scholarly journals Control Measures for Continuous Deep Sedation Until Death: A Framing Analysis of the Views of Physicians

2021 ◽  
pp. 104973232110376
Author(s):  
Stijn Vissers ◽  
Lenzo Robijn ◽  
Sigrid Dierickx ◽  
Freddy Mortier ◽  
Joachim Cohen ◽  
...  
Keyword(s):  
Deep Sedation ◽  
Self Regulation ◽  
Interesting Case ◽  
Control Measures ◽  
External Control ◽  
Framing Analysis ◽  
Structured Interviews ◽  
Continuous Deep Sedation ◽  
Sound Control ◽  
Professional Self

Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians’ frames to develop sound control measures.

Mentalizing Imagery Therapy mobile application for family dementia caregivers: feasibility and effects on mood and caregiving

2018 ◽  
Author(s):  
Abu Sikder ◽  
Francis Yang ◽  
Rhiana Schafer ◽  
Glenna A. Dowling ◽  
Lara Traeger ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Mobile Application ◽  
Self Regulation ◽  
Pilot Trial ◽  
Depression Symptom ◽  
Structured Interviews ◽  
Physical Strain ◽  
Dementia Caregivers ◽  
Loved One ◽  
People With Dementia

Objectives: Due to psychological and physical strain, family caregivers of patients with Alzheimer’s disease and related dementias are at high risk for depression and stress related disorders. We investigated the feasibility of a mobile application (App) intervention delivering Mentalizing Imagery Therapy (MIT), which incorporates guided imagery and mindfulness, to facilitate self-regulation and increase perspective on the mental life of self and others. Method: A 4-week pilot trial of an MIT App for family caregivers of people with dementia was conducted to assess feasibility of use, mood and depression symptom benefit, and relationship changes. Semi-structured interviews were conducted at the study’s conclusion to characterize participants’ perceived benefits. Results: 80% of 21 consented participants downloaded the App, utilized it at least once, and were further analyzed. Of these participants, average usage of audio recordings was 14 ± 10 (SD) days out of 28 possible, and 29 ± 28 individual sessions. Acute improvement in mood from before to after completion of exercises was uniformly observed (p < .001), and after four weeks there was a significant increase in positive affect and a reduction in negative affect. Participants with severe levels of depression (n=3) at baseline exhibited an improvement in symptoms at 4 weeks averaging 30% (p < .05). Semi-structured interviews revealed an increase in the ability to remain “centered" despite caregiving challenges, take the perspective of the loved one, and positively reframe the caregiver experience.Conclusion: App delivery of MIT is feasible for family dementia caregivers. Results showed moderate to high usage of the app for a majority of the users, and promising improvements in mood and depression. These data provide justification for larger, controlled trials.

A structured policy review of the principles of professional self-regulation

2013 ◽  
Vol 60 (1) ◽  
pp. 13-22 ◽  
Author(s):  
D.C. Benton ◽  
M.A. González-Jurado ◽  
J.V. Beneit-Montesinos
Keyword(s):  
Self Regulation ◽  
Policy Review ◽  
Professional Self

General practitioners' report of continuous deep sedation until death for patients dying at home: A descriptive study from Belgium

2010 ◽  
Vol 17 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Livia Anquinet ◽  
Judith A. C. Rietjens ◽  
Lieve Van den Block ◽  
Nathalie Bossuyt ◽  
Luc Deliens
Keyword(s):  
General Practitioners ◽  
Deep Sedation ◽  
Descriptive Study ◽  
Continuous Deep Sedation ◽  
Dying At Home ◽  
At Home

Migrant doctors’ narratives about patients

2021 ◽  
Author(s):  
Mariana Lazzaro-Salazar ◽  
Olga Zayts
Keyword(s):  
Hong Kong ◽  
Professional Practices ◽  
Vicarious Experience ◽  
Structured Interviews ◽  
Collaborative Project ◽  
Host Culture ◽  
Audio Recordings ◽  
Health And Illness ◽  
Professional Self ◽  
The Creation

Abstract Narratives of personal and vicarious experience are part and parcel of being a doctor, as doctors routinely (re)interpret and (re)tell patients’ narratives when reflecting on clinical cases. Taking an interest in migrant doctors’ self-initiated narratives about patients in doctor-researcher interviews about cultural transitions, this study examines over thirty hours of audio-recordings of forty semi-structured interviews conducted as part of a collaborative project in Chile and Hong Kong. The study explores how migrant doctors construct their professional ‘self’ through narratives about patients, and how these narratives help migrant doctors legitimise their arguments and professional stance in criticizing cultural and societal attitudes towards health and illness, and the professional practices of local doctors. Finally, the paper reflects on the ways in which migrant doctors’ identity positionings provide space for the creation of a “symbolic territory” in which the practices of migrant doctors co-exist within the boundaries of the practices of local doctors in the host culture.

Assessing the management of healthcare waste for disease prevention and environment protection at selected hospitals in Kinshasa, Democratic Republic of Congo

2021 ◽  
pp. 0734242X2110481
Author(s):  
Gabriel Kalombe Kyomba ◽  
Joêl Nkiama Numbi Konde ◽  
Diafuka Saila-Ngita ◽  
Thomas Kuanda Solo ◽  
Guillaume Mbela Kiyombo
Keyword(s):  
Waste Management ◽  
Ebola Virus ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Bottom Ash ◽  
Control Measures ◽  
Structured Interviews ◽  
Republic Of Congo ◽  
Healthcare Waste ◽  
Health Care Waste

Incineration is the most used healthcare waste (HCW) disposal method. Disease outbreaks due to Ebola virus and SARS-CoV2 require attention to HCW management to avoid pathogens spread and spillover. This study describes HCW management prior to incineration and hospital incinerators performance by analysing bottom ashes from hospitals in Kinshasa, Democratic Republic of Congo. We used semi-structured interviews to capture information on pre-incineration waste management and analysed the chemical composition of 27 samples of incinerator bottom ashes using the energy dispersive X-ray fluorescence. Neither sorting nor waste management measures were applied at hospitals surveyed. Incinerator operators were poorly equipped and their knowledge was limited. The bottom ash concentrations of cadmium, chromium, nickel and lead ranged between 0.61–10.44, 40.15–737.01, 9.11–97.55 and 16.37–240.03 mg kg−1, respectively. Compared to Chinese incinerator performance, the concentrations of some elements were found to be lower than those from China. This discrepancy may be explained by the difference in the composition of HCW. The authors conclude that health care waste in Kinshasa hospitals is poorly managed, higher concentrations of heavy metals are found in incinerator bottom ashes and the incinerators quality is poor. They recommend the strict application of infection prevention control measures, the training of incinerator operators and the use of high-performance incinerators.

scholarly journals The Development of Self-Regulation in Four UK Professional Communities

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Stan Lester
Keyword(s):  
United Kingdom ◽  
Prior Experience ◽  
Self Regulation ◽  
Academic Discourse ◽  
Professional Communities ◽  
Professional Groups ◽  
The United Kingdom ◽  
Professional Self

Professional self-regulation is often conceptualised as involving the delegation of state powers to professional groups.  An examination of four groups in the United Kingdom provides examples of self-regulation that have developed, with one partial exception, without the support of any statutory framework. Some common aspects of self-regulation are identified along with some differences that relate to how the professions have evolved, and to their operating contexts. Significant influences include how the profession is situated among adjacent groups, the degree of demand from clients and employers for qualified practitioners, and potentially whether the occupation is suitable as an initial career or requires  a measure of maturity and prior experience. An argument is made for greater recognition, both through practical examples and in academic discourse of self-regulation that is initiated and furthered voluntarily through negotiation between professions, their members and their clients rather than via legislative powers. 

Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

2017 ◽  
Vol 9 (2) ◽  
pp. 143-145 ◽  
Author(s):  
Takuya Shinjo ◽  
Tatsuya Morita ◽  
Daisuke Kiuchi ◽  
Masayuki Ikenaga ◽  
Hirofumi Abo ◽  
...  
Keyword(s):  
Palliative Care ◽  
National Survey ◽  
Clinical Setting ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Treatment Decision ◽  
Mail Questionnaire ◽  
Terminally Ill Patients ◽  
Continuous Deep Sedation

ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

scholarly journals An Exploration of How Women Experience the Process of Intimate Partner Violence in Relationships Characterised by Bi-Directional Aggression.

2021 ◽  
Author(s):  
◽  
Annette Levine
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Self Regulation ◽  
Policy Research ◽  
Intimate Partner ◽  
Preventive Action ◽  
Structured Interviews ◽  
Future Directions ◽  
Widespread Access ◽  
The Relationship

<p>This qualitative study explored how women in New Zealand experienced the process of intimate partner violence in relationships with men, which were characterised by bi-directional aggression. Using thematic analysis, semi-structured interviews with 11 women who experienced bi-directionally aggressive relationships were analysed and four themes were identified that encompassed 1) the foundations of bi-directional aggression; 2) the nature of bi-directional aggression within the relationship; 3) how the women were stuck in the relationship, and; 4) moving forward. The findings indicate how the vulnerabilities to bi-directional aggression can develop from early life and perpetuate and exacerbate over time in the context of the relationship dynamic. This highlights the need to implement preventive action to support adaptive self-regulation development in young people and families, provide education about bi-directional aggression and widespread access to support and treatment resources for all genders. Further implications and future directions for policy, research and practice regarding bi-directional aggression are discussed.</p>

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