modified fabrics compared to the non-treated fabrics. From DSC results, it was found that the thermo-stability of the non-treated and collagen modified fabrics changed a lot. The morphology of different samples from SEM and AFM also approved the immobilization of collagen. The moisture absorption and hydrophilicity of the fabrics after collagen immobilization improved compared to the non-treated fabrics.
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Silva Júnior, Fernando José Guedes da, and Claudete Ferreira de Souza Monteiro. "The meanings of death and dying: the perspective of crack users." Revista Latino-Americana de Enfermagem 20, no. 2 (April 2012): 378–83. http://dx.doi.org/10.1590/s0104-11692012000200022.
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The consumption of crack can constitute in an inauthentic form of the existence that leads a person to live improperly the being-toward-death. Given this reality, this study aimed to comprehend the significance of death and dying for the user of crack and to unveil the meanings attributed to this significance. This qualitative study was conducted, based on the phenomenological method, with 12 crack users, in the therapeutic process, in a Psychosocial Care Center - Alcohol and Drugs (CAPSad), in the period from February to April 2011, in Teresina, Piauí. The results show that death is signified, ontically, as a companion, a partner, a passage, a journey and as the crack itself. It was concluded that this significance expressed an inauthentic experience, directed toward the incessant interaction with crack, accompanied by a feeling of nullity and relational disengagement.
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Gomes, Barbara, Natalia Calanzani, and Irene J. Higginson. "Reversal of the British trends in place of death: Time series analysis 2004–2010." Palliative Medicine 26, no. 2 (January 18, 2012): 102–7. http://dx.doi.org/10.1177/0269216311432329.
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Background: Increased attention is being paid to the place where people die with a view to providing choice and adequately planning care for terminally ill patients. Secular trends towards an institutionalised dying have been reported in Britain and other developed world regions. Aim: This study aimed to examine British national trends in place of death from 2004 to 2010. Design and setting: Descriptive analysis of death registration data from the Office for National Statistics, representing all 3,525,564 decedents in England and Wales from 2004 to 2010. Results: There was a slow but steady increase in the proportion of deaths at home, from 18.3% in 2004 to 20.8% in 2010. Absolute numbers of home deaths increased by 9.1%, whilst overall numbers of deaths decreased by 3.8%. The rise in home deaths was more pronounced in cancer, happened for both genders and across all age groups, except for those younger than 14 years and for those aged 65–84, but only up to 2006. The rise was more evident when ageing was accounted for (age–gender standardised proportions of home deaths increased from 20.6% to 23.5%). Conclusions: Following trends in the USA and Canada, dying is also shifting to people’s homes in Britain. Home deaths increased for the first time since 1974 amongst people aged 85 years and over. There is an urgent need across nations for comparative evidence on the outcomes and the costs of dying at home.
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Meeker, Mary Ann, and Deborah P. Waldrop. "Changing Focus: End-of-Life Care in a New York State Managed Long-Term Care Program." Journal of Applied Gerontology 38, no. 10 (October 19, 2017): 1371–90. http://dx.doi.org/10.1177/0733464817737620.
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In the United States, managed long-term care programs offer a noninstitutional approach to meeting the needs of increasing numbers of frail elders. Providing services that support both quality of life and quality of dying poses unique challenges. Using a qualitative descriptive design, we explored these challenges from the perspectives of care providers. Themes were identified using qualitative content analysis techniques applied to transcripts of 33 semistructured interviews. Professionals comprising an interdisciplinary care team and home health aide direct care providers described cues by which they identified movement into the end-of-life phase, their understandings of how care changed, and their concerns and recommendations for improvement. When the changing care needs could be met, a “good death” ensued, but that was not always possible. Managed long-term care programs are called upon to develop the capacity to integrate the phase of dying into the full story of each life for which they care.
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McClement, Susan, Suzanne Wowchuk, and Kathleen Klaasen. "“Caring as if it were my family”: Health care aides' perspectives about expert care of the dying resident in a personal care home." Palliative and Supportive Care 7, no. 4 (November 26, 2009): 449–57. http://dx.doi.org/10.1017/s1478951509990459.
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AbstractObjective:A qualitative pilot study was conducted to identify and describe expert behaviors in care of the dying resident in a personal care home setting from the perspective of health care aides (N= 5) nominated by their peers as demonstrating excellence in end-of-life care.Methods:Data was collected through audio-taped semi-structured interview, and transcribed verbatim using constant-comparative analysis procedures.Results:The over-arching theme emerging from the data was “caring as if it were my family.” Subsumed within this main theme included the sub-themes of: (1) care of the resident; (2) tending to the environment; (3) care of the family; (4) going to bat; and (5) processing loss.Significance of results:The findings from this pilot study provide preliminary empirical evidence that could inform educational programs for and performance evaluation of, health care aides providing end-of-life care in personal care home environments.
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Ek, Kristina, Birgitta Andershed, Eva Sahlberg-Blom, and Britt-Marie Ternestedt. "“The unpredictable death”—The last year of life for patients with advanced COPD: Relatives' stories." Palliative and Supportive Care 13, no. 5 (October 15, 2014): 1213–22. http://dx.doi.org/10.1017/s1478951514001151.
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AbstractObjective:The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives.Method:Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis.Result:All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable.Significance of Results:The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.
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Gaiser, Meike, Joachim Kirsch, and Till Sebastian Mutzbauer. "Using Nonexpert Online Reports to Enhance Expert Knowledge About Causes of Death in Dental Offices Reported in Scientific Publications: Qualitative and Quantitative Content Analysis and Search Engine Analysis." Journal of Medical Internet Research 22, no. 4 (April 17, 2020): e15304. http://dx.doi.org/10.2196/15304.
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Background Fatalities rarely occur in dental offices. Implications for clinicians may be deduced from scientific publications and internet reports about deaths in dental offices. Objective Data involving deaths in dental facilities were analyzed using Google as well as the PubMed database. By comparing both sources, we examined how internet data may enhance knowledge about deaths in dental offices obtained from scientific medical publications, which causes of death are published online, and how associated life-threatening emergencies may be prevented. Methods To retrieve relevant information, we searched Google for country-specific incidents of death in dental practices using the following keywords: “death at the dentist,” “death in dental practice,” and “dying at the dentist.” For PubMed searches, the following keywords were used: “dentistry and mortality,” “death and dental treatment,” “dentistry and fatal outcome,” and “death and dentistry.” Deaths associated with dental treatment in a dental facility, attributable causes of death, and documented ages of the deceased were included in our analysis. Deaths occurring in maxillofacial surgery or pre-existing diseases involved in the death (eg, cancer and abscesses) were excluded. A total of 128 cases from online publications and 71 cases from PubMed publications that met the inclusion criteria were analyzed using chi-square statistics after exclusion of duplicates. Results The comparison between the fatalities from internet (n=117) and PubMed (n=71) publications revealed that more casualties affecting minors appeared online than in PubMed literature (online 68/117, 58.1%; PubMed 20/71, 28%; P<.001). In PubMed articles, 10 fatalities in patients older than 70 years of age were described, while online sources published 5 fatalities (P=.02). Most deaths, both from internet publications and PubMed literature, could be assigned to the category anesthesia, medication, or sedation (online 80/117, 68.4%; PubMed 25/71, 35%; P<.001). Deaths assigned to the categories infection and cardiovascular system appeared more often in the PubMed literature (infection: online 10/117, 8.5%; PubMed 15/71, 21%; P=.01; cardiovascular system: online 5/117, 4.3%; PubMed 15/71, 21%; P<.001). Furthermore, sedative drugs were involved in a larger proportion of fatal incidents listed online compared to in PubMed (online 41/117, 35.0%; PubMed: 14/71, 20%, P=.03). In the United States, more deaths occurred under sedation (44/96, 46%) compared to those in the other countries (Germany and Austria 1/17, 6%, P=.002; United Kingdom 1/14, 7%, P=.006). Conclusions Online and PubMed databases may increase awareness of life-threatening risks for patients during dental treatment. Negative aspects of anesthesia and sedation, as well as the number of deaths of young patients, were underestimated when reviewing PubMed literature only. Medical history of patients, medication dosages, and vital function monitoring are significant issues for practitioners. A high-impact finding from online reports was the underestimation of risks when performing sedation and even general anesthesia. Detailed knowledge of the definition and understanding of deep sedation and general anesthesia by dentists is of major concern. By avoiding potentially hazardous procedures, such as sedation-aided treatments performed solely by dentists, the risk of treatment-induced life-threatening emergencies may be reduced.
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Dumont, Isabelle, and Jocelyn Maclure. "Objection de conscience et aide médicale à mourir : une étude qualitative auprès de médecins québécois." Canadian Journal of Bioethics 2, no. 2 (March 20, 2019): 110–34. http://dx.doi.org/10.7202/1065691ar.
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Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a physician’s right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people.
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Chandhoke, Gur, Gregory Russell Pond, Oren Hannun Levine, and Simon Oczkowski. "Oncologists and medical assistance in dying: Where do we stand?" Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 64. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.64.
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64 Background: With the passage of Bill C-14 in June 2016, medical assistance in dying (MAiD) was formally enacted into Canadian law. Since then, approximately 2,000 patients have died with medical assistance across the country, with cancer being the most common qualifying condition. We aimed to understand the views of oncology providers (OPs) regarding MAiD. Methods: We designed and administered an online survey to Canadian OPs’ to assess experience with MAiD, self-perceived knowledge, willingness to participate, and perception of the role of OPs in introducing MAiD as an end-of-life care option. We used complete sampling via the Canadian Association of Medical Oncologists (CAMO) and the Canadian Association of Radiation Oncologists (CARO) membership email lists. The survey was sent to 366 Radiation Oncologists, and 325 Medical Oncologists. Data was collected from April-June 2018. Results were analyzed using descriptive statistics as well as univariate and multivariate analysis. Results: We received 224 responses (response rate 32.4%). 70% of OPs have been approached by patients requesting MAiD. OPs were confident in their knowledge of the eligibility criteria, and previous exposure to MAiD was associated with confidence in this domain (odds ratio [OR]=3.77, 95% CI=2.05-6.94, p value<0.001). OPs were most willing to engage in MAiD with an assessment for eligibility, yet most refer to specialized teams for assessments. A majority of physicians (52.8%) would initiate a conversation of MAiD with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions: In this first national survey of Canadian OP’s regarding MAiD, we found that most OP’s encounter patient requests for MAiD, are confident in knowledge of eligibility, and are willing to act as assessors of eligibility. Many OP’s believe that it is appropriate to present MAiD as a therapeutic option at the end of life under some circumstances. This finding warrants further deliberation amongst national/regional bodies for the development of consensus guidelines in order to ensure equitable access to MAiD for patients who wish to pursue it.
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Gayatri, Aghnaa. "The Role of Primary Care in End of Life Care." Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) 1, no. 2 (June 4, 2018): 53. http://dx.doi.org/10.22146/rpcpe.36124.
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Primary Care has been acknowledged to be the solution towards the achievement of “Health for All” as declared in the Declaration of Alma Ata1. Its importance has been further emphasized in the World Health Organization (WHO) 2008 Report2, where the changing world is in dire need of health care that surpasses all boundaries and can be delivered to all. It is stated that current health systems that are mostly hospital-based pose the risk of fragmented and uncoordinated care for the people. The move towards primary care is aimed at solving this problem amongst many others.One of the features that distinguishes primary care from other levels of care is that it addresses the needs of people irrespective of their age, gender, and disease, thus caring for individuals from the very beginning of life until death3. Caring for the dying patient has been traditionally considered as palliative or hospice care which is being provided to terminally ill patients in secondary settings4. With the shift of population by the increasing of elderly people, chronic conditions also become a major health problem which can eventually lead to death, and these often occur at homes and at the nursing care centers5. Care for the dying patient should not be just about preparing the patient for death. It is important to manage the dying patient in terms of management of symptoms and providing psychological support. Primary care situated as the first line of health care has an important role in ensuring that end of life care is well provided from the earliest stage possible, in coordination with other services when necessary.......
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Tait, Victoria, Megan Higgs, Linda Magann, Joanne Dixon, Jan Maree Davis, and Ritin Fernandez. "Attitudes of Nonpalliative Care Nurses towards Palliative Care." International Journal of Palliative Care 2015 (January 21, 2015): 1–6. http://dx.doi.org/10.1155/2015/469174.
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The quality of palliative care given to terminally ill patients and their family members can be directly impacted by the attitudes that nurses hold towards palliative care. This study aimed to investigate the attitudes of nonpalliative care nurses towards death and dying in the context of palliative care. Nurses working within the medical aged care, cardiology and respiratory wards at two metropolitan teaching hospitals in Sydney completed the Frommelt Attitudes Towards Care of the Dying (FATCOD) scale, an anonymous self-administered questionnaire, and a twelve-item demographic questionnaire. A total of 95 completed surveys were used in the final analysis. The total FATCOD score was 119.8±11.1, patient FATCOD was 79.6±8.6, and family FATCOD was 40.2±4.4. Of significance, the professional variables designation and role were associated with attitudes in the total FATCOD and country of birth, designation, highest level of education, and role were associated with attitudes towards the patient FATCOD. Scores for communication between the nurse and the terminally ill patient were poor. Health care facilities should focus on developing strategies to improve the communication skills among nonpalliative care nurses in order to optimize patient outcomes.