Evaluation of Ovarian Cancer Care at the End of Life in a Single Tertiary Hospital

Aim: Fundamentally, aggressive care is considered to be avoided for the patients at the end of life. However, this is not always adhered in real-world practice. We attempted to determine whether, and if so how, the aggressive care is made for patients with ovarian cancer during the last month prior death. Methods: Enrolled were a total of 104 patients with ovarian cancer (including fallopian tube or primary peritoneal cancer), who were treated in Kuopio University Hospital in Finland during 2009-2014. The aggressive care was defined according to the standards outlined by the National Quality Forum;shortly, chemotherapy, emergency-room/intensive-care visit/admission, hospital admission, and death in hospital. Results: Two thirds of patients (67%) had received at least one form of aggressive care during the last month of their lives. Especially, admission in hospital in the last 30 days of life was the most common form of aggressive cancer care. Younger patients (<72 years) received significantly more often aggressive care than the older patients (80% vs 43%, p = 0.004). Those women that underwent end-of-life discussions earlier than one month prior to death had significantly less aggressive care than those women that had discussions during the last month (48% vs. 90%, p = 0.001). Conclusions: Ovarian cancer patients received commonly at least one form of aggressive care at the end of their lives. More efforts should be taken to improve the quality of palliative and end-of-life care.

ePROMs in the End of Life and in Making Ethical Decisions. An Integrative Review with Narrative

Background: Patient-reported outcome measures (PROMS) are essential tools in clinical practice and research to assess patients’ needs from their unique perspectives. They allow the healthcare team to monitor patient status and concerns outside the clinical setting. However, the real innovation in this field is its digitization: electronic patient-reported outcome measures (ePROMs). Aims: This review aimed to get an overview of whether these new technologies are being used to aid palliative care teams in their daily struggle to provide comfort to their patients. Methods: We conducted a systematic review of articles retrieved from PubMed and Web of Science, up to November 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search strategy yielded 242 records, of which 13 met the predefined inclusion and exclusion criteria. In addition, relevant information related to ePROMs was extracted from each study. Results: Outcomes were grouped into the quality of life assessment, symptom burden and simple assessments, and the decision to introduce Palliative Cures (PC). In 61.5% of cases, ePROMs positively impacted patients’ quality of life. Furthermore, in 46.15% of cases, ePROMs led Primary Care (PC) teams to make an ethical decision;the same relative value as in the circumstances did not define the direction in ethical terms. Conclusion: Remind professionals and patients that these tools exist and can be applied in many situations. If used correctly, they can provide patients with a better quality of life and more complete information for professionals.

End of Life Care Medical Education: 48 Hour Hospice Home Immersion Alters Students’ Lives

Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their ability to synthesize and demonstrate basic medical knowledge and clinical skills but offers little assessment of the maturation of attitudes or their values. The University of New England College of Osteopathic Medicine (UNECOM), immerses second year medical students in a hospice home for 48 hours to enhance students’ perspectives in interprofessional palliative and end of life care. Methods: This project utilized qualitative ethnographic and autobiographic research designs. Two female second year medical students (27 y/o & 26 y/o) were immersed for 48 hours into a local hospice home, sleeping in a bed where others had died, to answer the question: “What is it like for ME to live in the Hospice Home for 48 hours and how does this contribute to my future as a practitioner?” Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and patient/family encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Themes common to both students that factored in the research question and their prior stated interest areas of medical humanities and person-centered care at end of life were identified. Three themes were selected for this article: 1) Person-Centered Experiences, 2) Spectrum of Communication, and 3) Introspection: Attitudes and Values. The process of living in the hospice home for 48 hours revealed students’ attitudes about various disease processes, their personal experiences with death and dying, and their assumptions about how patients approach death. Conclusion: This Hospice Home Immersion project provided both an educational approach and learning environment that was effective in advancing medical students’ attitudes, skills, and knowledge as evidenced by their self-reported life altering learning about end of life and palliative care.

Factors Relating to Nurses’ End-of-Life Care

This integrative review aimed to investigate factors relating to end-of-life care of nurses. The review was conducted according to PICo (Participant, area of Interest, and Context). Keywords identified were: “nurse” AND “end-of-life care” (“dyingcare” OR “‘deathcare”, OR “near end stage of life care” OR “palliative care” OR “hospice care” OR “comfortable care in near death” OR “quality of dying patients care”), AND “nurses”. The database searched through PubMed, ProQuest, Google Scholar, Web of Science and SCOPUS. The searching inclusion criteria were limited to English and Chinese language studies about nurses’ end-of-life care from 2010 to 2019, yielding 258 English language articles and 2Chinese language articles. Results: A total of fifteen articles were selected based on inclusion criteria. Two subjects were obtained from the results that related to nurses’ care during the process of end of life: 1) Nurses’ demographic factors;and 2) Modifiable factors. Nurses’ demographic factors were age, years of work experience, level of education and experience of the death of a family member/friend. Modifiable factors included knowledge, attitude, confidence, relationship, environment and resources, communication, nursing activities, philosophy and culture of care, skills and training. These factors were explored in various areas and majority of the studies had been conducted in public government hospitals. Conclusion: The major power ability of care was observed in nurses who acted the significant part in caring for the terminally ill during the dying process. Caring for dying patients was related to many factors which could affect the fabric of nursing care at the end stage of life. The elements found in this review could lead to recommendations with implications for nursing practice so as to improve and enhance end-of-life care. Some factors could be considered like predictors affecting nursing practice for chronical ill patients in further research. In addition, nurses’ tranquility care in community hospitals should be more focused.

Importance of Life Cycle Analysis of the Printed Circuit Board Computer

It is estimated that there is a generation of 307,224 ton/year [1] of waste from electronic and electronic equipment (WEEE) in Mexico, of which 10% is recycled, 40% remains stored and 50% reaches landfills or uncontrolled dumps. In the practice, even the regulatory instruments are not consolidated and the adequate management of the use of WEEE management, so the aim of this study is an analysis of life cycle of printed circuit boards (TCI) to identify the management alternatives that represent the least impact to the environment. This assessment was carried out using software SIMAPRO to determine the environmental impact of each scenario, through the comparison of impacts and the proposed improvements to reduce it, following phases of this methodology by applying standards, ISO 14040/ISO 14044 [2], using data from the INE official reports since 2006 until 2010 which concentrate the information of the WEEE problem in Mexico. These data were pooled to carry out inventories according to the availability in the information, identifying the environmental impacts generated by processing. The conclusions of the LCA will serve to identify the stage with greater environmental impact, and thus propose ideas for improvement in order to minimize this impact.

Pearls of Wisdom: Israeli Elderly Reflect on Their Lives, and Make Suggestions for Future Generations

Reminiscing by older adults can facilitate beneficial outcomes through the preparation for the end of life,the cohesiveness of life narratives,and creation of life meanings.Given this,and the historical challenges of communication between generations,the objective of this study was two-fold:(1)to harness the beneficial role reminiscence can play in the mental health of older adults;(2)to facilitate generational learning by documenting and thematically analyzing the experiences and knowledge of older adults.We hypothesized that our interviews,which had the stated goal of helping younger people navigate life challenges,would not only act as catalyst for the participants to reminisce but also create a corpus of knowledge which could be later distilled into accessible“pearls of wisdom”.The interviews were conducted in Israel with 102 participants who were between 60 and 93 years of age with six questions constructed to promote further commentary.Through the interviews we were successful in producing a large representation of the older adults’experiences and what they believed would be beneficial for the younger generation.Due to the potential benefits for participants and larger communities we recommend this approach be adopted for future studies.

Rationale for integration of palliative care in the medical intensive care:A narrative literature review

Despite the remarkable technological advancement in the arena of critical care expertise,the mortality of critically ill patients remains high.When the organ functions de-teriorate,goals of care are not fulfilled and life-sustaining treatment becomes a burden on the patient and caregivers,then it is the responsibility of the physician to provide a dignified end to life,control the symptoms of the patient and provide psychological support to the family members.Palliative care is the best way forward for these patients.It is a multidimensional specialty which emphasizes patient and family-based care and aims to improve the quality of life of patients and their caregivers.Although intensive care and palliative care may seem to be at two opposite ends of the spectrum,it is necessary to amalgamate the postulates of palliative care in intensive care units to provide holistic care and best benefit patients admitted to intensive care units.This review aims to highlight the need for an alliance of palliative care with intensive care in the present era,the barriers to it,and models proposed for their integration and various ethical issues.