Family Members' Experiences with Viewing in the Wake of Sudden Death

2012 ◽  
Vol 64 (1) ◽  
pp. 65-82 ◽  
Author(s):  
Christina Harrington ◽  
Bethany Sprowl
Keyword(s):  
Sudden Death ◽  
Practice Guidelines ◽  
Family Members ◽  
Evidence Base ◽  
Qualitative Approach ◽  
Supporting Evidence ◽  
Over Time ◽  
Professional Interactions

Sudden deaths leave families in crisis and interacting with many professionals from notification through to burial. Whether to view the deceased is often central to discussion. Practice guidelines have evolved over time regarding where, when, how, and why viewing should or should not occur. Unfortunately, there is much contradiction in existing recommendations and a marked absence of a supporting evidence base for the practice of viewing itself, and the influence of this practice on the overall bereavement process. Using a qualitative approach, this study explored the perspectives and experiences of the suddenly bereaved with respect to: viewing or not having viewed; whether or not their viewing experiences have impacted on their bereavement process; and explored particular aspects of their experience such as interactions with various professionals. Results of this study are clustered and presented under three core themes: viewing specifics; intrapersonal responses; and professional interactions.

Suicide and sudden death bereavement in Australia: A longitudinal study of family members over 2 years after death

2019 ◽  
Vol 54 (1) ◽  
pp. 89-98 ◽  
Author(s):  
Kairi Kõlves ◽  
Qing Zhao ◽  
Victoria Ross ◽  
Jacinta Hawgood ◽  
Susan H Spence ◽  
...  
Keyword(s):  
Sudden Death ◽  
Suicide Ideation ◽  
Family Members ◽  
Confounding Factors ◽  
Depression Anxiety Stress Scale ◽  
Stress Scale ◽  
Symptoms Of Depression ◽  
Time Interaction ◽  
Grief Reactions ◽  
Over Time

Objective: Grief reactions change over time. However, only a limited number of studies, and none in Australia, have analysed changes in individual grief reactions longitudinally. The aim is to examine changes in grief reactions, mental health and suicidality of close family members bereaved by suicide, 6, 12 and 24 months after their loss compared with those bereaved by other forms of sudden death, adjusting for confounding factors. Method: Participants were 142 adult family members bereaved by suicide and 63 by other sudden death, followed up at 6, 12 and 24 months in Queensland, Australia. The Grief Experience Questionnaire, Depression Anxiety Stress Scale and Beck Scale for Suicide Ideation were used as main outcomes. Mixed-effects linear and logistic regressions were utilized for statistical analyses. Results: There were significant differences in rejection, stigmatization, shame and responsibility between the suicide and sudden death bereaved over the 2-year period, after adjusting for potential confounding factors. Rejection, stigmatization, search for explanation, somatic reactions and symptoms of depression and anxiety (Depression Anxiety Stress Scale) declined significantly over time in both groups. Rejection and somatic reactions showed group-by-time interaction effects, with a decrease in the suicide bereaved and no change in the sudden death bereaved. Loss of social support and suicidal ideation did not show a group or time effect. Conclusion: Although our findings confirm that there are several common dimensions to experiencing a sudden death of a family member, several differences were found between the suicide and non-suicide sudden death bereaved including significantly higher levels of rejection, stigmatization, shame and responsibility remaining in the suicide compared to sudden death bereaved 2 years after their loss. These findings should be considered in clinical practice and when designing postvention services in Australia.

P5711Limits of the cardiovascular knowledge base: results from a systematic analysis of the evidence substantiating the European Society of Cardiology clinical practice guidelines

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W B Van Dijk ◽  
E Schuit ◽  
M C De Vries ◽  
R Van Der Graaf ◽  
D E Grobbee
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Class I ◽  
Class Iii ◽  
Systematic Analysis ◽  
Expert Opinions ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
Over Time

Abstract Background The clinical practice guidelines of the European Society of Cardiology (ESC) have a tremendous impact on cardiological practice. To enable clinicians to deliver the best care, substantiated knowledge has to ground these guidelines. However, recently many have voiced questions about the evidence levels forming the basis of guidelines. The latest analysis of cardiovascular guidelines was performed in the United States in 2009 and revealed that they were mainly based on lower level evidence or expert opinion. Moreover, a systematic analysis of the evidence base supporting the ESC guidelines has not been performed before, such an analysis is needed to embody the trust placed in them. Purpose To systemically evaluate the scientific evidence base underlying ESC guidelines. Methods We extracted all recommendations from ESC guidelines published on the ESC website since 2009, with their class of recommendation (treatment is beneficial [class I]; uncertain [class IIa/b]; harmful [class III]) and their level of evidence (multiple randomized controlled trials (RCTs)/meta-analyses [level A]; single RCT/large non-randomized studies [level B]; expert opinions/small studies [level C]). We assessed the distributions of recommendation classes, the underlying evidence levels and their ratios. Furthermore, we compared subsequent guidelines to investigate if evidence levels substantiating recommendations improved over time. Results In the past decade, 43 documents were published as guidelines on the ESC website; 5 were excluded because they concerned definitions, focused updates or position papers, leaving 38 for analysis. A total of 4704 recommendations were extracted, including 2313 (49%) class I, 1341 (29%) class IIa, 677 (14%) class IIb and 373 (8%) class III recommendations. 800 (17%) recommendations were supported by level A evidence; 1439 (31%) by level B, and 2465 (52%) by level C evidence (figure 1a). The majority of class I recommendations (i.e. treatment is beneficial) were based on level C evidence. The same was true for class II and III recommendations. When guidelines were updated there was a median increase of 32 (IQR, 14–40) recommendations. Overall, the number of recommendations supported by level A evidence fell by 1%, while level B and C evidence rose (17% and 16%) (figure 1b). Despite introducing 50 class I recommendations, only a minority of the recommendations were supported by level A evidence (3), less by level B evidence (−7) and the majority by level C evidence (54). Figure 1 Conclusion(s) This first systematic analysis of the ESC guidelines shows that half of its recommendations are grounded in expert opinions or based on small studies. Over time the number of recommendations increased, this increase was primarily based in expert opinions and small studies. To maintain professional and public trust in the ESC guidelines further research is essential to enlighten whether, why and which gaps exist in the cardiovascular knowledge base. Acknowledgement/Funding ZonMw Top-grant

Abstract 204: Who Funds “Evidence-Based Medicine” in our Guidelines: Government or Industry? Analysis of the AHA/ACC Class I Secondary Prevention Guidelines in 2011 vs. 2001

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Payal Kohli ◽  
Sabina A Murphy ◽  
Christopher P Cannon
Keyword(s):  
Secondary Prevention ◽  
Positive Impact ◽  
Evidence Base ◽  
Class I ◽  
Funding Source ◽  
Supporting Evidence ◽  
Lifestyle Interventions ◽  
Pubmed Database ◽  
Consensus Statements ◽  
Over Time

Background: Heated debate on the “influence” of the pharmaceutical industry has led some to question whether trials sponsored by industry provide strong evidence for clinical practice. We sought to analyze this issue by looking at what the independent ACC/AHA Guideline committee cited as the evidence base for Class I (strongest) recommendations, and evaluated the funding source, as well as changes over time. Methods: After importing all citations from the AHA/ACC Secondary Prevention 2011 Update into EndNote citation manager, we excluded those that were not primary publications (e.g. consensus statements or summary guidelines). Funding source was determined from the PubMed database (or if not specified, the primary publication itself). Research support was divided by PubMed categories: U.S. governmental (gov’t), non-U.S. gov’t (typically industry), or mixed. (Note that further division of funding source into any (U.S and foreign) governmental source vs. exclusively industry, is ongoing.) All Class I recommendations were reviewed to determine what percentage of the supporting evidence was funded by U.S. gov’t vs. non-U.S. gov’t, weighting those in the mixed category equally between the other two categories. Chi-square tests were used to statistically compare these percentages. Results: Overall, 62% of studies cited to support Class I recommendations in 2011 were sponsored by non-US gov’t (e.g. industry) sources. Nine of 12 categories of Class I recommendations had the majority of the studies supported by non-gov’t/industry rather than from US gov’t funding (Table 1). This was true both for lifestyle interventions and pharmacological therapies, although the percentage of industry-funded trials for pharmacological therapies was significantly higher as compared to studies for lifestyle interventions (83% vs. 46%, p<0.001). Looking at trends over time, in the 2001 guideline, 51% of studies supporting Class I recommendations were funded by the US gov’t, while of the newer additions since 2001, 78% have been funded by non-gov’t/industry sources (p=0.005). Thus, the time trend for the overall % of recommendations that were sponsored by non-US gov’t/industry has risen from 49% in 2001 to 62% in the 2011 guidelines. Conclusion: Based on this initial categorization from PubMed, it appears that the majority of trials providing the evidence for the ACC/AHA Secondary Prevention guideline comes from non-government/industry-sponsored trials, and this percentage has increased over time. This finding suggests that industry-sponsored trials do provide a positive impact on clinical guidelines.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

ANALISIS KOMPARATIF TUTURAN BAHASA INDONESIA PADA MAHASISWA UNIVERSITAS IQRA BURU

2020 ◽  
Author(s):  
HARZIKO
Keyword(s):  
Historical Development ◽  
Qualitative Approach ◽  
Data Selection ◽  
Communication Tool ◽  
Comparative Linguistics ◽  
Data Presentation ◽  
Vocal System ◽  
The Difference ◽  
Bahasa Indonesia ◽  
Over Time

Language is a tool used to convey ideas, ideas, feelings, and thoughts to others. Language, which is an arbiter sound symbol system that is used by members of one community to work together, interact, and identify themselves. In other words, language can be a means to convey intent or purpose so that the desired thing is achieved. As a communication tool, language develops over time. Therefore, language will never die if its speakers still care and love for the language comparative linguistics as a study or study of language which includes the comparison of cognate languages or the historical development of a language. This research aims to elucidate the use of Indonesian language at students of Iqra Buru University with Comparative Analysis. The method used in this research is descriptive with a qualitative approach. Data collected by observation, interview, and documentation techniques. Sources of data in this study were 5 speakers 5 speakers language Analyzing the data by means of data selection, data classification, and data presentation. The results of the study stated that there were phonological differences, namely the Jamee vowel system contained / ɛ / and / ɔ /, while the vocal system was / a / and the consonant system was Jamee / ɣ / or / R /, while the language / r /, then the difference pronunciations include single vowels, for example makɛn, bɔRa in Jamee and eating, bara in Language used by iqra Rush university students. Keywords

Religion and Memory in Tacitus' Annals

2018 ◽  
Author(s):  
Kelly E. Shannon-Henderson
Keyword(s):  
Cultural Memory ◽  
Family Members ◽  
Religious Life ◽  
Memory Theory ◽  
State Changes ◽  
New Form ◽  
Religious Material ◽  
Over Time

This study demonstrates the importance of references to religious material in Tacitus’ Annals by analyzing them using cultural memory theory. Throughout his narrative of Julio-Claudian Rome in the Annals, Tacitus includes numerous references to the gods, fate, fortune, astrology, omens, temples, priests, emperor cult, and other religious material. Tacitus, who was not only a historian but also a member of Rome’s quindecimviral priesthood, shows a marked interest in even the most detailed rituals of Roman religious life. Yet his portrayal of religious material also suggests that the system is under threat with the advent of the principate. Traditional rituals are forgotten as the shape of the Roman state changes. Simultaneously, a new form of cultic commemoration develops as deceased emperors are deified and the living emperor and his family members are treated in increasingly worshipful ways by his subjects. The study traces the deployment of religious material throughout Tacitus’ narrative, to show how Tacitus views the development of this cultic ‘amnesia’ over time, from the reign of the cryptic, autocratic, and oddly mystical Tiberius, through Claudius’ failed attempts at reviving tradition, to the final sacrilegious disasters of the impious Nero.

scholarly journals Three Evidence Based Methods to Compensate for a Lack of Subject Background when Ordering Chemistry Monographs

2008 ◽  
Vol 3 (3) ◽  
pp. 3
Author(s):  
Robert A. Wright
Keyword(s):  
Statistical Analysis ◽  
Statistical Significance ◽  
Evidence Base ◽  
Circulation Rate ◽  
Evidence Based ◽  
Practical Application ◽  
Present Evidence ◽  
Library System ◽  
Over Time ◽  
Selection Of

Objective – The aim of this article is to present evidence based methods for the selection of chemistry monographs, particularly for librarians lacking a background in chemistry. These methods will be described in detail, their practical application illustrated, and their efficacy tested by analyzing circulation data. Methods – Two hundred and ninety-five chemistry monographs were selected between 2005 and 2007 using rigorously-applied evidence based methods involving the Library's integrated library system (ILS), Google, and SciFinder Scholar. The average circulation rate of this group of monographs was compared to the average circulation rate of 254 chemistry monographs selected between 2002 and 2004 when the methods were not used or were in an incomplete state of development. Results – Circulations/month were on average 9% greater in the cohort of monographs selected with the rigorously-applied evidence based methods. Further statistical analysis, however, finds that this result can not be attributed to the different application of these methods. Conclusion – The methods discussed in this article appear to provide an evidence base for the selection of chemistry monographs, but their application does not change circulation rates in a statistically significant way. Further research is needed to determine if this lack of statistical significance is real or a product of the organic development and application of these methods over time, making definitive comparisons difficult.

scholarly journals Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines

2019 ◽  
Vol 47 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Pradeep M. Jayaram ◽  
Manoj K. Mohan ◽  
Ibrahim Farid ◽  
Stephen Lindow
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Magnesium Sulfate ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Supporting Evidence ◽  
Agree Ii ◽  
Fetal Neuroprotection ◽  
Agree Ii Tool

Abstract Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research. We searched databases of PUBMED, EMBASE, COCHRANE, Web of Science, LILACS; and included the national and the international clinical practice guidelines. We included seven guidelines out of 227 search results. We evaluated the methodological quality of guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) tool and systematically extracted guideline characters, recommendation and supporting evidence base. Summary Five guidelines were of high quality and two were of moderate quality. One guideline achieved more than an 80% score in all the domains of AGREE II tool. All guidelines recommend use of magnesium sulfate for fetal neuroprotection. However, there are differences in other recommendations such as upper gestational age, dose, duration, repeating treatment and use of additional tocolytics. Outlook Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there are no international consensual recommendations.

scholarly journals Multimorbidity of chronic non-communicable diseases: burden, care provision and outcomes over time among patients attending chronic outpatient medical care in Bahir Dar, Ethiopia—a mixed methods study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051107 ◽  
Author(s):  
Fantu Abebe Eyowas ◽  
Marguerite Schneider ◽  
Shitaye Alemu ◽  
Fentie Ambaw Getahun
Keyword(s):  
Quantitative Study ◽  
Qualitative Data ◽  
Premature Mortality ◽  
Evidence Base ◽  
Communicable Diseases ◽  
Bahir Dar ◽  
Multiple Sources ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Over Time

IntroductionMultimorbidity refers to the presence of two or more chronic non-communicable diseases (NCDs) in a given individual. It is associated with premature mortality, lower quality of life (QoL) and greater use of healthcare resources. The burden of multimorbidity could be huge in the low and middle-income countries (LMICs), including Ethiopia. However, there is limited evidence on the magnitude of multimorbidity, associated risk factors and its effect on QoL and functionality. In addition, the evidence base on the way health systems are organised to manage patients with multimorbidity is sparse. The knowledge gleaned from this study could have a timely and significant impact on the prevention, management and survival of patients with NCD multimorbidity in Ethiopia and in LMICs at large.Methods and analysisThis study has three phases: (1) a cross-sectional quantitative study to determine the magnitude of NCD multimorbidity and its effect on QoL and functionality, (2) a qualitative study to explore organisation of care for patients with multimorbidity, and (3) a longitudinal quantitative study to investigate disease progression and patient outcomes over time. A total of 1440 patients (≥40 years) on chronic care follow-up will be enrolled from different facilities for the quantitative studies. The quantitative data will be collected from multiple sources using the KoBo Toolbox software and analysed by STATA V.16. Multiple case study designs will be employed to collect the qualitative data. The qualitative data will be coded and analysed by Open Code software thematically.Ethics and disseminationEthical clearance has been obtained from the College of Medicine and Health Sciences, Bahir Dar University (protocol number 003/2021). Subjects who provide written consent will be recruited in the study. Confidentiality of data will be strictly maintained. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.

scholarly journals The Evolving Role of Catheter Ablation in Patients With Heart Failure and AF

2019 ◽  
Vol 8 (1) ◽  
pp. 47-53
Author(s):  
Sandeep Prabhu ◽  
Wei H Lim ◽  
Richard J Schilling
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Catheter Ablation ◽  
Patient Group ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Patients With Heart Failure ◽  
Recent Developments

AF and heart failure are emerging epidemics worldwide. Several recent trials have provided a growing evidence base for the benefits of catheter ablation in this patient group, which are yet to be universally adopted in clinical practice guidelines. This paper provides a summary of recent developments in this field and provides pragmatic advice to the treating physician regarding the appropriate role of catheter ablation in the overall management of patients with comorbid AF and heart failure.

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