Witnessing death does not necessarily relieve the dis-comfort of death: analysis of the relationship between religiosity and thanatophobia in medicine undergraduate students

Introduction: It is known that very few issues related to death and religiosity/spirituality are addressed during medical graduation. Understanding the process of death and dying is still a problem for medical students before the terminal condition of a patient. Probably the medical students of the fifth graders overestimate their abilities, probably because they have not yet had contact with terminally ill patients or because they have not graduated, they do not take responsibility for the death of a patient they are following. In Brazil, many students believe that the topic of spirituality influences health, but they do not feel prepared to address this issue with patients. Objective: It was to analyze whether there is a relationship between religiosity and thanatophobia in medical students. It also analyzed whether there was a correlation between fear of death and specific religions, sex and age, and the index of religiosity with sex and age. Methods: Followed a prospective observational cross-sectional model, following the STROBE clinical research rules. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 2,031,705, and obtaining the patient's consent. Results: A total of 542 students (61.2% of the total) answered the questionnaire. Most were female (65.7%) and with a mean age of 22.31 (ranging from 17 to 39 years). The majority of students have a religion (90.1%) and 90.4% considered it important to address the issue of death and religiousness during graduation. In this study, it was observed that most students, in addition to having some kind of religion, consider it important to address the themes highlighted during the course. This was similar to the findings in other studies. There was no statistically significant relationship between having a religion and being less afraid of death. However, students with higher levels of intrinsic religiosity showed greater discomfort when dealing with terminal patients. Furthermore, no studies comparing these two subjects were found. It was also found in this research that students with high levels of religiosity consider it more important to address the issues in question, with the majority being female students. Conclusion: It is necessary to include the topic in the medical academy, and it is essential to prepare a more humanistic and dedicated professional for patients, whether active or palliative treatment.

Caregiver Challenges Seen From the Perspective of Certified Home Hospice Medical Directors

Background: Hospice medical directors (HMDs) play an important role as part of the interdisciplinary hospice team. Family caregivers (CGs) play a critical role in caring for patients receiving home hospice care. Understanding the challenges HMDs face when working with CGs is important when addressing potential gaps in care and providing quality end of life (EoL) care for the patient/CG dyad. Objectives: To understand issues HMDs encounter when working with and caring for CGs and to determine how they manage these issues in the home hospice setting. Design: Twelve semistructured phone interviews with certified HMDs were conducted. Data were analyzed using standard qualitative methods. Subjects: Participants included certified HMDs obtained from a public website. Results: Participants’ responses regarding the major issues HMDs faced when working with CGs were categorized into 6 themes: (1) assessing CG competency, (2) CG financial burden, (3) physical burden of caregiving, (4) managing CG expectations, (5) CGs denial of patient’s terminal condition, and (6) CGs unwilling or unable to engage with providers about their needs or the patient’s needs. Conclusions: HMDs confirmed the important role CGs play in providing care to home hospice patients. Challenges faced by HMDs vary from assessing CG competency in providing care to the patient, dealing with the physical and financial toll that CGs face, and addressing CGs’ expectations of hospice care. Future studies are needed to explore solutions to these issues to better support CGs in the home setting.

Caring for Patients With Dementia at End of Life

Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.

Chronic kidney disease in adult horses: causes, diagnosis and management

Chronic kidney disease is a rare disease in horses, unlike humans and companion animals where it is frequently encountered. There are multiple causes, although, since the disease typically presents late in the disease process, the instigating factor is often not ascertained. Clinical signs most commonly include weight loss, ventral oedema and polyuria-polydipsia. There is a need for more sensitive markers of renal damage or dysfunction so that the disease can be detected earlier in its course. Serum symmetric dimethylarginine and neutrophil gelatinase-associated lipocalin are potential biomarkers that are being investigated in this regard. Currently, once the diagnosis has been made, treatment is supportive only, with no options to halt the progression of the disease. Although this is a terminal condition, horses can be maintained with an adequate quality of life for several years after diagnosis in some cases.

Deployment the Spoke of a Large-Sized Transformable Refl ector Using a Sequential Optimization Algorithm

The use of large-sized opening reflectors close-packed in spacecraft is associated with spreading the spokes at a given angle, extending the fragments of the spokes and adjusting the shape of the radio-reflecting mesh. The problem of optimizing these processes with automatic output of the reflector to the deployed working state is urgent. The optimal control problem of spreading spokes of a large-sized space-based reflector with respect to bending vibrations is investigated in the article. The optimization process is complicated by ensuring convergence of iterative procedure for control finding. The bending vibrations of the spokes complicate the task of spreading. That makes it difficult to fix spokes when reaching the stops. In this paper the mathematical model of spoke dynamics is improved with respect to spoke’s bend change in length and in time, the model takes into account the presence of stop and retainer devices and an actuator. It is proposed to consider a hierarchy of two target composed functions and develop an algorithm for sequential optimization for a smooth exit to the stops. It is suggested to include the terminal condition for the angular spreading rate in the first criterion. A study was carried out using mathematical simulation for the process of turning the spoke by a given angle at small values of the angular velocity at the final moment of time taking into account bending vibrations. The exact values of the weight coefficients included in the target composed functions are found. Weight coefficients influence on transient processes is investigated. The performance of the algorithm was checked when the value of the optimization interval was changed. The comparison of the results of simulation modeling with control options using the PID controller, application of an algorithm with a predictive model and an algorithm with optimal correction of the control structure, revealed by means of the maximum principle, was carried out. The results of simulation modeling foe spokes spreading process using the sequential optimization algorithm demonstrate the achievement of the required accuracy with permissible tolerance residual vibrations. The developed algorithm of sequential optimization forms control in a real time and it is recommended to use it in more complex solutions under random disturbances using measurement process and optimization of observation intervals.

Discordance between the perceptions of clinicians and families about end-of-life trajectories in hospitalized dementia patients

Background Due 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. Context The 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. Methods Qualitative 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. Results Although 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 results Our 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.

Updates from the fray: rational off-label and over-the-counter prescribing in amyotrophic lateral sclerosis

Background: Amyotrophic lateral sclerosis (ALS) is a terminal condition, which is increasing in incidence. Therapeutic interventions have enjoyed limited success. However, research is progressing, with some promising drug candidates emerging. Patients cannot always wait for the results of large trials. The general practitioner has a central role in management of ALS. Objective: To review and summarise available evidence evaluating the disease-modifying and life-extending potential of approved medications available off-label or over the counter. To inform doctors and patients of updates in the field and assist their decision-making. Discussion: Three experimental candidates were deemed to have a reasonable likelihood of efficacy, and doses/routes of administration were clarified. Possibilities for novel therapies were outlined, and the importance of research support was highlighted.