Cancer Caregivers’ Prognostic and End-of-Life Communication Needs and Experiences and their Impact

ContextFamily caregivers of patients with advanced cancer are integrally involved in communications regarding prognosis and end-of-life (EOL) planning and care. Yet little research has examined caregivers’ communication experiences or the impact of these experiences on patients and caregivers at EOL.ObjectivesInvestigate cancer caregivers’ communication experiences and potential impact on patient and caregiver outcomes.MethodsSemistructured interviews with bereaved family cancer caregivers (N=19) about their communication needs and experiences as their loved one approached EOL and died. Audiotaped interviews were transcribed and thematically analyzed for communication-related themes.ResultsCaregivers described fulfilling many important communication roles including information gathering and sharing, advocating, and facilitating—often coordinating communication with multiple partners (e.g., patient, family, oncology team, hospital team). Caregivers reported that, among the many topics they communicated about, prognosis and EOL were the most consequential and challenging. These challenges arose for several reasons including caregivers’ and patients' discordant communication needs, limited opportunity for caregivers to satisfy their personal communication needs, uncertainty regarding their communication needs and responsibilities, and feeling unacknowledged by the care team. These challenges negatively impacted caregivers’ abilities to satisfy their patient-related communication responsibilities, which shaped many outcomes including end-of-life decisions, care satisfaction, and bereavement.ConclusionCaregivers often facilitate essential communication for patients with advanced cancers yet face challenges successfully fulfilling their own and patients’ communication needs, particularly surrounding prognostic and end-of-life conversations. Future research and interventions should explore strategies to help caregivers navigate uncertainty, create space to ask sensitive questions, and facilitate patient-caregiver discussions about differing informational needs.     

Deaf and Hard-Of-Hearing High School and College Students’ Perceptions of Speech-To-Text and Interpreting/Note Taking Services and Motivation

In this investigation, one study examined the perceptions and motivation of 55 deaf/hard-of-hearing (DHH) high school students who used the C-Print speech-to-text service as an accommodation in one mainstream course and interpreting and note taking in a second mainstream course. A second study examined the perceptions and motivation of 88 DHH college students who used each service in a different course. Students in the two studies completed a survey that asked separate sets of questions for the speech-to-text and for the interpreting/note taking supported courses. Results indicated that students rated the printed or electronic file text, saved for the purpose of after class study as part of the speech-to-text service, as more helpful than notes from a note taker.     

Revisiting antithrombin in health and disease,congenital deficiencies and genetic variants,and laboratory studies on α and β forms

Antithrombin [AT] is the main inhibitor for activated plasma coagulation serine esterases, inhibiting thrombin, Factors Xa and IXa, but also Factors XIIa, XIa, VIIa, kallicrein, and plasmin. Its activity is highly enhanced by heparin, through binding to the pentasaccharide sequences, for inhibition of all coagulation proteases, except thrombin, which inhibition requires its additional binding to the heparin polysaccharide chain. However, AT is the major inhibitor of thrombin in the blood circulation. Congenital or acquired deficiencies of AT expose affected patients to an increased risk of developing unprovoked and recurrent thrombo-embolic diseases. Antithrombin can be measured with various laboratory techniques, by either immunological or functional methods. Earlier, a radial immunodiffusion immunoassay allowed measurement of the protein antigenic content. Functional assays are mainly designed with Anti-Thrombin or Anti-Factor Xa chromogenic methods and are useful for detecting genetic molecular mutations with decreased inhibitory activity and contributed to study the conformational changes of antithrombin and its variants, which potentially regulate the activity of this serine protease inhibitor. These assays are not equivalent in terms of diagnosing protein abnormalities, associated with increased thrombotic incidence, and they have variable performance for reflecting impaired antithrombin binding capacity for heparin, reduced progressive inhibition of serine proteases, or accelerated switch rates to the latent and less active forms. A small proportion of AT (<10%) is present in blood in the β-form, with a lower oligosaccharide content, a lower Molecular Weight, a higher binding rate to endothelial glycosaminoglycans, and a higher anticoagulant activity, hence requiring specific laboratory methods for its measurement. The β-AT form is then of critical importance for controlling blood activation by tissue injury and preventing development of thrombo-embolic diseases. This article reviews the performance characteristics of the currently available assays, and their usefulness for monitoring the use of AT concentrates in intensive care units, disseminated intravascular coagulation or severe infections, to restore the anticoagulant protective effect of heparin by supplementing the requested AT concentration. The issues of automation, harmonization and standardization are also revisited and discussed.     

Relationship between abnormal blood rheology and development and recovery of hyperte nsion and cerebral infarction

Background：Increasedbloodpressureinhypertensionisrelatedtovesselsresistance，cardiacoutput，aswellasbloodviscosity．Strokeiscommonfollowinghypertension．Anumberofstudiesreportedthatabnormalbloodrheologywasfrequentinstrokesuggestingcorrelationofbloodrheologywithonset，development，recoveryofhyperten－sion．Hypertensionisthemostoneofindependentriskfactorsofstroke．Inthecurrentpaper，weinvestigatedpathogenesisanddevel－opmentofhypertensionandcerebralinfarctiontoprovideprinciplefoundationforearl…     

Manipulators and integrated OR systems – requirements and solutions

Videoendoscopic (laparoscopic and thoracoscopic) surgery is characterized by challenges for the whole OR team. Additional equipment must be monitored and managed by the surgeon and the nurses in a rather dark environment. The surgeon is using long‐shafted instruments that reduce the degrees of freedom of the possible instrument movements, thus limiting the dexterity for the surgeon. The use of trocars results in a pivot point effect when moving the instruments, which needs some experience on the surgeon's side to move the instruments adequately and into the right direction. Finally the hand‐eye‐coordination is dependent on the camera position relative to the instruments and a stable image of the situs shown at the monitor. To overcome these challenges, several new technologies have been developed and introduced into the OR by the industry, also using robotics to help the surgeon perform the procedure. Integrated OR systems enable the OR team to control virtually all devices in the OR from a centralized panel; scope‐positioning systems provide the surgeon with a stable image under his own control and manipulators for the instruments allow fine movements with additional degrees of freedom. This article gives a short overview of currently available technologies, describing the design requirements and the functionality of the different systems     

Chemosensitization and chemoprotection

Cancer gene therapy over the past several yearshas involved the introduction of genes intohematopoietic cells for: (1) protecting the normalcells from the side effects of chemotherapy; (2)introduction of genes into the neoplastic cells for the     

Of bedpans and ivory towers? Nurse academics' identities and the sacred and profane: a Bernsteinian analysis and discussion paper

Aim

In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics’ identities.

Background

The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it.

Method

Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated.

Findings

Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics’ attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills.

Conclusions

To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.     

Patient blood management and blood conservation – Complimentary concepts and solutions for blood establishments and clinical services in South Africa and beyond

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.     

The Cognitive and Emotional Phenomenology of Depression and Anxiety: Are Worry and Hopelessness the Cognitive Correlates of NA and PA?

The study attempted to integrate the cognitive content-specificity and tripartite literatures to create a more holistic model of the emotional, physiological, and cognitive phenomenology of depression and anxiety. In addition, the constructs of hopelessness and worry were used to clarify ambiguous findings in the cognitive content-specificity research and to identify possible cognitive correlates of high NA and low PA. The results from 124 clients at a university counseling center supported this attempt at integrating these literatures. Overall, there was good evidence that worry is a cognitive correlate of high NA. Consequently, we view worry and high NA as features of a constellation of correlated indices that are shared with both depressed and anxious mood states. Alternatively, the results also support the position that hopelessness is a cognitive correlate of low PA. These features—low PA and hopelessness—define correlated indices that help discriminate depressed from anxious states. We view this integration of the cognitive and emotional literatures as providing evidence for a comprehensive map of the emotional and cognitive phenomenology in depression and anxiety.     

Testosterone and cardiovascular disease – the controversy and the facts

Since November 2013, there has been a flurry of articles written in the media touting the risk of cardiovascular (CV) disease in men treated with testosterone, based on two recent reports. Since first synthesized in 1935, testosterone therapy has demonstrated substantial benefits for men with testosterone deficiency (also called hypogonadism). Testosterone has an acceptable safety profile and literature spanning more than 30 years, suggesting a decreased CV risk with low levels of testosterone and benefits associated with testosterone therapy. However, nonmedical media outlets have seized on reports of increased CV risk, and published scathing editorials impugning testosterone therapy as a dangerous and overprescribed treatment. Here, we review these recent studies, and find no scientific basis for assertions of increased CV risk. This article is intended to provide the clinician with the facts needed for an informed discussion with men who suffer from testosterone deficiency and who desire treatment for their symptoms.     

UK accident and emergency departments and emergency contraception: what do they think and do?

OBJECTIVES: A postal questionnaire survey was conducted to assess what staff in UK accident and emergency (A&E) departments thought of providing an emergency contraception service, the degree of enthusiasm in and level of provision of the service, and staff attitudes to the introduction or continuation of provision of the service. METHODS: A questionnaire was sent to all 560 departments providing A&E services in the UK. RESULTS: Of the 560 units sent questionnaires, 355 (63.4%) replied. Half the units were located in small county towns, and a quarter in large towns. Requests for emergency contraception were received by 96% of responding units, but only 57% provided treatment. Requests for emergency contraception in 84 of these units ranged between one and 50 per month. The A&E senior house officer (SHO) and the gynaecology SHO and registrar prescribed most of the pills. Nurses were more involved in nurse led or general practitioner (GP) led units. Initial treatment only was given by 77% of providing units while the remainder also discussed subsequent contraception. Follow up was arranged with GPs by 92 units, and with family planning clinics by 66 units. Information packs were available in only 37 providing units. A total of 155 of providing units felt it was worthwhile and 56% of respondents thought emergency contraception should be provided by A&E departments. However, 91 units could identify one or more groups within the hospital who were antagonistic to provision by A&E departments, of which non-A&E medical staff formed the largest group. Over the counter availability of emergency contraception was not supported by 62% of respondents. CONCLUSION: The results show that while the female population appears to see a need for emergency contraception services to be provided in A&E departments, there is some reluctance by UK A&E departments to provide the service. Given the current interest in approaches to reducing unplanned pregnancies, especially in teenagers, provision of emergency contraception by A&E departments requires a pragmatic approach to ensure their cooperation in providing the service when alternative sources of provision are not available.     

Manifestations and causes of psychological and behavioral problems in infant patients and patients of early age

Largeamountsclinicalfactsdemonstratethatmanydiseasescaninduceemotionaldisturbancesandpsychologicalproblemssuchasfear,anxiety,restlessness,agitationandirritabilityininfantilepatientsandpatientsofearlyage.Theauthorwouldliketodiscussbrieflyseveralcommonpsychologicalandbehavioralproblemsandthecorrespondingcausesofthem.1CommonpsychologicalandbehavioralproblemsininfantpatientsandpatientsofearlyageCryingandmakingnoise:Cryingandmakingnoiseisasignalinfantsandchildrenusetoconveylargeamountsofinformation…     

Manifestations and Causes of psychological and behavioral problems in infant patients and patients of early age

Lage amounts clinical facts demonstrate that many diseases can induce emotional disturbances and psychological problems such as fear,anxiety,restlessness,agitation and irritability in infantile patients and patients of early age.The author would like to discuss briefly several common psychological and behavioral problesms and the corresponding causes of them.     

State mandatory overtime regulations and newly licensed nurses' mandatory and voluntary overtime and total work hours

Nurse overtime has been used to handle normal variations in patient census and to control chronic understaffing. By 2010, 16 states had regulations to limit nurse overtime. We examined mandatory overtime regulations and their association with mandatory and voluntary overtime and total hours worked by newly licensed registered nurses (NLRNs). For this secondary data analysis, we used a panel survey of NLRNs; the final dataset consisted of 1,706 NLRNs. Nurses working in states that instituted overtime regulations after 2003 or in states that restricted any type of mandatory overtime had a lower probability of experiencing mandatory overtime than those nurses working in states without regulations. Nurses who worked in states with mandatory overtime regulations reported fewer total hours worked per week. The findings of this study provided insight into how mandatory overtime regulations were related to nurse mandatory and voluntary overtime and the total number of hours worked. Future research should investigate institutions' compliance with regulations and the impact of regulations on nurse and patient outcomes.