Older Adults’ Experience of Meaning at the End of Life in Two Danish Hospices: A Qualitative Interview Study

The aim of this study was to explore how older adults (aged > 65) confronted with imminent death express their thoughts and feelings about death and dying and verbalize meaning. Furthermore, the aim was to investigate how health professionals could better address the needs of this patient group to experience meaning at the end of life. The study applied a qualitative method, involving semi-structured interviews with 10 participants at two hospices. The method of analysis was interpretative phenomenological analysis. We found three chronological time-based themes: (1) Approaching Death, (2) The time before dying, and (3) The afterlife. The participants displayed scarce existential vernacular for pursuing meaning with approaching death. They primarily applied understanding and vocabulary from a medical paradigm. The participants’ descriptions of how they experienced and pursued meaning in the time before dying were also predominantly characterized by medical vernacular, but these descriptions did include a few existential words and understandings. When expressing thoughts and meaning about the afterlife, participants initiated a two-way dialogue with the interviewer and primarily used existential vernacular. This indicates that the participants’ scarce existential vernacular to talk about meaning might be because people are not used to talking with healthcare professionals about meaning or their thoughts and feelings about death. They are mostly “trained” in medical vernacular. We found that participants’ use of, respectively, medical or existential vernacular affected how they experienced meaning and hope at the end of life. We encourage healthcare professionals to enter into existential dialogues with people to support and strengthen their experiences of meaning and hope at the end of life.

How Do Alliance Portfolio Factors Affect a Precision Medicine Firm’s Innovation Performance?

Precision medicine is an approach to disease treatment and prevention that seeks to maximize effectiveness by taking into account individual variability in genes, environment, and lifestyle. The medical paradigm has been changed with the emergence of precision medicine and many companies with business related to precision medicine should cooperate with other companies. The purpose of this study is to analyze the alliance portfolio factors that affect firms’ innovation performance. This study examined whether the diversity factors of the alliance portfolio and alliance management capability influenced its innovation performance. Additionally, we investigated the moderate effects of participation of research organizations in the alliance portfolio. As a result, there was an inverted U-shaped relationship between the industry diversity of the portfolio and innovation performance; therefore, the participation of research organizations in the alliance portfolio showed a positive effect. Additionally, the value governance diversity changed to have a positive effect by interacting with research organizations. This study provides information on the alliance portfolio factors that affect the innovation performance of precision medicine companies.

Tibetan Medical Paradigms for the SARS-CoV-2 Pandemic

As prophesized in early Tibetan medical works, the emergence of a pathogen such as SARS-CoV-2 that could inflict such a virulent infectious disease such as COVID-19 provided conditions for an expected yet alarming new phenomenon to threaten the health of inhabitants on the Tibetan Plateau. As SARS-CoV-2 spread into a global pandemic, Tibetan physicians worldwide engaged in symposiums, conferences, and clinical exchanges to situate the virus and its disease within Tibetan medical nosology. They sought to reconcile prophesies of global impact and develop critical treatment protocols for their communities. This article presents this particular perspective on COVID-19 as discussed among Tibetan medical colleagues in early April 2020, with follow-up discussions a year later. It introduces the disease’s nosology as a specific type of virulent infection (gnyan rims), and describes the etiology, diagnosis, and treatment as explicated in the Tibetan classic Four Medical Treatises and related commentaries. As Tibetan physicians gain attention for their treatments of mild- and medium-severity COVID-19 cases, understanding the Tibetan medical paradigm for the condition highlights distinctions of therapeutic and investigative relevance compared to biomedical and other traditional Asian medical approaches.

Comparison of aluminum toxicology and homeopathic Alumina: a mixed methods study

Toxicology forms part of homeopathy. The founder of homeopathy, Samuel Hahnemann, incorporated many toxicological symptoms in his Materia Medica. These symptoms are part of the information homeopathic practitioners relay on to choose the appropriate medication for their patients. This medication is administered in form of ultra-high dilutions. Hahnemann also developed Materia Medica on the base of provings done with high diluted substances only – simply because these substances did not have a known toxicology at his time. Alumina is one of these substances. Today we possess a reliable toxicology of aluminum and its compounds. The objective of this study was to determine the grade of concordance between homeopathic (highly diluted) Alumina and aluminum toxicology. A striking concordance will add to evidence of homeopathically potentized substances. The present was a literature-based investigation conducted from a phenomenologist stance. The design is a novel one. Symptoms of aluminum intoxication were obtained from case reports published in scholarly journals. 70 original research articles containing case-reports of 5 aluminum-induced diseases served for the extraction of over 300 symptoms. These symptoms were compared to Hahnemann´s Alumina proving symptoms. A review of modern investigations of the toxic effects of aluminum showed that the conventional medical paradigm and basic science are just starting to explore the huge number of noxious effects the metal has on human, animal and plant health. Qualitative explorations of the relevant homeopathic literature (toxicology in homeopathy and Alumina in randomized controlled trials) resulted in the finding that toxicology plays a minor role in modern homeopathy and that Alumina has been poorly investigated. The result of the quantitative part of this study – the comparison of proving and toxicology obtained from clinical cases – shows an uneven picture. It leads to only partly significant concordances between symptoms from both sources which are strong in core areas of Alumina´s remedy action while the overall comparison shows a coincidence of 50.76% (39.76% for symptoms probably produced by UHDs). This study has to be seen as a pilot for a literature-based proof of the evidence of homeopathic potencies. There remains much to be done, especially in the realm of homeopathic proving and its design. Hahnemann´s procedure – to rely on sensible provers – should be reconsidered. The reproving of Alumina should be envisaged. Keywords: Homeopathy, proving, toxicology, homeopathic pathogenetic trial (HPT), Alumina, aluminum

Silent Sources of the History of Epidemics in the Islamic World: Literature on Ṭāʿūn/Plague Treatises

From 1347 onwards, new literature emerged in the Islamic and Western worlds: the Ṭā‘ūn [Plague] Treatises. The literature in Islamdom was underpinned by three things: (i) Because the first epidemic was a phenomenon that had been experienced since the birth of Islam, ṭā‘ūn naturally occurred on the agenda of hadith sources, prophetic biography, and historical works. This agenda was reflected in the treatises as discussions around epidemics, particularly plague, as well as the fight against disease in general in a religious and jurisprudential framework. (ii) Works aimed at diagnosing the plague and dealing with various aspects of it tried to explain disease on the basis of Galenic-Avicennian medicine within the framework of miasma theory, thus deriving their basis from this medical paradigm. (iii) Finally, the encounter with such a brutal illness prompted a quest for all possible remedies, including the occultist culture. This background shaped the language and content of the treatises at different levels. This article first evaluates the modern studies on plague treatises written in the Islamic world. Then, it surveys the Islamic historical sources in order to pin down the meaning they assign to the concepts of wabā’ [epidemic disease] and ṭā‘ūn [plague]. Certain medical works that were the resources for medical doctrines and terminology for plague treatises are also evaluated with a focus on these two concepts. Thus, the aim of this survey is to understand the general conception of epidemic disease and plague in the Islamic world before the Black Death (1346-1353). I discuss and analyze the characteristics of the Ṭā‘ūn literature, which constitutes the main subject of the article and present a database on the literature. While the works from the Mamluk and Ottoman periods constitute a continuous tradition in some respects, Ottoman treatises differ from the Mamluk works in terms of certain features, especially content. Although this study touches on the common aspects of the works from the two periods, it instead analyzes this literature with a focus on points where the two traditions diverge.

Mingled bodies and voices: Maternal reflections on caregiver expertise and intellectual disability

The risk of viral infection during the COVID-19 pandemic has caused many hospitals to prohibit all patient visitors, including family caregivers for people with intellectual disabilities. Drawing on a postmodern, intersubjective view of the body, as well as my experience as the mother of a young adult with profound disabilities, I argue that caregiver knowledge while unconventional within the medical paradigm must be viewed as essential expertise. People with profound intellectual disabilities often have concurrent, complex medical issues that are complicated by their inability to self-advocate. Optimal care rests upon the ongoing presence and expertise of their primary caregiver. Medical professionals risk patient care by excluding the essential expertise of family caregivers at any time, and specifically during COVID-19.

COVID-19 pandemic, the scarcity of medical resources, community-centred medicine and discrimination against persons with disabilities

This research aims to examine access to medical treatment during the COVID-19 pandemic for people living with disabilities. During the COVID-19 pandemic, the practical and ethical problems of allocating limited medical resources such as intensive care unit beds and ventilators became critical. Although different countries have proposed different guidelines to manage this emergency, these proposed criteria do not sufficiently consider people living with disabilities. People living with disabilities are therefore at a higher risk of exclusion from medical treatments as physicians tend to assume they have poor quality of life, whereas access to medical treatment should be based on several parameters, including clinical data and prognosis. However, the COVID-19 pandemic shifts the medical paradigm from person-centred medicine to community-centred medicine, challenging the main ethical theories. We reviewed the main guidelines and recommendations for resources allocation and examined their position toward persons with disabilities. Based on our findings, we propose criteria for not discriminating against people with disabilities in allocating resources. The shift from person-centred to community-centred medicine offers opportunities but also risks sacrificing the most vulnerable people. The principle of reasonable accommodation must always be considered to guarantee the rights of persons with disabilities.

Evaluation of AI-Assisted Telemedicine Service Using a Mobile Pet Application

This study indirectly verifies the possibility of telemedicine for humans through a mobile application (app) targeting pets. It examined the perception of telemedicine services and the current status of the companion animal industry, the app platform, and its applied technology by industry domain, and four representative types of artificial intelligence (AI) technologies applicable in the medical field. A survey was conducted through an app implementing pet telemedicine, and hypotheses were established and statistically tested based on the adoption period of pets, health status, mobile service utilization (as an index measuring the ease of use of recent AI functions), and positive and negative perceptions of telemedicine services. As revealed by prospect theory, users with a negative perception of pet telemedicine tended to maintain negative perceptions about telemedicine for humans. This study proved that the severity of pet diseases and the ease of use of recent AI technologies act as a moderating effect on the perception of telemedicine services through the verification of reinforcement and additional hypotheses. It suggests a plan to overcome sanctions against telemedicine by utilizing AI technology. A positive effect on changing the medical paradigm to telemedicine and the improvement of the medical legal system were also observed.

PARADIGM SHIFT IN MEDICINE: FROM RESTITUTION OF HUMAN HEALTH TO MANIPULATION

Rapidly developing as an applied field of natural scientific knowledge, medicine is becoming an invasive and purely technical medical activity that is no longer aimed at ensuring and maintaining normal human health, but at intervention in it in order to manage it. It has been shown that the introduction of advances in medical science and technology has contributed to a change in the structure of pathologies and to the unfolding of the phenomenon of the floating border between the norm and pathology of the human body. In the developing conditions classical object-oriented medical paradigm is no longer single and universal, and the approach to medical care delivery based on it is no longer effective. The new paradigm, which is being developed in science and social practices, allows for the subjectivisation of disease and treatment phenomena in medicine and the expansion of these phenomena from a social, ethical and anthropologi-cal perspective. The need for a subject-oriented approach that involves the patient in the treatment process is discussed.

When body makes its presence felt: Somatic-informed movement practice as an integral part of the hospital care team

This article addresses the nature of somatic-informed movement practice (SIMP1) taking place in hospitals as a participatory art form. It focuses on the data from a report that collates the scope of practice, working patterns and procedures of somatic-informed movement practitioners in the United Kingdom (Collinson and Herd 2020), specifically the views of the six practitioners interviewed. The article first identifies key principles and values underpinning SIMP, exploring ways in which it might support people with illness. This is followed by a description of the aims and function of the report and data which enables us to see how SIMP cultivates embodied relational awareness through a ‘co-creative’ process, and concludes by addressing why creativity and presence can support people who may have lost trust and connection with their bodies through illness. The article acknowledges the challenge of placing embodied arts practice (such as SIMP) in a medical paradigm and includes recommendations for ways forward.