Suchergebnisse

How do we prepare our patients for decisions that will need to be made for end-of-life care? End-of-life care discussions should occur early on in the patient's disease process and often requires a great deal of coordination between multiple caregivers. There are also ethical, cultural, social, and spiritual considerations during this very important time in the disease process. Research suggests that we are not doing an adequate job of addressing end-of-life care with our patients and that a great deal of money and resources are being spent in the last days of life when there may be no clinical indication to do so. Registered nurse case managers have a unique knowledge base to serve in the role of coordinating care and leading the multidisciplinary care team in an effort to use resources responsibly while providing patients and families with options for end-of-life care.

This review proposes that the end of life is a uniquely contemporary life course stage. Epidemiologic, technological, and cultural shifts over the past two centuries have created a context in which dying has shifted from a sudden and unexpected event to a protracted, anticipated transition following an incurable chronic illness. The emergence of an end-of-life stage lasting for months or even years has heightened public interest in enhancing patient well-being, autonomy, and the receipt of medical care that accords with patient and family members' wishes. We describe key components of end-of-life well-being and highlight socioeconomic and race disparities therein, drawing on fundamental cause theory. We describe two practices that are critical to end-of-life well-being (advance care planning and hospice) and identify limitations that may undermine their effectiveness. We conclude with recommendations for future sociological research that could inform practices to enhance patient and family well-being at the end of life.

Abstract  Staff carers in pediatric skilled nursing facilities (PSNF) deal directly with dying residents, and are on the forefront of communication with families. These providers have expressed misunderstandings regarding the meaning of resuscitation status and redirection of care. This descriptive study evaluated perceptions and understanding of end of life issues by the staff in a PSNF who provide care for individuals with severe developmental disabilities and complex medical problems. A 16‐item pre‐intervention survey was administered to the staff prior to an informational presentation explaining issues related to end of life care. An 8‐item post‐intervention survey assessed any change in understanding of these issues. A total of 55 persons completed either a pre‐ or post‐intervention survey; 47 staff completed both surveys. While most staff carers were comfortable with providing care for patients with serious illnesses or needing comfort measures (narcotics, oxygen) when they are dying, they are significantly less comfortable with discontinuation of feeds or routine medications at the end of life. Observed was a significant increase in those who indicated it is acceptable to stop feedings for a dying patient in the post‐intervention survey, but there no significant difference in understanding of definition of DNR before or after the intervention. Authors note the need to provide more comprehensive information and support to assist staff carers to understand aspects of end of life care in a PSNF setting.

AbstractEnvironmental and social awareness are the key elements of the sustainable tire industry. End-of-life tire (ELT) waste flow is an important environmental problem worldwide since it produces severe air, water, and soil pollution issues. Significant advancements have been made in ELT management in the last few years. As a result, ELTs should not only be regarded as waste but also as a source of environmentally friendly materials. Besides, sound ELT management has vital importance for circular economy and sustainable development. Over the last decade, ELT management has attracted many researchers and practitioners. Unfortunately, a comprehensive review of the ELT management area is still missing. This study presents the first critical review of the whole ELT management area. It aims to present an extensive content analysis overview of state-of-the-art research, provide its critical analysis, highlight major gaps, and propose the most significant research directions. A total of 151 peer-reviewed studies published in the journals between 2010–2020 are collected, analyzed, categorized, and critically reviewed. This review study redounds comprehensive insights, a valuable source of references, and major opportunities for researchers and practitioners interested in not only ELT material flow but also the whole waste management area.
Graphical abstract

The authors argue that allowing patients more say in deciding their own time of death could result in a greater overall length of life. In support of this they cite evidence that the last month of life can consume 40% of the total spent on healthcare during the lifetime of an individual. The paper reasons that the same resources invested in healthcare at earlier stages in life would yield much greater extensions in life length. Adapted from the source document.

AbstractIntroductionMaintaining oral health is vital for every individual's quality of life. Little consideration, however, has been given to the oral health of patients approaching end‐of‐life, perhaps due to sensitivities over research ethics. The aim of this rapid review is to synthesize existing evidence on oral health in this population.Methods and resultsA rapid review of the literature was conducted using the key words: "Oral/Dental Health" in "End‐of‐life" or "Palliative care" patients. Nineteen articles met the inclusion criteria: five retrospective cohort studies, ten cross sectional studies, two experimental studies, one systematic review, and one audit. Quality was medium to low.The prevalence of oral/dental conditions was high in the end‐of‐life population, as were self‐reported symptoms, and poor OHRQOL. Staff placed value on oral health but identified several barriers to providing both routine daily and professional dental care. Professional oral care was beneficial in relieving palliative specific conditions and providing guidance/training for daily care.ConclusionThere is a paucity of high quality research in relation to oral health at end‐of‐life. The existing literature suggests that oral health and oral health related quality of life are poor and professional support and care for this population is needed.