Suchergebnisse

In order to ensure the quality of life for the aging society, it is necessary to reconsider the end of life decision-making, service organization, continuous improvement thereof. Such decisions are ethnically complex and require a lot of human and financial resources. Aim of the work: To investigate the attitude of health care professionals and administrators to the end of life decision management in Lithuanian health care institutions. Research methodology. Anonymous questionnaire survey was performed. The group of respondents consisted of the employees of intensive care units of Vilnius, Kaunas, Klaipeda city hospitals (doctors, nurses), administration staff (unit selected according to the selection criteria) and politicians. The study was conducted in December 2016 . The number of fully completed questionnaires – 237. The response rate was 52.3%. Statistical analysis of data was performed using the statistical data analysis package IBM SPSS Statistics Subscription. Differences of variables were considered as statistically significant when p < 0.05. Relations between the attributes were assessed using the chi-square (χ²) criterion. Results. Statistically significantly, greater part of the "clinicians" respondents (27.9%) compared with non-clinicians (12.3%) stated that the decisions related to the patient's vital functions should be taken by the patient himself. The greater part of the "clinicians" respondents (52.9%) compared with non-clinicians (41.5%) believe that the number of qualified personnel in health care facilities is insufficient. The shortage is observed among psychologists, nurses, and nursing assistants. A statistically significantly greater proportion of those involved in the waiting of the life end outcome (57.5%) compared with non-participating (33.8%) respondents believe that the number of qualified personnel is insufficient in health care facilities and a statistically significantly higher proportion of those who did not participate (66.2%) compared to the participants (42.5%) respondents believe that the numbers of qualified personnel are sufficient (p <0.5). Statistically significantly greater part of the "clinicians" respondents (88.4%) compared with non-clinicians (75.4%) answered that it is necessary to apply additional motivation measures for staff working with palliative patients. Conclusions: Significant decision-making in the health care system, especially for the end of life decisions, is a hybrid of the general management knowledge and specialized medical (health care) knowledge. When assessing the results of research, we can state that significantly more "clinicians" respondents rated the availability and quality of service worse than the respondents' non-clinicians. Part of the "clinicians" (44.8%) would initiate the rearrangement and improvement of hospital services related with the end of life decisions however, they do not know where to start. In the opinion of the research participants, the crucial decisions concerning the end of life should be made by a clinical consultation, the patient himself or the God. The majority (29.5%) of nurses and doctors (16.5%) who took part in the research believe that the staff devotes sufficient attention to the patient. Practical recommendations. To create a personnel incentive system that encourages provide more attention to the patient, carefully carry out their duties, seek to promote the satisfaction of patients and is relatives with the performance of the physician. Reallocation of financial resources for employment of the missing qualified personnel (nurses, assistant nurses, psychologists for the staff, patients and their relatives).

In order to ensure the quality of life for the aging society, it is necessary to reconsider the end of life decision-making, service organization, continuous improvement thereof. Such decisions are ethnically complex and require a lot of human and financial resources. Aim of the work: To investigate the attitude of health care professionals and administrators to the end of life decision management in Lithuanian health care institutions. Research methodology. Anonymous questionnaire survey was performed. The group of respondents consisted of the employees of intensive care units of Vilnius, Kaunas, Klaipeda city hospitals (doctors, nurses), administration staff (unit selected according to the selection criteria) and politicians. The study was conducted in December 2016 . The number of fully completed questionnaires – 237. The response rate was 52.3%. Statistical analysis of data was performed using the statistical data analysis package IBM SPSS Statistics Subscription. Differences of variables were considered as statistically significant when p < 0.05. Relations between the attributes were assessed using the chi-square (χ²) criterion. Results. Statistically significantly, greater part of the "clinicians" respondents (27.9%) compared with non-clinicians (12.3%) stated that the decisions related to the patient's vital functions should be taken by the patient himself. The greater part of the "clinicians" respondents (52.9%) compared with non-clinicians (41.5%) believe that the number of qualified personnel in health care facilities is insufficient. The shortage is observed among psychologists, nurses, and nursing assistants. A statistically significantly greater proportion of those involved in the waiting of the life end outcome (57.5%) compared with non-participating (33.8%) respondents believe that the number of qualified personnel is insufficient in health care facilities and a statistically significantly higher proportion of those who did not participate (66.2%) compared to the participants (42.5%) respondents believe that the numbers of qualified personnel are sufficient (p <0.5). Statistically significantly greater part of the "clinicians" respondents (88.4%) compared with non-clinicians (75.4%) answered that it is necessary to apply additional motivation measures for staff working with palliative patients. Conclusions: Significant decision-making in the health care system, especially for the end of life decisions, is a hybrid of the general management knowledge and specialized medical (health care) knowledge. When assessing the results of research, we can state that significantly more "clinicians" respondents rated the availability and quality of service worse than the respondents' non-clinicians. Part of the "clinicians" (44.8%) would initiate the rearrangement and improvement of hospital services related with the end of life decisions however, they do not know where to start. In the opinion of the research participants, the crucial decisions concerning the end of life should be made by a clinical consultation, the patient himself or the God. The majority (29.5%) of nurses and doctors (16.5%) who took part in the research believe that the staff devotes sufficient attention to the patient. Practical recommendations. To create a personnel incentive system that encourages provide more attention to the patient, carefully carry out their duties, seek to promote the satisfaction of patients and is relatives with the performance of the physician. Reallocation of financial resources for employment of the missing qualified personnel (nurses, assistant nurses, psychologists for the staff, patients and their relatives).

The aim: To evaluate the attitude of doctors from Lithuania to the aiming of futile treatment in the ICU. Objectives: 1) To evaluate the attitude of doctors from Lithuania to the aiming of futile treatment for patients with poor prognosis in the ICU. 2) To assess the doctor's opinion of who should decide whether to administer futile treatment. 3) To evaluate doctor's attitude to the aiming of futile treatment depending on their age, medical experience, gender and subspecialization. Methods: The study included 173 anaesthesiologists-reanimatologists. An anonymous original questionnaire survey was designed where the situation of patient with poor prognosis in ICU were provided. Respondents specified which medical interventions they would apply for this patient. Also, the physicians were asked about frequency of medical futility in their clinical practice, aspects about end of life decisions and legislative framework in Lithuania. Results: Majority of doctors answered that patient's admission to ICU was reasonable (54.9 %), that they wouldn't order hemodialysis (81.5 %), wouldn't escalate the treatment (63.5 %), wouldn't extubate (78.6 %), wouldn't perform cardiopulmonary resuscitation if asystole appears (85.5 %), discontinuate to supply vasopressors and sedate the patient to let her die without pain (77.5 %). 96.5 % of respondents answered that they would reveal about hopeless situation of the patient for the relatives, 63.6 % wouldn't limit the access to the patient, however older physicians and those who are female would limit the access more often than the others (p<0.05). Even 80.4 % of anaesthesiologists-reanimatologists think that it is not well defined how to treat patients in end of life. 65.9 % of respondents think that end of life decisions should be done by doctors' consulate and family members. Conclusion: Anaesthesiologists-reanimatologists negatively evaluate the aiming of futile treatment in ICU. In their opinion end of life decisions should be done by doctors' consulate and family members. Older age and male gender and subspecialization influence the decision to limit the access to the patient.

The aim: To evaluate the attitude of doctors from Lithuania to the aiming of futile treatment in the ICU. Objectives: 1) To evaluate the attitude of doctors from Lithuania to the aiming of futile treatment for patients with poor prognosis in the ICU. 2) To assess the doctor's opinion of who should decide whether to administer futile treatment. 3) To evaluate doctor's attitude to the aiming of futile treatment depending on their age, medical experience, gender and subspecialization. Methods: The study included 173 anaesthesiologists-reanimatologists. An anonymous original questionnaire survey was designed where the situation of patient with poor prognosis in ICU were provided. Respondents specified which medical interventions they would apply for this patient. Also, the physicians were asked about frequency of medical futility in their clinical practice, aspects about end of life decisions and legislative framework in Lithuania. Results: Majority of doctors answered that patient's admission to ICU was reasonable (54.9 %), that they wouldn't order hemodialysis (81.5 %), wouldn't escalate the treatment (63.5 %), wouldn't extubate (78.6 %), wouldn't perform cardiopulmonary resuscitation if asystole appears (85.5 %), discontinuate to supply vasopressors and sedate the patient to let her die without pain (77.5 %). 96.5 % of respondents answered that they would reveal about hopeless situation of the patient for the relatives, 63.6 % wouldn't limit the access to the patient, however older physicians and those who are female would limit the access more often than the others (p<0.05). Even 80.4 % of anaesthesiologists-reanimatologists think that it is not well defined how to treat patients in end of life. 65.9 % of respondents think that end of life decisions should be done by doctors' consulate and family members. Conclusion: Anaesthesiologists-reanimatologists negatively evaluate the aiming of futile treatment in ICU. In their opinion end of life decisions should be done by doctors' consulate and family members. Older age and male gender and subspecialization influence the decision to limit the access to the patient.

Sąjūdis (Lithuanian independence movement) as an object of scholarly investigation has a certain history or maybe even a historiographic tradition. One of the first who started to investigate this problem was the representative of lithuanian diaspora in the US, professor of the University of Wisconsin Alfred Eric Senn. The changes of Lithuanian political life during the revival period were analyzed also by the Sąjūdis members themselves: Bronislavas Genzelis and Virgilijus Juozas Čepaitis. However, they often fail to avoid subjective views of certain personalities, their data is not always based on sources. Only at the end of the 20th and beginning of the 21st centuries Sąjūdis received proper attention from historians. The society at large was presented with scholarly publications, collections of articles and sources on particular subjects. Among these publications one can distinguish the one written by Česlovas Laurinavičius and Vladas Sirutavičius which deals with the political history of Lithuania in 1988–1990. After the careful analysis of scholarly publications dealing with the topic of Sąjūdis, one may notice the tendency to restrict the investigations of the events only prior to the restoration of lithuanian independence in March 1990. However, the process of transformation of spontaneous social renewal movement into a public organization is still remaining a white spot in history. There are several reasons for this, the most important of which is, to my mind, political. Historians are not willing to confuse their scientific investigations with their political preferences. In the Lithuanian historiography one might notice a tendency for historical investigations of Sąjūdis to intensify prior to the anniversaries of Lithuanian independence restoration. Historians usually restricted their works to the analysis of the national revival period events taking place in the country's capital. [.]

Sąjūdis (Lithuanian independence movement) as an object of scholarly investigation has a certain history or maybe even a historiographic tradition. One of the first who started to investigate this problem was the representative of lithuanian diaspora in the US, professor of the University of Wisconsin Alfred Eric Senn. The changes of Lithuanian political life during the revival period were analyzed also by the Sąjūdis members themselves: Bronislavas Genzelis and Virgilijus Juozas Čepaitis. However, they often fail to avoid subjective views of certain personalities, their data is not always based on sources. Only at the end of the 20th and beginning of the 21st centuries Sąjūdis received proper attention from historians. The society at large was presented with scholarly publications, collections of articles and sources on particular subjects. Among these publications one can distinguish the one written by Česlovas Laurinavičius and Vladas Sirutavičius which deals with the political history of Lithuania in 1988–1990. After the careful analysis of scholarly publications dealing with the topic of Sąjūdis, one may notice the tendency to restrict the investigations of the events only prior to the restoration of lithuanian independence in March 1990. However, the process of transformation of spontaneous social renewal movement into a public organization is still remaining a white spot in history. There are several reasons for this, the most important of which is, to my mind, political. Historians are not willing to confuse their scientific investigations with their political preferences. In the Lithuanian historiography one might notice a tendency for historical investigations of Sąjūdis to intensify prior to the anniversaries of Lithuanian independence restoration. Historians usually restricted their works to the analysis of the national revival period events taking place in the country's capital. [.]

The beginning of XXI century was marked by few events that had influence on international relations in the whole world. Terror attacks in the United States of America in September 11, 2001, were the first such high a big range attacks against the USA. It had shown that the USA – the most powerful state of the world – is vulnerable to more danger, than nuclear weapons alone. After September 11 the USA started war against terrorism in Afghanistan, and many states supported it. However, in spring 2003 the USA unilaterally, without international support, decided to use military power in Iraq, arguing that Iraq possessed potential threat – weapons of mass destruction. Unilateralism, and military and technological differences between the USA and its allies have brought to light a presumption that in the international system there is a single pole, a superpower (hyperpower), the United States of America. The existence of one pole only can have different consequences on international system and international security. The aim of this article was to determine specific features of the unipolar world, influence of polarity of international system upon international security, and specific threats to security that emerge only in unipolar international systems. Another aim was to try to predict the end of the unipolar system: what could be the next poles and when could it come to the end. After analysing a number of articles concerning this topic, few conclusions were drawn. Contemporary international system is unipolar and the single pole is the USA; the USA is superior in military, economic, geopolitical, and political spheres at the same time. Increasing military power and unilateralism of the USA may be treated as a threat to international security. Great powers are trying to balance unipolar power, however, the creation of balance to unipolar power is complicated for several reasons.[.].

The beginning of XXI century was marked by few events that had influence on international relations in the whole world. Terror attacks in the United States of America in September 11, 2001, were the first such high a big range attacks against the USA. It had shown that the USA – the most powerful state of the world – is vulnerable to more danger, than nuclear weapons alone. After September 11 the USA started war against terrorism in Afghanistan, and many states supported it. However, in spring 2003 the USA unilaterally, without international support, decided to use military power in Iraq, arguing that Iraq possessed potential threat – weapons of mass destruction. Unilateralism, and military and technological differences between the USA and its allies have brought to light a presumption that in the international system there is a single pole, a superpower (hyperpower), the United States of America. The existence of one pole only can have different consequences on international system and international security. The aim of this article was to determine specific features of the unipolar world, influence of polarity of international system upon international security, and specific threats to security that emerge only in unipolar international systems. Another aim was to try to predict the end of the unipolar system: what could be the next poles and when could it come to the end. After analysing a number of articles concerning this topic, few conclusions were drawn. Contemporary international system is unipolar and the single pole is the USA; the USA is superior in military, economic, geopolitical, and political spheres at the same time. Increasing military power and unilateralism of the USA may be treated as a threat to international security. Great powers are trying to balance unipolar power, however, the creation of balance to unipolar power is complicated for several reasons.[.].

The beginning of XXI century was marked by few events that had influence on international relations in the whole world. Terror attacks in the United States of America in September 11, 2001, were the first such high a big range attacks against the USA. It had shown that the USA – the most powerful state of the world – is vulnerable to more danger, than nuclear weapons alone. After September 11 the USA started war against terrorism in Afghanistan, and many states supported it. However, in spring 2003 the USA unilaterally, without international support, decided to use military power in Iraq, arguing that Iraq possessed potential threat – weapons of mass destruction. Unilateralism, and military and technological differences between the USA and its allies have brought to light a presumption that in the international system there is a single pole, a superpower (hyperpower), the United States of America. The existence of one pole only can have different consequences on international system and international security. The aim of this article was to determine specific features of the unipolar world, influence of polarity of international system upon international security, and specific threats to security that emerge only in unipolar international systems. Another aim was to try to predict the end of the unipolar system: what could be the next poles and when could it come to the end. After analysing a number of articles concerning this topic, few conclusions were drawn. Contemporary international system is unipolar and the single pole is the USA; the USA is superior in military, economic, geopolitical, and political spheres at the same time. Increasing military power and unilateralism of the USA may be treated as a threat to international security. Great powers are trying to balance unipolar power, however, the creation of balance to unipolar power is complicated for several reasons.[.].

Due to the lack of complex research on people with epilepsy and emphasis on physical (body) functioning, the QOL in people with epilepsy is perceived unambiguously and poor knowledge of their QOL factors is noticed. Based on Amartya Sen's capability approach, the dissertation carry out a complex research on the QOL in people with epilepsy and its factors. The research in the dissertation reveal that people with epilepsy worst function in the social, cultural, political participation, health, employment, mobility, social relations, self-esteem and independence domains. The research revealed the disagreement of functioning and capabilities of people with epilepsy, especially of mobility, participation and employment domains. Major part of the people do not operate due to the fear of seizures and lack of willingness. The results of the research show that personal conversion factors have a great influence on QOL in people with epilepsy, especially their age, education and factors of the disease. When the disease symptoms are more obvious, the QOL in people with epilepsy is more influenced by the disease factors. When the disease symptoms are milder – the greater become personal conversion factors. The impact of stigma for QOL in people with epilepsy remains even if the epileptic symptoms are not so visible. The assessment of the domain of agency used in the research revealed that people with epilepsy lack their personal perception they do not perceive themselves as the main agents in their lives.

Due to the lack of complex research on people with epilepsy and emphasis on physical (body) functioning, the QOL in people with epilepsy is perceived unambiguously and poor knowledge of their QOL factors is noticed. Based on Amartya Sen's capability approach, the dissertation carry out a complex research on the QOL in people with epilepsy and its factors. The research in the dissertation reveal that people with epilepsy worst function in the social, cultural, political participation, health, employment, mobility, social relations, self-esteem and independence domains. The research revealed the disagreement of functioning and capabilities of people with epilepsy, especially of mobility, participation and employment domains. Major part of the people do not operate due to the fear of seizures and lack of willingness. The results of the research show that personal conversion factors have a great influence on QOL in people with epilepsy, especially their age, education and factors of the disease. When the disease symptoms are more obvious, the QOL in people with epilepsy is more influenced by the disease factors. When the disease symptoms are milder – the greater become personal conversion factors. The impact of stigma for QOL in people with epilepsy remains even if the epileptic symptoms are not so visible. The assessment of the domain of agency used in the research revealed that people with epilepsy lack their personal perception they do not perceive themselves as the main agents in their lives.