Journal articles on the topic 'Terminal care Australia'
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1
Harris, Ross. "Terminal Care in Australia." Hospice Journal, The 3, no. 1 (April 15, 1987): 77–90. http://dx.doi.org/10.1300/j011v03n01_07.
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Harris, Ross D., and Lyn M. Finlay-Jones. "Terminal Care in Australia." Hospice Journal 3, no. 1 (March 1987): 77–90. http://dx.doi.org/10.1080/0742-969x.1987.11882583.
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Wakefield, Melanie, and Michael Ashby. "Attitudes of surviving relatives to terminal care in South Australia." Journal of Pain and Symptom Management 8, no. 8 (November 1993): 529–38. http://dx.doi.org/10.1016/0885-3924(93)90082-7.
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Hunt, R., A. Bonett, and David Roder. "Trends in the terminal care of cancer patients: South Australia, 1981-1990." Australian and New Zealand Journal of Medicine 23, no. 3 (June 1993): 245–51. http://dx.doi.org/10.1111/j.1445-5994.1993.tb01725.x.
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Dawes, John. "Dying with Dignity: Prisoners and Terminal Illness." Illness, Crisis & Loss 10, no. 3 (July 2002): 188–203. http://dx.doi.org/10.1177/1054137302010003002.
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During the past twenty years in Australia, there has been a developing concern about deaths in police and correctional custody. This article discusses a small but important component of deaths in correctional custody: the care of those prisoners in the terminal phase of a terminal illness. Hospice care in prison as well as in the community (achieved through compassionate release provisions) is discussed, and some of the problems with both strategies are identified. Two briefcase histories are discussed. The background to concern about dying prisoners is the aging of Australians in the community as well as those imprisoned, greater community awareness of issues dealing with loss and grief for the survivors of such deaths (through the work of state and territory coroners and support groups), and correctional agencies' becoming increasingly aware of their duty of care responsibilities.
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Mitchell, Geoffrey, Caroline Nicholson, Keith McDonald, and Anne Bucetti. "Enhancing palliative care in rural Australia: the residential aged care setting." Australian Journal of Primary Health 17, no. 1 (2011): 95. http://dx.doi.org/10.1071/py10054.
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The delivery of palliative care in residential aged care communities is challenging, even more so in rural areas due to workforce ageing and shortages. The objectives of the present study were to: (i) assess the needs of, and quality of palliative care delivered to residents of 16 residential aged care facilities in rural southern Australia; and (ii) identify the needs of care staff to facilitate the delivery of quality palliative care. A cross-sectional survey of all residents, assessing the degree of functional limitation, stage of palliative care, and the presence of several quality indicators was conducted. Separate focus groups of care staff and relatives of residents sought information on the quality of care delivered, perceived strengths and weaknesses of the care delivered, and education and training needs. Quality palliative care in residential aged care facilities (RACFs) is hampered by workforce shortages, with low ratios of registered nurses, limited access to general practitioners after hours, and some communication difficulties. Some staff reported low confidence in technical and psychosocial aspects of care, especially for relatives. Relatives described mostly appropriate care, while acknowledging workload constraints. Most residents whose condition was unstable, deteriorating or terminal received advance care planning, though family expectations and unwillingness to discuss end-of-life care did tend to delay planning. Unstable residents with a reasonable prognosis were more likely to be transferred to hospital than terminally ill residents. Palliative care in participating RACFs appears to be adequate. Provision of targeted education for health care providers and implementation of protocols for advance care planning and end-of life care pathways will enhance this care.
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Reymond, Liz, Fiona J. Israel, and Margaret A. Charles. "A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities." Australian Health Review 35, no. 3 (2011): 350. http://dx.doi.org/10.1071/ah10899.
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The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings. What is known about the topic? Residential aged care facilities (RACFs) are the hospices of today. Many RACF staff are not confident in the delivery of high quality palliative care, resulting in inappropriate transfers of dying residents to acute care facilities. Needs-based palliative care pathways are being used increasingly to direct care in a variety of healthcare environments. What does this paper add? Provides the first evidence in Australia that a residential aged care end-of-life care pathway (RAC EoLCP) improves outcomes of care for dying residents and results in fewer residents being inappropriately transferred to acute care facilities. What are the implications for practitioners? Use of the RAC EoLCP will improve resident and health system outcomes by guiding the delivery of high quality palliative care and improving the palliative care capacity of generalist health providers.
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Bradford, Kate L. "The Nature of Religious and Spiritual Needs in Palliative Care Patients, Carers, and Families and How They Can Be Addressed from a Specialist Spiritual Care Perspective." Religions 14, no. 1 (January 16, 2023): 125. http://dx.doi.org/10.3390/rel14010125.
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This paper is written from the perspective of a specialist religious and spiritual care practitioner who practises in major referral hospitals in Sydney, Australia. In these hospitals, religious care and ward-based spiritual care chaplaincy services are offered in tandem. The perspective offered is based on the author’s knowledge, research, and experience in how people make the necessary religious or spiritual adjustments to their deep view of reality when faced with severe or chronic pain or terminal illness. Religious and/or Spiritual Care (R/SC) are interventions that scaffold people through a process of sense-making which helps them find meaning in their new reality. These R/SC adjustments concern conscious and unconscious beliefs about ultimate meaning, morality, justice, transcendence, and relationships within themselves, and with others and the supernatural. Palliative care practitioners described the importance of spiritual care and integrated spiritual care principles into their biopsychosocial-spiritual model of care in the 1960s. As palliative care practitioners have increasingly clarified their discipline as a distinct discipline in medicine, religious and spiritual care practitioners have struggled to define their place. These concerns merit a fresh evaluation of the religious and spiritual needs of patients, carers, and families of those suffering chronic pain and terminal illness and further clarification of the specialist discipline of religious and spiritual care.
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Calver, Janine, C. D'Arcy J. Holman, and Gill Lewin. "A preliminary casemix classification system for Home and Community Care Clients in Western Australia." Australian Health Review 27, no. 2 (2004): 27. http://dx.doi.org/10.1071/ah042720027.
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The objective of the study was to examine the feasibility of using routinely available assessment, Minimum Data Set (MDS), socio-economic, geographic and unit cost data to define a discrete number of clinically meaningful, costhomogeneous Home and Community Care (HACC) client groups. Participants included new and existing Western Australian (WA) HACC beneficiaries from 1 January to 31 September 2001. Seventy two HACC agencies from metropolitan and rural regions participated, which represented 29% of the sector. A total of 9,404 quarterly periods of care contributed to the exploratory classification analysis and 12,697 to the confirmatory analysis. The final structure contained nine terminal nodes, achieved an R 2 of 23.7%, and was robust to fluctuations in cost. Higher costs were associated with increased functional dependency and the need for clinical services. The classification is empirically grounded, simple and robust, and has a number of potential policy and practice applications. Further refinement is required to improve its suitability as a funding tool.
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Hsiao, Wen-Hsuan, Chun-Li Wang, Lung-Chun Lee, Szu-Pei Chien, Chin-Chu Hsu, and Wei-Min Chu. "Exploring Risk Factors of Unexpected Death, Using Palliative Care Outcomes Collaboration (PCOC) Measures, among Terminal Patients Receiving Palliative Care in Taiwan." International Journal of Environmental Research and Public Health 19, no. 20 (October 15, 2022): 13294. http://dx.doi.org/10.3390/ijerph192013294.
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Palliative care has the ability to relieve both physical discomfort and psychological distress in terminally ill patients. However, unexpected death may still occur in palliative care settings. This study aimed to utilize Palliative Care Outcomes Collaboration (PCOC) data to better determine any associated factors which may surround unexpected death in palliative care settings. Data were extracted from the PCOC database by the palliative care team within Taichung Veterans General Hospital (TCVGH). Data of deceased patients were extracted during the period from January 2021 to December 2021 from multiple palliative care settings. The deaths of patients whose last recorded palliative phase was 1–3 were defined as unexpected. A total of 280 deceased patients were included, with mean age at death being 67.73, 61% being male, and 83.2% cancer patients. We discovered that shortness of breath, as assessed by the Symptom Assessment Scale (SAS), decreased risk of unexpected death (OR: 0.91, 95% CI: 0.84–0.98), while impending death discharge (OR: 3.93, 95% CI: 1.20–12.94) and a higher Australia-modified Karnofsky performance status (AKPS) score (OR: 1.15, 95% CI: 1.10–1.21) were associated with unexpected death. Thus, medical staff must inform the family of patients early on regarding any risk factors surrounding unexpected death to help everyone involved be prepared in advance.
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Tait, Paul A., Weng Hou Cheung, Michael Wiese, and Kirsten Staff. "Improving community access to terminal phase medicines in Australia: identification of the key considerations for the implementation of a ‘core medicines list’." Australian Journal of Primary Health 23, no. 4 (2017): 373. http://dx.doi.org/10.1071/py16153.
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During the terminal phase, access to medicines is critical for people wishing to spend their last days of life at home. Yet, access to medicines can be problematic. The aim of this study was to report the perspectives of specialist and generalist health professionals (HPs) on the issues of community access to medicines for this vulnerable group. A qualitative descriptive study design investigated the views of HPs working in palliative care roles in South Australia. Nurses, doctors and pharmacists described their experiences of accessing medicines for management of terminal phase symptoms during semi-structured focus group discussions. Content analysis identified six themes including: ‘Medication Supply’, ‘Education and Training’, ‘Caregiver Burden’, ‘Safety’, ‘Funding’ and ‘Clinical Governance’. Future projects should aim to address these themes when developing strategies for the management of people wishing to die at home.
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Pincombe, Jan, Margaret Brown, and Helen Mccutcheon. "No Time for Dying: A Study of the Care of Dying Patients in Two Acute Care Australian Hospitals." Journal of Palliative Care 19, no. 2 (June 2003): 77–86. http://dx.doi.org/10.1177/082585970301900202.
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Objectives Research was conducted in two teaching hospitals in Australia to collect data on the care of patients dying in the acute care setting. Methodology Non-participant observation of the care of dying patients in medical wards was the primary method of data collection and selected staff were interviewed. Observers collected data on the type of care, who gave the care, and the time given to care. Thematic analysis was applied to both the observational and interview data. Participants Patients selected were over the age of 18 years, with a terminal diagnosis and an estimated six days to live. Results Three major factors emerged from the data to form the context in which patients were cared for and died: 1) the organizational factor, 2) the environmental factor, and 3) the human factor. The presence or absence of family members influenced the amount of care given. If family members were not present, dying could be an isolating experience, with minimal care focused on routine hospital activities. Conclusion This research indicated that the principles of palliative care are yet to be incorporated in the acute care hospital setting.
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Keon-Cohen, Zoe M., David A. Story, Juli A. Moran, and Daryl A. Jones. "An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals." Anaesthesia and Intensive Care 50, no. 3 (March 18, 2022): 234–42. http://dx.doi.org/10.1177/0310057x211032652.
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The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1–2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.
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Gilbert, Julia, and Jane Boag. "‘To die, to sleep’ – assisted dying legislation in Victoria: A case study." Nursing Ethics 26, no. 7-8 (November 19, 2018): 1976–82. http://dx.doi.org/10.1177/0969733018806339.
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Background: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. Objectives: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. Research design: Narrative review and case study. Participants and research context: case study. Ethical considerations: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. Findings: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. Discussion: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. Conclusion: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.
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DiGiacomo, Michelle, Yutaka Hatano, Jane Phillips, Joanne Lewis, Amy P. Abernethy, and David C. Currow. "Caregiver characteristics and bereavement needs: Findings from a population study." Palliative Medicine 31, no. 5 (August 8, 2016): 465–74. http://dx.doi.org/10.1177/0269216316663855.
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Background: Globally, most care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can help provide better support to facilitate adjustment. Aim: We compared characteristics, expressed unmet needs and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age. Design: The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care. Setting/participants: Participants were aged over 15 years, resided in households in South Australia and had someone close to them die from a terminal illness in the last 5 years. Results: Of the 1540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to ‘move on’ with life and needed greater emotional support and information about illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to ‘move on’. Conclusion: Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health and social services.
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Burns, Emma, Holly G. Prigerson, Steve J. Quinn, Amy P. Abernethy, and David C. Currow. "Moving on: Factors associated with caregivers’ bereavement adjustment using a random population-based face-to-face survey." Palliative Medicine 32, no. 1 (June 19, 2017): 257–67. http://dx.doi.org/10.1177/0269216317717370.
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Background: Providing care at end of life has consequences for caregivers’ bereavement experience. ‘Difficulty moving on with life’ is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers’ ability to ‘move on’ have not been examined across the population. Aim: To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to ‘move on’ 13–60 months after the ‘expected’ death of someone close. Design: The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to ‘move on’. Multivariable logistic regression models explored the characteristics moving on and not moving on. Setting: Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. Results: A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to ‘move on’. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with ‘moving on’. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not ‘moving on’. Conclusion: These results support the relevance of ‘moving on’ as an indicator of caregivers’ bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
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Tait, Paul, Chris Horwood, Paul Hakendorf, and Timothy To. "Improving community access to terminal phase medicines through the implementation of a ‘Core Medicines List’ in South Australian community pharmacies." BMJ Supportive & Palliative Care 10, no. 1 (February 6, 2017): e4-e4. http://dx.doi.org/10.1136/bmjspcare-2016-001191.
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ObjectivesDifficulties accessing medicines in the terminal phase hamper the ability of patients to die at home. The aim of this study was to identify changes in community access to medicines for managing symptoms in the terminal phase throughout South Australia (SA), following the development of a ‘Core Medicines List’ (the List) while exploring factors predictive of pharmacies carrying a broad range of useful medicines.MethodsIn 2015, SA community pharmacies were invited to participate in a repeat survey exploring the availability of specific medicines. Comparisons were made between 2012 and 2015. A ‘preparedness score’ was calculated for each pharmacy, scoring 1 point for each medicine held from the following 5 classes: opioid, benzodiazepine, antiemetic, anticholinergic and antipsychotic.ResultsThe proportion of pharmacies carrying all items from the List rose from 7% in 2012 to 18% in 2015 (p=0.01). Multiple linear regression demonstrated that a monthly online newsletter subscription (p=0.04) and provision of a clinical service to aged care facilities (p=0.02) were predictors of pharmacies carrying all items on the List. Furthermore, multiple linear regression demonstrated that the provision of an afterhours service (p=0.02) and clinical services to aged care facilities (p=0.04) were predictors of pharmacies with a high ‘preparedness score’. In responding to issues with supply of medicines at end of life, respondents were more likely to contact the prescriber if aware of palliative patients (p=0.03).ConclusionsThese results suggest that there is value in developing and promoting a standardised list of medicines, ensuring that community palliative patients have timely access to medicines in the terminal phase.
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Price, David. "Euthanasia, pain relief and double effect." Legal Studies 17, no. 2 (July 1997): 323–42. http://dx.doi.org/10.1111/j.1748-121x.1997.tb00410.x.
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The law's overseeing of administrations of pain-relieving treatment with inevitable life-shortening consequences is of crucial significance in view of the dogmatic approach of English criminal law to active euthanasia. As Lanham states in respect of society's treatment of terminal physical pain:‘If the euthanasia option is not available, some other method will have to be found. In Britain and Australia that method involves palliative care and the hospice movement. By contrast, in the Netherlands active euthanasia is available and palliative care is poorly developed.’The recent prosecution in R v Cox made it abundantly clear that causing death in order to relieve a patient of further pain and suffering amounts to murder under current law. By contrast, knowingly shortening life through the administration of pain-killing drugs was recently declared to be lawful by Lord Goff in the House of Lords in Airedale NHS Hospital Trust v Bland.
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Katz, Naomi T., Martyn Lloyd-Jones, Lucy Demediuk, Kerry McLaughlin, Megan McKechnie, and Michelle Gold. "A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine." Journal of Patient Experience 9 (January 2022): 237437352210791. http://dx.doi.org/10.1177/23743735221079141.
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In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.
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KELLY, B., P. BURNETT, D. PELUSI, S. BADGER, F. VARGHESE, and M. ROBERTSON. "Factors associated with the wish to hasten death: a study of patients with terminal illness." Psychological Medicine 33, no. 1 (December 23, 2002): 75–81. http://dx.doi.org/10.1017/s0033291702006827.
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Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions.Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated.Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms.Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.
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Chen, Chen Hsiu, Su Ching Kuo, and Siew Tzuh Tang. "Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis." Palliative Medicine 31, no. 5 (August 4, 2016): 406–18. http://dx.doi.org/10.1177/0269216316663976.
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Background: No systematic meta-analysis is available on the prevalence of cancer patients’ accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. Aim: To examine the prevalence of advanced/terminal cancer patients’ accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. Design: Systematic review and meta-analysis. Methods: MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990–2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression. Results: In total, 34 articles were retrieved for systematic review and meta-analysis. At best, only about half of advanced/terminal cancer patients accurately understood their prognosis (49.1%; 95% confidence interval: 42.7%–55.5%; range: 5.4%–85.7%). Accurate prognostic awareness was independent of service received and publication year, but highest in Australia, followed by East Asia, North America, and southern Europe and the United Kingdom (67.7%, 60.7%, 52.8%, and 36.0%, respectively; p = 0.019). Accurate prognostic awareness was higher by clinician assessment than by patient report (63.2% vs 44.5%, p < 0.001). Conclusion: Less than half of advanced/terminal cancer patients accurately understood their prognosis, with significant variations by region and assessment method. Healthcare professionals should thoroughly assess advanced/terminal cancer patients’ preferences for prognostic information and engage them in prognostic discussion early in the cancer trajectory, thus facilitating their accurate prognostic awareness and the quality of end-of-life care decision-making.
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Hughes, Rachel Elizabeth, and Kate Thompson. "Integration of specialist palliative care services into a multidisciplinary adolescent and young adult (AYA) oncology team." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 64. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.64.
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64 Background: Palliative care is recommended alongside standard oncological care for patients with advanced cancer or high symptom burden (Smith TJ, Temin S, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8)880-7.). AYA oncology patients are distinguished by several age-specific developmental and biopsychosocial factors, resulting in a unique impact profile (Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28:4819-4824). Methods: To examine the benefits of multidisciplinary AYA care, a palliative care fellow was incorporated into an existing AYA oncology team in Australia, for a 12 month period. This role facilitated assessment/management of symptoms, general health issues, treatment toxicity, end of life care and bereavement support. Results: Between 2012 and 2013, of 83 new patients were referred to the AYA oncology service, 27 (32.5%) were referred the palliative care fellow. Notably, 37% of patients referred were receiving curative intent treatment. 10 patients (37%) were referred at diagnosis for symptom management. Pain was the most frequent reason for referral (n=17 63%). A total of 7 patients (26%) were referred for advanced disease/terminal care. Conclusions: Evaluation demonstrates that onsite availability of palliative care services is acceptable, facilitates early referral and has encouraged collaborative, AYA multidisciplinary care. A significant additional finding has been recognition of the demand for symptom management of patients early in their cancer experience. Further development and evaluation of AYA specific palliative care is warranted.
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Kissane, David W., and Graeme C. Smith. "Consultation-Liaison Psychiatry in an Australian Oncology Unit." Australian & New Zealand Journal of Psychiatry 30, no. 3 (June 1996): 397–404. http://dx.doi.org/10.3109/00048679609065005.
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Objective: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. Method: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients. Results: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed. Conclusions: Both individual and family-centred care is required in an oncology service; a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services; there is scope for substantial growth in preventive and supportive work.
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Liu, Chia-Jen, Te-Chun Yeh, Su-Hsuan Hsu, Chao-Mei Chu, Chih-Kuang Liu, Mingchih Chen, and Sheng-Jean Huang. "Bibliometric Analysis of Palliative Care-Related Publication Trends During 2001 to 2016." American Journal of Hospice and Palliative Medicine® 35, no. 10 (May 8, 2018): 1280–86. http://dx.doi.org/10.1177/1049909118773751.
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Background: The scientific contributions (publications) and international influence (citations) from authors providing the palliative care (PC)-related literature has a limited number of bibliometric reports. We aimed to analyze PC-related literature using the Institute for Scientific Information Web of Science (WoS) database. Methods: WoS database was used to retrieve publications with the following key words with title: “palliative care” OR “End of Life care” OR “terminal care.”. The statistical analysis of the documents published during 2001 to 2016 was performed. The quantity and quality of research were assessed by the number of total publications and citation analysis. In addition, we also analyzed whether there were possible correlations between publication and socioeconomic factors. Results: The total research output was 6273 articles for PC. There was a 3-fold increase in the number of publications during the period and strong correlation between the year and number of PC-related publications ( R2 = .96). The United States took a leading position in PC research (2448, 39.0%). The highest average citations was reported for the Norway (21.8). Australia had gained the highest productive ability in PC research (24.9 of articles per million populations). The annual impact factor rose progressively with time and increased 1.13 to 2.24 from 2003 to 2016. The number of publications correlated with gross domestic product ( r = .74; P < .001). Conclusion: The United States and United Kingdom contributed most of the publications, but some East Asian countries also had a great performance. According to the socioeconomic factors, the publication capacity of top 20 countries is correlated with their economic scale.
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Agar, Meera R., Sungwon Chang, Ingrid Amgarth-Duff, Maja V. Garcia, Jane Hunt, Jane L. Phillips, Aynharan Sinnarajah, and Robin Fainsinger. "Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study." Palliative Medicine 36, no. 5 (May 2022): 830–40. http://dx.doi.org/10.1177/02692163221082245.
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Background: Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration (‘hypodermoclysis’) has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. Aim: To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. Design: Multisite, multinational consecutive cohort study. Setting/participants: Patients receiving hypodermoclysis in an inpatient palliative care setting. Results: Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). Conclusions: Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis.
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Pudjiadi, Antonius Hocky, Tuty Rahayu, Stephanie Wijaya, and Fatima Safira Alatas. "Serum NT-Pro-BNP versus Noninvasive Bedside Inotropic Index in Paediatric Shock: A Contest of Myocardial Performance in Response to Fluid Loading." Critical Care Research and Practice 2021 (November 30, 2021): 1–8. http://dx.doi.org/10.1155/2021/7458186.
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Background. Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith–Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods. This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results. Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p = 0.001 and p = 0.004 , respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50–9965.00) ng/mL vs. 196.00 (65.00–509.00) ng/mL, p = 0.002 ) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP <242.5 ng/mL was associated with fluid responders (AUC: 0.768 (0.615–0.921), p = 0.003 ), 82.1% sensitivity, and 68.7% specificity for subjects >12 years old. Delta NT-pro-BNP in fluid responders (15.00 (−16.00–950.00) ng/mL) did not differ from fluid nonresponders (505.00 (−797.00–1600.00) ng/mL), p = 0.456 . Postloading SMII >1.25 W·m−2 was associated with fluid responders (AUC: 0.683 (0.553–0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p = 0.006 ). Conclusion. Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.
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Turkin, P. Yu, A. A. Slesareva, S. V. Rodionov, G. A. Varich, A. A. Kuzhuget, and S. A. Ponomar. "Modern technologies of venous ulcers treatment in elderly population." Ambulatornaya khirurgiya = Ambulatory Surgery (Russia) 19, no. 1 (May 19, 2022): 34–42. http://dx.doi.org/10.21518/1995-1477-2022-19-1-34-42.
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Venous trophic ulcers take place in the terminal stage of chronic venous insufficiency. The problem of venous trophic disorders is extremely relevant due to the high prevalence among the population. This review considers the comparative characteristics of morbidity data on the example of Germany and the Russian Federation. Particular attention paid to the influence of the course of the disease on patient’s life quality during treatment. The causes of high-cost treatment are reported with approximate calculations for 1 clinical case and total annual costs according to foreign researchers (Australia, Great Britain, USA). The risk factors are discussed in the form of certain concomitant nosologies that significantly aggravate the healing process of ulcers with a brief description of the pathogenesis. The review defines the main goals of the treatment of venous trophic ulcers, as well as separate groups of directions in which it is reasonable to carry out therapeutic measures. Article presents a comparative analysis between the methods of applying compression therapy (elastic bandaging, the use of special stockings) and the influence of the choice on the quality of life of patients. Various methods of topical wound care are described with the obligatory consideration of the stage of the wound process, alternative methods of local treatment are listed (for example, the use of autologous platelet-rich plasma). The efficacy of systemic pharmacotherapy in trophic disorders and the treatment potential of various groups of drugs on the rate of ulcer healing were evaluated. The advantages of using surgical treatment are determined, the main surgical techniques are listed, highlighting the advantages and disadvantages of each. Possible treatment strategies for elderly patients also discussed. The complexity of evaluating the effectiveness of new techniques and an integrated approach to treatment is shown, which in the future will help to correct the direction of finding new ways to solve the problem of venous ulcers in this specific group of patients.
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Parker, Deborah, Carol Grbich, and Ian Maddocks. "Financial Issues in Caring for Someone with Terminal Cancer at Home." Australian Journal of Primary Health 7, no. 2 (2001): 37. http://dx.doi.org/10.1071/py01032.
Full textAbstract:
For the majority of patients with terminal cancer their preferred place of death is at home. Many factors determine this choice, in particular the availability of a carer, the patient's physical condition and adequate services. A factor often underestimated is the financial impact of caring for someone at home. This paper examines the financial concerns of carers of terminally ill cancer patients and whether current Australian health care policy is able to address these concerns. Two main categories of cost were identified, those related to the patients physical care needs and those that impacted on carer lifestyle. The current government allowances to assist carers in these costs are limited by carers either being unaware that the benefits existed or by the strict qualifying criteria that restrict access to those who care for the terminally ill.
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PERKINS, PHILIP D. "A revision of the Australian species of the water beetle genus Hydraena Kugelann (Coleoptera: Hydraenidae)." Zootaxa 1489, no. 1 (May 31, 2007): 1–207. http://dx.doi.org/10.11646/zootaxa.1489.1.1.
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The Australian species of the water beetle genus Hydraena Kugelann, 1794, are revised, based on the study of 7,654 specimens. The 29 previously named species are redescribed, and 56 new species are described. The species are placed in 24 species groups. High resolution digital images of all primary types are presented (online version in color), and geographic distributions are mapped. Male genitalia, representative female terminal abdominal segments and representative spermathecae are illustrated. Australian Hydraena are typically found in sandy/gravelly stream margins, often in association with streamside litter; some species are primarily pond dwelling, a few species are humicolous, and one species may be subterranean. The areas of endemicity and species richness coincide quite closely with the Bassian, Torresian, and Timorian biogeographic subregions. Eleven species are shared between the Bassian and Torresian subregions, and twelve are shared between the Torresian and Timorian subregions. Only one species, H. impercepta Zwick, is known to be found in both Australia and Papua New Guinea. One Australian species, H. ambiflagellata, is also known from New Zealand. New species of Hydraena are: H. affirmata (Queensland, Palmerston National Park, Learmouth Creek), H. ambiosina (Queensland, 7 km NE of Tolga), H. antaria (New South Wales, Bruxner Flora Reserve), H. appetita (New South Wales, 14 km W Delagate), H. arcta (Western Australia, Synnot Creek), H. ascensa (Queensland, Rocky Creek, Kennedy Hwy.), H. athertonica (Queensland, Davies Creek), H. australula (Western Australia, Synnot Creek), H. bidefensa (New South Wales, Bruxner Flora Reserve), H. biimpressa (Queensland, 19.5 km ESE Mareeba), H. capacis (New South Wales, Unumgar State Forest, near Grevillia), H. capetribensis (Queensland, Cape Tribulation area), H. converga (Northern Territory, Roderick Creek, Gregory National Park), H. cubista (Western Australia, Mining Camp, Mitchell Plateau), H. cultrata (New South Wales, Bruxner Flora Reserve), H. cunninghamensis (Queensland, Main Range National Park, Cunningham's Gap, Gap Creek), H. darwini (Northern Territory, Darwin), H. deliquesca (Queensland, 5 km E Wallaman Falls), H. disparamera (Queensland, Cape Hillsborough), H. dorrigoensis (New South Wales, Dorrigo National Park, Rosewood Creek, upstream from Coachwood Falls), H. ferethula (Northern Territory, Cooper Creek, 19 km E by S of Mt. Borradaile), H. finniganensis (Queensland, Gap Creek, 5 km ESE Mt. Finnigan), H. forticollis (Western Australia, 4 km W of King Cascade), H. fundaequalis (Victoria, Simpson Creek, 12 km SW Orbost), H. fundata (Queensland, Hann Tableland, 13 km WNW Mareeba), H. hypipamee (Queensland, Mt. Hypipamee National Park, 14 km SW Malanda), H. inancala (Queensland, Girraween National Park, Bald Rock Creek at "Under-ground Creek"), H. innuda (Western Australia, Mitchell Plateau, 16 mi. N Amax Camp), H. intraangulata (Queensland, Leo Creek Mine, McIlwrath Range, E of Coen), H. invicta (New South Wales, Sydney), H. kakadu (Northern Territory, Kakadu National Park, Gubara), H. larsoni (Queensland, Windsor Tablelands), H. latisoror (Queensland, Lamington National Park, stream at head of Moran's Falls), H. luminicollis (Queensland, Lamington National Park, stream at head of Moran's Falls), H. metzeni (Queensland, 15 km NE Mareeba), H. millerorum (Victoria, Traralgon Creek, 0.2 km N 'Hogg Bridge', 5.0 km NNW Balook), H. miniretia (Queensland, Mt. Hypipamee National Park, 14 km SW Malanda), H. mitchellensis (Western Australia, 4 km SbyW Mining Camp, Mitchell Plateau), H. monteithi (Queensland, Thornton Peak, 11 km NE Daintree), H. parciplumea (Northern Territory, McArthur River, 80 km SW of Borroloola), H. porchi (Victoria, Kangaroo Creek on Springhill Rd., 5.8 km E Glenlyon), H. pugillista (Queensland, 7 km N Mt. Spurgeon), H. queenslandica (Queensland, Laceys Creek, 10 km SE El Arish), H. reticuloides (Queensland, 3 km ENE of Mt. Tozer), H. reticulositis (Western Australia, Mining Camp, Mitchell Plateau), H. revelovela (Northern Territory, Kakadu National Park, GungurulLookout), H. spinissima (Queensland, Main Range National Park, Cunningham's Gap, Gap Creek), H. storeyi (Queensland, Cow Bay, N of Daintree River), H. tenuisella (Queensland, 3 km W of Batavia Downs), H. tenuisoror (Australian Capital Territory, Wombat Creek, 6 km NE of Piccadilly Circus), H. textila (Queensland, Laceys Creek, 10 km SE El Arish), H. tridisca (Queensland, Mt. Hemmant), H. triloba (Queensland, Mulgrave River, Goldsborough Road Crossing), H. wattsi (Northern Territory, Holmes Jungle, 11 km NE by E of Darwin), H. weiri (Western Australia, 14 km SbyE Kalumburu Mission), H. zwicki (Queensland, Clacherty Road, via Julatten).
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McGrath, Pam. "Are We Making Progress? Not in Haematology!" OMEGA - Journal of Death and Dying 45, no. 4 (December 2002): 331–48. http://dx.doi.org/10.2190/ku5q-ll8m-fppa-lt3w.
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It will be shown, through the presentation of recent research findings, that haematology is a neglected area in terms of sensitive care of the dying. The Australian evidence indicates that scant progress has been made in relation to even the most basic palliative care practices such as sensitive, honest information giving or appropriate referral to the palliative system. Rather, the data show that during the terminal trajectory, patients from these diagnostic groups and their families remain trapped in processes within the high-tech, curative system that are not responsive to the needs of the dying.
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HOSIE, ANDREW, and SHANE T. AHYONG. "First records of the giant barnacles, Austromegabalanus nigrescens (Lamarck, 1818) and A. psittacus (Molina, 1782) (Cirripedia: Balanidae) from New Zealand, with a key to New Zealand Balanidae." Zootaxa 1674, no. 1 (January 7, 2008): 59. http://dx.doi.org/10.11646/zootaxa.1674.1.5.
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The shallow water barnacles, Austromegabalanus nigrescens and A. psittacus, are reported from New Zealand waters for the first time. Moreover, these are the first known introductions of Austromegabalanus. Nearly 70 specimens of A. nigrescens were collected from the Taharoa Ironsands Terminal and a single conjoined group of A. psittacus was collected in Port Wellington. We also report A. nigrescens from North West Cape, the northernmost record for the species in Western Australia. A key to the Balanidae known from New Zealand is provided.
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Smallwood, Natasha, Jennifer Mann, Hui Guo, and Nicole Goh. "Patients With Fibrotic Interstitial Lung Disease Receive Supportive and Palliative Care Just Prior to Death." American Journal of Hospice and Palliative Medicine® 38, no. 2 (July 10, 2020): 154–60. http://dx.doi.org/10.1177/1049909120938629.
Full textAbstract:
Background: Fibrotic interstitial lung diseases (f-ILDs) are often progressive and incurable. As patients experience significant symptoms and have a poor prognosis, early palliative care referral is recommended. Objective: To examine the care delivered to patients with f-ILD during the terminal hospital admission and the past 2 years of life. Methods: A retrospective audit was performed for consecutive patients who died from f-ILD at 2 Australian teaching hospitals between January 1, 2012, and December 31, 2016. Results: Of 67 patients, 44 (66%) had idiopathic pulmonary fibrosis. Median age was 78 years. Median respiratory function: forced expiratory volume in 1 second 69.0% predicted (interquartile range [IQR]: 58.0%-77.0%), forced vital capacity 64.0% predicted (IQR = 46.8%-74.3%), and diffusing capacity of carbon monoxide 36.0% predicted (IQR = 31.0%-44.0%). In the 2 years prior to the terminal admission, 38 (57%) patients reported severe breathlessness and 17 (25%) used opioids for symptom relief. Twenty-four (36%) patients received specialist palliative care (SPC) and 11 (16%) completed advance care planning. During the terminal admission, 10 (15%) patients were admitted directly under SPC. A further 33 (49%) patients were referred to SPC, on average 1 day prior to death. Sixty-three (94%) patients received opioids and 49 (73%) received benzodiazepines for symptom management. Median starting and final opioid doses were 10 and 23 mg oral morphine equivalent/24 hours, respectively. Opioids were commenced on average 2 (IQR 1-3) days prior to death. Conclusions: Although most patients were identified as actively dying in the final admission, referral to SPC and use of palliative medications occurred late. Additionally, few patients accessed symptom palliation earlier in their illness.
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Damarell, Raechel A., Deidre D. Morgan, Jennifer J. Tieman, and David Healey. "Bolstering General Practitioner Palliative Care: A Critical Review of Support Provided by Australian Guidelines for Life-Limiting Chronic Conditions." Healthcare 8, no. 4 (December 11, 2020): 553. http://dx.doi.org/10.3390/healthcare8040553.
Full textAbstract:
General practitioners (GPs) are increasingly expected to provide palliative care as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. Palliative care content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed palliative care content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs’ stated information needs and support them to provide quality end-of-life care. Six databases and guideline repositories were searched (2011–2018). Eligible guidelines were those for a GP audience and explicitly based on an appraisal of all available evidence. Content was mapped against an established palliative care domain framework (PEPSI-COLA) and quality was assessed using AGREE-II. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of palliative care domain coverage. The ‘communication’ needs domain was best addressed while patient physical and emotional needs were variably covered. Spiritual, out-of-hours, terminal care and aftercare content was scant. Few guidelines addressed areas GPs are known to find challenging or acknowledged useful decision-support tools. A template covering important domains might reduce content variability across guidelines.
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Millner, Jacqueline. "Caring through art: Reimagining value as political practice." Art & the Public Sphere 8, no. 2 (December 1, 2019): 163–74. http://dx.doi.org/10.1386/aps_00014_1.
Full textAbstract:
Recent feminist critiques of neo-liberalism have argued for care as an alternative structuring principle for political systems in crisis and have proposed that the transformation of the existing capitalist order demands the abolition of the (gendered) hierarchy between ‘care’ ‐ the activities of social reproduction that nurture individuals and sustain social bonds ‐ and economic production. Key to answering what it might mean for care to become the central concern or core process of politics is imagining alternatives outside deeply ingrained and guarded conventions. It is in this imagining that artists have much to contribute, more so still because for many artists, maintaining a practice in neo-liberal contexts demands nurturing collectivities, sensitivities and resourcefulness ‐ essential aspects of care. By focusing on recent Australian examples, this article examines what role artists can play in engaging with, interpreting or enacting care in practices ‐ such as works of self-care, care for country and the environment, care for material culture and heritage, care for institutions and processes, and care for others ‐ which might help forge an alternative ethics in the age of neo-liberalism. This exploration is driven by the need for a contemporary values revolution as we ‐ as a species, as a planet ‐ face existential threats including climate emergency and terminal inequality. Can art be a generative site to work towards alternative ethics that privilege trans-subjective relations predicated on attentiveness and tending, on spending time, on holding space?
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Magnusson, Roger S., and Peter H. Ballis. "The response of health care workers to AIDS patients' requests for euthanasia." Journal of Sociology 35, no. 3 (December 1999): 312–30. http://dx.doi.org/10.1177/144078339903500304.
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This paper reports on research into the practice of euthanasia amongst Australian health care professionals specialising in HIV/AIDS. It draws on data from thirty-nine semi-structured interviews carried out in Sydney, Melbourne, Brisbane and Canberra with physicians, general practitioners, hospital and community nurses, therapists and community workers. Using a qualitative methodology, the study seeks to identify how (illegal) euthanasia is currently practised, the degrees of involvement, the various forms that involvement takes, and the social relations which provide the context for involvement. In this paper we outline three categories of 'doers' to illustrate the range of attitudes and practices concerning euthanasia. This 'typology' carries a number of implications for recent policy debates over the legalisation of euthanasia. In particular it illustrates, at least within the context of AIDS care, the fragmentation of consensus over euthanasia amongst health care workers, the reality of current illegal euthanasia practices, and the limitations of a prohibitionist policy. While the legalisation of euthanasia within a regulatory framework is sometimes portrayed as an extreme or 'radical' response to terminal illness, the data presented in this paper suggest that prohibitionism is also radical in its failure to control euthanasia practice.
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Shobbrook, Robyn M. "Conversion of the Anglo-Australian Observatory Library Card Catalogue using PC Software." International Astronomical Union Colloquium 110 (1989): 188–89. http://dx.doi.org/10.1017/s0252921100003353.
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A commercial software package has been used on a personal computer for the conversion of the Anglo-Australian Observatory card library catalogue. The software is sophisticated but has proven to be extremely flexible and easy to use for any library management task. The software is available at three levels; the AAO has the top level which allows for eight different databases on the one system. Each record may contain up to nine pages or screens of information and there is also a thesaurus facility. Although a multi-user system was preferred the cost of the software was out of the question. The flow-chart (Fig 1.) describes how a multi-user system was created from software designed for a single-user PC. The main files have been down-loaded in accession number order onto the VAX 11/780 minicomputer and these may be accessed on any terminal either at the laboratory headquarters at Epping in Sydney or at the telescope site at Coonabarabran 500 kms north-west of Sydney. The ‘read-only’ files can be searched using the VAX edit commands and a VAX sort facility is available for a listing of selected items if required. As a substitute measure this is proving to be most useful. Later when the files are too large and searching becomes slow it may be possible to purchase additional copies of the commercial PC software which allows more sophisticated search procedures.
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Liebherr, James K. "Platynini (Coleoptera:Carabidae) of Vanuatu: Miocene diversification on the Melanesian Arc." Invertebrate Systematics 19, no. 4 (2005): 263. http://dx.doi.org/10.1071/is04032.
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Vanuatu supports 11 resident species of the carabid beetle tribe Platynini: five indigenous species shared with other Pacific islands and Australia and six newly described precinctive species. Notagonum delaruei, sp. nov. represents a single descendant species of one colonisation event. Helluocolpodes, gen. nov. (type species Colpodes helluo Darlington of New Guinea) is proposed to accommodate a monophylum comprising the type species plus Helluocolpodes discicollis, sp. nov., H. mucronis, sp. nov., H. multipunctatus, sp. nov., H. sinister, sp. nov. and H. vanemdeni, sp. nov., all from Vanuatu. Generic assignments are informed by cladistic analysis of anatomical characters for a variety of Pacific platynine taxa. Metacolpodes Jeannel is redefined cladistically to include seven Pacific and Asian species. Biogeographic relationships among island areas housing platynine taxa on the Australian and Pacific Plates are investigated using a chrono–area cladogram, i.e. a taxon–area cladogram for which terminals are dated based on geological evidence and internal nodes based on non-reversible temporal optimisation. Conclusions reached by constraining the ages of areas within the context of phylogenetic relationships of their resident taxa include: (1) Vanuatu has supported resident platynine taxa since the Middle to Late Miocene; (2) the Hawaiian Blackburnia first colonised that archipelago in the Miocene, long before the present oldest high island, Kauai, came into existence; (3) the New Zealand Ctenognathus most likely arose from Miocene colonisation of New Zealand via Fiji; and (4) the low diversity of the Tahitian platynine fauna is due to relatively recent, Pliocene or later, colonisation of the Society Island chain by this group, also from a Fijian source.
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Talbot, V. "Heavy metal concentrations in the oysters Saccostrea cuccullata and Saccostrea sp. from the Dampier Archipelago, Western Australia." Marine and Freshwater Research 36, no. 2 (1985): 169. http://dx.doi.org/10.1071/mf9850169.
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Ranges of concentrations (mg kg-1 wet wt) of Ag (0-0.4), Cd (0-0.8), Co (not detected), Cr (0-0.8), Mn (0.4-3.2), Ni (0.2-1 .7) and Pb (0-1 .7) were determined in S. cuccullata and Saccostrea sp. (probably S. commercialis) from several locations in the Dampier Archipelago and nearby Cape Lambert. Concentrations of Cu and Zn in individual specimens of these oysters ranged from 1.4 to 555 and from 55 to 1800 mg kg-1 wet weight, respectively, reached their maximum values at localized areas adjacent to the Dampier township and iron-ore exporting terminals at Dampier and Cape Lambert, and correlated significantly with length and wet weight. Fe concentrations in individual oysters throughout the Archipelago, which is the centre of an iron-ore exporting industry, ranged from 4.2 to 1629 mg kg-1 wet weight and did not correlate significantly with oyster length or wet weight.
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Berard, Neville, Sundar Prasad, Brett Miller, Mathieu Deiber, and Nathan Fuller. "PHYSICAL MODELLING OF PROPELLER SCOUR ON AN ARMOURED SLOPE." Coastal Engineering Proceedings, no. 36 (December 30, 2018): 11. http://dx.doi.org/10.9753/icce.v36.sediment.11.
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CITIC Pacific Mining (CPM) is proposing to increase throughput at their existing Sino Iron Terminal in Cape Preston, Western Australia, using self-propelled Handysize transshipment shuttle vessels (TSV) instead of dumb barges. Initial assessment using various desktop methods (PIANC, 2015) indicated that the armoured rock slope adjacent to the berth face would incur damage due to wash from the vessel side thrusters and the main propeller. Large scale (13.5:1) physical model tests were undertaken in a 6 m x 15 m x 1.4 m deep basin at UNSW to measure wash velocity and armour stability. The physical modelling demonstrated that the rock slope was more stable than expected, but that some armour was mobilized. Additional tests were also completed to investigate the efficacy of Articulated Concrete Block Mattresses (ACMs) to protect the rock slope from propeller wash.
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Katz, Naomi T., Bronwyn H. Sacks, Brian H. Le, and Jenny L. Hynson. "Pre-emptive prescription of medications for the management of potential, catastrophic events in patients with a terminal illness: A survey of palliative medicine doctors." Palliative Medicine 33, no. 2 (October 29, 2018): 178–86. http://dx.doi.org/10.1177/0269216318809668.
Full textAbstract:
Background: Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice. Aim: The aim of this study was to explore Australasian palliative medicine doctors’ approaches to pre-emptive prescription of medications to manage catastrophic events. Design: Anonymous survey data were collected electronically. Setting/Participants: Australian and New Zealand palliative medicine fellows and trainees were surveyed. Results: Surveys were completed by 121 doctors; 108 (89.2%) who care for adult patients only and 13 (10.8%) who care for paediatric patients or paediatric and adult patients. In all, 74 (61.2%) respondents pre-emptively prescribed medications at least five times per year, and most orders were never administered. Significant visible bleeding and severe, acute airway obstruction were almost universally considered catastrophic events. Many respondents expressed concern about the lack of evidence to guide pre-emptive medication prescription in this setting. Clinicians reported adverse events related to pre-emptive medication orders being available ( n = 30, 24.8%), as well as orders not being available ( n = 61, 50.4%). Conclusion: Our study supports the need for guidelines, as well as formal education programmes for medical trainees and nursing staff about this important area of practice.
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Diorio, Caroline, Kevin O. McNerney, Michele P. Lambert, Michele Paessler, Julie Chase, Kandace Gollomp, Benjamin L. Laskin, et al. "Evidence of Microangiopathy in Children with Sars-Cov-2 Regardless of Clinical Presentation." Blood 136, Supplement 1 (November 5, 2020): 28–29. http://dx.doi.org/10.1182/blood-2020-137240.
Full textAbstract:
Introduction: During the Coronavirus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), 3 distinct phenotypes have emerged in children. The majority of children have mild or no symptoms. Similar to adults, a minority of children can be severely affected with respiratory distress requiring intensive care. Finally, they may develop a phenomenon presumed unique to children termed Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is a hyperinflammatory syndrome characterized by fever and organ dysfunction (particularly cardiac) in the setting of recent COVID-19 infection. Reports from the adult literature have invoked thrombotic microangiopathy (TMA) and complement activation as a potential cause for severe manifestations of COVID-19 (Zhang et al. NEJM. 2020; Campbell et al. Circulation 2020). Soluble C5b9 (sC5b-9), the terminal complement complex, has been implicated as a marker of hematopoietic stem cell transplant associated TMA (HSCT-TMA; Jodele et al. Blood 2014). We sought to elucidate the role of terminal complement activation and TMA in the different pediatric disease phenotypes. Methods: We enrolled children admitted to the Children's Hospital of Philadelphia during the COVID-19 pandemic who had evidence of SARS-CoV-2 infection on reverse transcriptase polymerase chain reaction (RT-PCR) from mucosa, or met clinical criteria for MIS-C. Patients (pts) were classified in to 3 categories: minimal COVID-19 symptoms or incidental finding of SARS-CoV-2 infection, severe COVID-19 requiring ventilatory support, or MIS-C. To investigate the role of TMA in children with COVID-19 we measured sC5b-9 in plasma of pts with the 3 manifestations of SARS-CoV-2, and in healthy controls. sC5b9 was measured in triplicate at two dilutions by ELISA. Proinflammatory cytokines were measured using V-Plex Pro-inflammatory Panel 1 Human Kits and analyzed on a QuickPlex SQ120. P-values were computed using Dunn's multiple comparisons test after Kruskal-Wallis testing. Blood smears were examined by a hematologist and hematopathologist for schistocytes. Results: 50 pts were enrolled on whom complete sC5b9 data were available: minimal COVID-19 (N=18), severe COVID-19 (N=11), and MIS-C (N=21). Plasma was obtained on healthy controls (N=26). The median sC5b9 level in healthy controls (57 ng/mL) differed significantly (p<0.001 in each case; Figure 1A) from that in pts with minimal disease (392 ng/mL), severe disease (646 ng/mL), and MIS-C (630 ng/mL); differences between MIS-C, minimal, and severe were not statistically significant. Elevations in sC5b9 correlated in a statistically significant manner with the maximum creatinine and blood urea nitrogen (BUN) measured during hospitalization (Figure 1B&C), but not age (p=0.512). sC5b9 did not correlate with lactate dehydrogenase (LDH), nor with the lowest levels of fibrinogen, hemoglobin or platelet counts. Of pts with available data, 19/26 (73.1%) had elevated LDH, 2/31 (6.4%) had hypofibrinogenemia, 35/47 (74.5%) were anemic, and 28/47 (59.6%) were thrombocytopenic. Pro-inflammatory cytokines were measured. Of particular interest to TMA is the neutrophil chemotactic factor IL-8, because of its role as a marker of endothelial damage (Dvorak et al. Front Pediatr 2019). Levels of IL-8 differed significantly between pts with MIS-C (p=0.0166) or pts with severe COVID-19 (p=0.0079), when compared to minimal COVID-19 pts; but not between pts with MIS-C and severe disease (p = 0.99). Blood smears were available on 34 patients. Schistocytes were present in 13/15 (87%) patients with MIS-C, 7/8 (87%) patients with severe COVID-19 and 5/11 (45%) patients with minimal COVID-19 (χ2=6.59, p=0.037). Conclusions: We demonstrate derangements of the final common pathway of complement activation in children with the 3 presentations of SARS-CoV-2. Strikingly, sC5b9s were abnormal even in children with minimal disease or incidental infection. Renal dysfunction correlated with elevations in sC5b9, strengthening the evidence that TMA plays a role in the pathophysiology of SARS-CoV-2 infection. Future work is aimed at further characterizing the role of the complement cascade in the pathogenesis of MIS-C and COVID-19 in children. The long-term complications of endothelial damage and complement activation are unknown and extended follow-up is warranted. Figure 1 Disclosures Diorio: Children's Hospital of Philadelphia: Research Funding; University of Pennsylvania: Research Funding. Lambert:22qSociety: Consultancy; RDMD ITP study: Consultancy; Octapharma: Consultancy, Research Funding; Educational Concepts in Medicine: Consultancy; Shionogi: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Argenix: Consultancy; CdLS Foundation: Consultancy; Sysmex: Research Funding; Dova: Consultancy, Membership on an entity's Board of Directors or advisory committees; Principia: Consultancy, Membership on an entity's Board of Directors or advisory committees; ClinGen: Honoraria; Platelet Disorder Support Association (PDSA): Consultancy; AstraZeneca: Research Funding; Bayer: Consultancy; ITP Australia: Consultancy. Henrickson:Horizon Pharma: Other: ad hoc board meeting. Odom John:Burroughs Wellcome: Research Funding; NIAID: Research Funding. Bassiri:CSL Behring: Other: Spouse receives stocks . Behrens:NIH/NIAID: Research Funding. Teachey:Janssen: Consultancy; Amgen: Consultancy; La Roche: Consultancy; Sobi: Consultancy.
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Hunt, Roger W., Katina D’Onise, Anh-Minh Thi Nguyen, and Kamalesh Venugopal. "Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012." Journal of Palliative Care 34, no. 4 (November 28, 2018): 224–31. http://dx.doi.org/10.1177/0825859718814813.
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Aims:To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.Materials and Methods:Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.Results:From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.Conclusions:Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.
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Mal, Tarun K., and Laura Narine. "The biology of Canadian weeds. 129. Phragmites australis (Cav.) Trin. ex Steud." Canadian Journal of Plant Science 84, no. 1 (January 1, 2004): 365–96. http://dx.doi.org/10.4141/p01-172.
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Phragmites australis (Cav.) Trin. ex Steud.-common reed, is a perennial, emergent aquatic plant with annual cane-like stems developed from an extensive rhizome system. It grows in low-lying wet areas such as fresh and salt-water marshes, drainage ditches, shallow lake edges, sandy banks, roadsides, woodlands and rocky places. Stems can reach up to 6.0 m in height, vary in diameter from 4 to10 mm and have 10 to 25 cm long hollow internodes. Clones are extended by perennial rhizomes with extensive aerenchymatous tissue that supplies oxygen. Roots develop from rhizomes and other submerged parts of shoots. Leaves are smooth, alternate with narrow-lanceolate laminae, 20 to 70 cm long and 1 to 5 cm broad, and tapering to long slender points. The inflorescence is a terminal panicle, often 30 cm long, dull purple to yellow, with main branches bearing many spikelets. Seed production and germination are extremely variable and comparatively rare in many populations. Phragmites australis carries out photosynthesis through the C3 pathway (or a variation thereof). Studies of genetic variation through isozyme and other molecular methods suggest that the populations are very closely related, and that variation in the metapopulation is small. Chloroplast DNA sequences of two non-coding regions indicate that non-native introduced genotypes of P. australis have displaced native genotypes in parts of North America. Phragmites australis often forms extensive monocultures in North America. As a consequence, habitat quality and species diversity have been documented to decline. However, in roadside populations it is effective in taking up many typical heavy metals that originate from nearby highways and buildings. Phragmites australis is found in all Canadian provinces and the Northwest Territories, but not in the Yukon Territory or Nunavut. The infestation of P. australis is most severe in the Great Lakes region and its migration is primarily mediated through rivers, canals and waterways but roadways are increasingly becoming important. Changes in the water regime have been linked to its success and could ultimately result in changes to the floristic composition of a habitat. Rodeo™, an aqueous solution of the isopropylamine salt of glyphosate, is most frequently used to control P. australis populations. Other methods of control include cutting, burning, and drainage of the species’ habitat. As P. australis is considered to be invasive in North America, introduction of biological control agents is now being investigated. Key words: Phragmites australis; common reed; Canadian distribution; wetlands; invasive weed
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Johnson, Claire E., Afaf Girgis, Christine L. Paul, and David C. Currow. "Palliative care referral practices and perceptions: The divide between metropolitan and non-metropolitan general practitioners." Palliative and Supportive Care 9, no. 2 (May 4, 2011): 181–89. http://dx.doi.org/10.1017/s1478951511000058.
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AbstractObjective:Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).Method:Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.Results:Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.Significance of results:Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.
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JAŁOSZYŃSKI, PAWEŁ. "Discovery of Penicillidmus in the Bismarck Archipelago, Papua New Guinea, with description of a new species from Lavongai (New Hanover) Island (Coleoptera, Staphylinidae, Scydmaeninae)." Zootaxa 4254, no. 3 (April 18, 2017): 391. http://dx.doi.org/10.11646/zootaxa.4254.3.10.
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Penicillidmus Jałoszyński, 2014 was established to accommodate two Australian species of Glandulariini. Penicillidmus masseyensis Jałoszyński, 2014 and P. unicolor Jałoszyński, 2014 are known to occur in Cape York, northern Queensland. With the adult body length ranging from 0.83 to 0.86 mm, these species are among the smallest Australian scydmaenines. Another, yet undescribed species represented by a female, is also known to occur within the same area (Jałoszyński 2014). Penicillidmus resembles similarly small adults of Microscydmus Saulcy & Croissandeau, 1893, but can be easily distinguished on the basis of remarkable cephalic and prothoracic structures. Unlike any other Glandulariini, species of Penicillidmus have a unique system of carinae on the flattened ventral surface of the head, located posterior and lateral to the mouthparts. The submental carina runs along the anterior margin of the submentum and extends laterally along cardinal bases; the longitudinal lateral carina runs at each side of mouthparts and extends from the anterior margin of the head capsule to the 'neck' region; and the transverse carina connects each longitudinal lateral carina with the mesoventral margin of the compound eye. Additionally, the apex of the terminal maxillary palpomere is thickened, and the pronotum bears a thick posterolateral brush of several long setae. The latter character is most easily observable; under a stereomicroscope the brush appears as a solid rod-like structure, individual setae can be recognized in transparent mounts under a compound microscope.
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Ramasamy, Karthik, Ajay Nooka, Hang Quach, Myo Htut, Rakesh Popat, Michaela Liedtke, Sascha A. Tuchman, et al. "Open Label, Multicenter, Dose-Escalation/ Expansion Phase Ib Study to Evaluate Safety and Activity of BET Inhibitor RO6870810 (RO), Given As Monotherapy to Patients (pts) with Advanced Multiple Myeloma." Blood 136, Supplement 1 (November 5, 2020): 12–14. http://dx.doi.org/10.1182/blood-2020-136392.
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Introduction Multiple myeloma (MM), relapsed or refractory (R/R) to standard of care therapies, represents a treatment indication with a significant unmet clinical need. Transcriptional activation of c-MYC through bromodomain and extra-terminal (BET) proteins contributes to the malignant phenotype of the disease. RO is a novel thienodiazepine, small molecule, non-covalent inhibitor of the BET family of bromodomains. Preclinical studies with BET inhibitors have demonstrated significant single agent in vivo activity in myeloma, accompanied by down-regulation of MYC and MYC target gene expression. We report results of a monotherapy phase 1b study of RO in R/R MM (NCT03068351). Methods Eligible pts with R/R MM included those treated with at least three prior lines of multiple myeloma therapy, including a proteasome inhibitor and an immunomodulatory agent, or who are double-refractory to a proteasome inhibitor and an immunomodulatory agent. Primary refractory myeloma pts were only allowed in the dose escalation portion of the study. In the dose escalation (part I), pts received subcutaneous (SC) escalating doses of RO (0.30-0.65 mg/kg) in a standard 3 + 3 design on days 1 - 14 of 21-day cycles to determine both the maximum tolerated dose (MTD) and recommended dose (RD). In the expansion cohort (part II), pts received RO as monotherapy at the RD level. Primary endpoint was safety (DLT, MTD, RD) and secondary endpoints included evaluation of pharmacodynamics (CD11b expression) and preliminary efficacy assessments based on IMWG criteria. Results Between June 2017 and April 2019, a total of 24 pts were enrolled in the US, the UK and Australia. 13 pts were enrolled in the dose escalation and 11 pts in the expansion part. The median age of pts was 65.5 years (range: 46 - 82 years). The study population was heavily pretreated with a median of 6 (3-9) prior therapies. Pts were refractory to immunomodulatory drugs (63%), proteasome inhibitors (46%), both (46%), or daratumumab (42%). 57 total cycles were administered, with a median of 2 (1-6) cycles per patient (pt). Two DLTs occurred in one pt in the 0.65 mg/kg cohort (thrombocytopenia grade 4, angina pectoris grade 3). The recommended dose is 0.65 mg/kg. Grade 3 treatment emergent AEs in ≥ 5% of pts were thrombocytopenia (11 pts [45.8%]), anemia (7 pts [29.2%]), fatigue (3 pts [12.5%]), injection site reaction, malaise, decreased appetite, and hyponatremia (2 pts [8.3%] each). 3 pts (12.5%) experienced a total of 4 AEs leading to discontinuation of the study treatment; these AEs were left ventricular dysfunction, fatigue, sepsis, and staphylococcal bacteremia (the latter two AEs occurred in the same pt). A total of 8 deaths (33.3%) were reported in the study, all as a consequence of progressive disease. The best overall response recorded was partial response in 4 pts (16.7 %), 3 of whom having received prior daratumumab. One pt experienced a minimal response, and stable disease was reported in 12 out of 24 (50%). There was no evidence for a dose-related increase in efficacy, though data are very limited (Table). Responses obtained during treatment with RO6870810 were short-lived and lasted for appr. 6 weeks. As evidence of target engagement, pharmacodynamic profiling demonstrated decreases in CD11b levels in peripheral blood mononuclear cells (Figure). Conclusions Treatment of MM pts with the BET inhibitor RO as monotherapy resulted in a high incidence of cytopenias, especially grade 3-4 thrombocytopenia and grade 3 anemia. However, none of these events led to study drug discontinuation. Cytopenias are a known side effect of BET inhibitors, with thrombocytopenia frequently reported as a DLT in various pt populations. Pts with NUT carcinoma, other solid tumors, or diffuse large B-cell lymphoma treated in the First in Man trial of RO had a low rate of cytopenias, indicating that the underlying disease and the extensive pre-treatment in MM may play a role in their occurrence (publication submitted). In this heavily pretreated R/R MM population, we have established 0.65 mg/kg as the recommended monotherapy dose. Pharmacodynamics effects were evident at this dose, but as monotherapy in this R/R MM cohort, response rates were low and less durable. Future drug combination approaches may result in an improved benefit / risk ratio. Disclosures Ramasamy: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; BMS: Consultancy, Research Funding, Speakers Bureau; Takeda: Consultancy, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Oncopeptides: Consultancy, Honoraria. Nooka:Adaptive Technologies: Consultancy, Honoraria; Oncopeptides: Consultancy, Honoraria; Spectrum Pharmaceuticals: Consultancy; GlaxoSmithKline: Consultancy, Honoraria, Other: Personal Fees: Travel/accomodations/expenses, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria; Karyopharm Therapeutics, Adaptive technologies: Consultancy, Honoraria, Research Funding. Quach:Amgen, Celgene, karyopharm, GSK, Janssen Cilag, Sanofi.: Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline, Karyopharm, Amgen, Celgene, Janssen Cilag: Consultancy; GlaxoSmithKline, Karyopharm, Amgen, Celgene, Janssen Cilag: Honoraria; Amgen, sanofi, celgene, Karyopharm, GSK: Research Funding. Htut:City of Hope Medical Center: Current Employment. Popat:AbbVie: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Other: Travel support, Research Funding; Bristol Myers Squibb: Consultancy, Honoraria; GSK: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Liedtke:Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria; Janssen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Caelum: Membership on an entity's Board of Directors or advisory committees; Adaptive: Membership on an entity's Board of Directors or advisory committees. Tuchman:Caelum: Honoraria; Sanofi: Honoraria, Research Funding; Amgen: Research Funding; Janssen: Research Funding; Oncopeptides: Consultancy; Roche: Research Funding; Karyopharm: Honoraria, Research Funding; Celgene: Honoraria, Research Funding, Speakers Bureau. Hertzberg:Gilead: Membership on an entity's Board of Directors or advisory committees; MSD: Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria; BMS: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support of parent study and funding of editorial support. Demario:BioNTech SE: Current Employment, Current equity holder in publicly-traded company; Hoffmann-La Roche Ltd.: Current equity holder in publicly-traded company, Ended employment in the past 24 months. Nueesch:Hoffmann-La Roche Ltd.: Current Employment, Current equity holder in publicly-traded company. Chesne:Hoffmann-La Roche Ltd.: Current Employment, Current equity holder in publicly-traded company. Franjkovic:Hoffmann-La Roche Ltd.: Current Employment, Current equity holder in publicly-traded company. Lechner:Roche Diagnostics GmbH: Current Employment, Current equity holder in publicly-traded company. Kornacker:Hoffmann-La Roche Ltd.: Current Employment, Current equity holder in publicly-traded company.
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Sarakhman, Oksana, Ruslana Shurpenkova, Tatiana Kalaitan, Оlena Sidelnyk, and Uljana Grudzevuch. "MARKET APPROACH TO INTERCHANGE COMMISSION REGULATION: ADVANTAGES AND DISADVANTAGES." Economic Analysis, no. 32(1) (2022): 208–18. http://dx.doi.org/10.35774/econa2022.01.208.
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Introduction. In Ukraine the lion's share of the commission fee for the services of the acquiring institution (the cost of trade acquiring) is the interchange fee (60% – 75%) – interbank exchange fee paid by the acquirer to the issuer of electronic means of payment for each direct or indirect person) non-cash transaction, made with a payment card, and varies between 1,4 – 1,8% of the transaction amount. The average cost of trade acquiring in Ukraine is 2% of turnover and plus approximately 300 hryvnias for terminal rent per month. Interchanging payment (funds paid by the acquirer's acquirer's bank) is two-thirds of the payment charged to the merchant. Purpose. Determining the most correct market approach in the current conditions to the formation of key areas for the regulation of the interchanging commission in Ukraine and analysis of trends in the regulation of such an approach by other states. Methodology. The data on the consequences of the introduced regulation of the interchange commission in other countries of the world are analyzed, in particular: in the United States of America, China, Australia, Great Britain and others. It is considered that the marginal rate is 0. 3% below the level of exchange commissions that exists in all Member States, and therefore the impact on credit card acceptance is likely to be significant. In particular, exchange approaches in Germany, Poland, Hungary, the Netherlands, Denmark, Spain and France were analyzed. Results. In this regard, the need to maintain exclusively market-based approaches to interchange commission regulation has been proven, as this will enable the financial industry to further increase non-cash payments, reduce the share of the shadow economy and increase state budget revenues as a result of digitalization of payments.
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Koffman, Jonathan, Emel Yorganci, Fliss Murtagh, Deokhee Yi, Wei Gao, Stephen Barclay, Andrew Pickles, et al. "The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT." Health Technology Assessment 23, no. 55 (October 2019): 1–150. http://dx.doi.org/10.3310/hta23550.
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Background Patients admitted to hospital with a terminal illness and uncertain recovery often receive inconsistent care and do not have the opportunity to die in their preferred place of death. Previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, have sometimes been badly implemented. The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle was developed to remedy this. It has not been evaluated in a randomised trial, but a definitive trial would face many hurdles. Objective To optimise the design of and determine the feasibility of a pragmatic, multicentre, cluster randomised controlled trial of the AMBER care bundle compared with best standard care. Design A feasibility cluster randomised controlled trial including semistructured interviews with patients and relatives, focus groups with health-care professionals, non-participant observations of multidisciplinary team meetings, a standard care survey, heat maps and case note reviews. Retrospective data were collected from the family or close friends of deceased patients via a bereavement survey. Setting Four general medical wards at district general hospitals in England. Participants There were 65 participants (control, n = 36; intervention, n = 29). There were 24 interviews, four focus groups, 15 non-participant meeting observations, six case note reviews and three heat maps, and 15 of out 23 bereavement, standard care surveys were completed. Intervention The AMBER care bundle is implemented by a nurse facilitator. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status and daily plan revisiting. The AMBER care bundle encourages staff, patients and families to talk openly about their preferences and priorities should the worst happen. Main outcome measures Two ‘candidate’ primary outcomes were selected to be evaluated for a future definitive trial: Integrated Palliative care Outcome Scale patient/family anxiety and communication subscale and ‘howRwe’. The secondary outcome measures were Integrated Palliative care Outcome Scale symptoms, Australian-modified Karnofsky Performance Status scale, EuroQol-5 Dimensions, five-level version, Client Service Receipt Inventory, recruitment rate, intervention fidelity and intervention acceptability. Results Data were collected for 65 patients. This trial was not powered to measure clinical effectiveness, but variance and changes observed in the Integrated Palliative care Outcome Scale subscale indicated that this measure would probably detect differences within a definitive trial. It was feasible to collect data on health, social and informal care service use and on quality of life at two time points. The AMBER care bundle was broadly acceptable to all stakeholders and was delivered as planned. The emphasis on ‘clinical uncertainty’ prompted health-care professional awareness of often-overlooked patients. Reviewing patients’ AMBER care bundle status was integrated into routine practice. Refinements included simplifying the inclusion criteria and improving health-care professional communication training. Improvements to trial procedures included extending the time devoted to recruitment and simplifying consent procedures. There was also a recommendation to reduce data collected from patients and relatives to minimise burden. Limitations The recruitment rate was lower than anticipated. The inclusion criteria for the trial were difficult to interpret. Information sheets and consent procedures were too detailed and lengthy for the target population. Health-care professionals’ enthusiasm and specialty were not considered while picking trial wards. Participant recruitment took place later during hospital admission and the majority of participants were lost to follow-up because they had been discharged. Those who participated may have different characteristics from those who did not. Conclusions This feasibility trial has demonstrated that an evaluation of the AMBER care bundle among an acutely unwell patient population, although technically possible, is not practical or feasible. The intervention requires optimisation. Trial registration Current Controlled Trials ISRCTN36040085. National Institute for Health Research (NIHR) Portfolio registration number 32682. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 55. See the NIHR Journals Library website for further project information.
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Moon, Felicity, David W. Kissane, and Fiona McDermott. "Discordance between the perceptions of clinicians and families about end-of-life trajectories in hospitalized dementia patients." Palliative and Supportive Care 19, no. 3 (April 6, 2021): 304–11. http://dx.doi.org/10.1017/s1478951521000109.
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AbstractBackgroundDue to the unpredictable dementia trajectory, it is challenging to recognize illness progression and the appropriateness of a palliative approach. Further confusion occurs during hospitalization where the presence of comorbid conditions complicates prognostication. This research examined clinicians and families' perceptions of dementia as a terminal condition in relation to end-of-life admissions.ContextThe study was based in the General Medicine units of one Australian public hospital. Medical, nursing, and social work clinicians were recruited to reflect multidisciplinary perspectives. Bereaved caregivers of deceased patients with dementia were interviewed 3 months following death.MethodsQualitative research underpinned by a social constructionist epistemology and framed through complex systems theory. Semi-structured interviews generated data that illuminated perceptions of deterioration observed toward the end of life.ResultsAlthough participants anticipated general cognitive and physical deterioration associated with dementia, the emergence of comorbid illness made it difficult to predict the onset of the end of life. During a hospital admission, clinicians attributed the end of life to the advanced outcomes of dementia, whereas families described new medical crises. End-of-life admissions illuminated intersections between dementia and comorbidities rather than illness progression. In contrast with the perception that people with dementia lose awareness at the end of life, families drew attention to evidence that their loved one was present during the dying phase.Significance of resultsOur findings challenge the dominant understanding of dementia trajectories. Bifurcations between clinicians and families' views demonstrate the difficulties in recognizing end-of-life transitions. Implications for the integration of palliative care are considered.
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Berger, J. D., K. N. Adhikari, D. Wilkinson, B. J. Buirchell, and M. W. Sweetingham. "Ecogeography of the Old World lupins. 1. Ecotypic variation in yellow lupin (Lupinus luteus L.)." Australian Journal of Agricultural Research 59, no. 8 (2008): 691. http://dx.doi.org/10.1071/ar07384.
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Agricultural crops and their wild progenitors are excellent candidates for ecophysiologal research because germplasm collections are often extensive and well described, and in its dissemination the crop may explore new habitats. The advent of high-resolution climate models has greatly improved our capacity to characterise plant habitats, and study species’ adaptive responses. The yellow lupin (Lupinus luteus) is ideal because it evolved as a Mediterranean winter-annual in relatively high-rainfall coastal regions, but was domesticated as a summer crop in temperate central Europe. Currently the crop is being developed for Mediterranean south-western Australia, raising an interesting ecophysiological problem: is it more appropriate to concentrate on wild material from Mediterranean habitats, which are likely to be more similar to the target environments, or on European germplasm domesticated for temperate summer cropping? Lupinus luteus collection sites across the natural and domesticated distribution range were characterised by calculating site-specific bioclimatic variables and habitat types defined using multivariate analysis. Germplasm was evaluated in 2 field trials measuring a range of characters describing plant growth, phenology, architecture, and productivity. The earliest phenology and highest vigour and productivity were recorded in domesticated material from central Europe, characterised by short but unstressful growing seasons with reliable rainfall, long day-lengths, and rapidly rising vegetative-phase temperatures levelling out after flowering. Mediterranean habitats were classified by altitude, climate, and growing-season length. Early, productive germplasm came from warmer/low elevation sites with inconsistent rainfall and stronger terminal drought. Germplasm from low temperature/high elevation sites with high, relatively frequent rainfall had late phenology and low growth rates, early vigour, seed yield, and harvest index. Distinct habitats within the distribution range of L. luteus have selected for ecotypes with different phenologies and growth rates, which strongly influence plant architecture, fecundity and yield. It is suggested that variable responses to vernalisation and differences in seed size are important in determining these traits. European germplasm has many of the terminal drought-avoiding characteristics required in a productive Mediterranean ideotype, but may lack drought tolerance, which is likely to be under stronger selection pressure in more stressful Mediterranean habitats.