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Background There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs). Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. Methods Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation (PACE). Phase II evaluated the feasibility and effects of PACE, using observation, record audit, and surveys of staff and family members. Qualitative data were analyzed using the framework approach. The statistical tests used on quantitative data were t -tests (for normally distributed characteristics), the χ 2 or Fisher’s exact test (for non-normally distributed characteristics) and the Mann–Whitney U -test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded. Results PACE provides individualized assessments of all patients entering the ICU. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. Implementation is supported by a training program with specialist palliative care. A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or generally useful. Of 213 family members, 165 (78%) responded to their survey, and two-thirds had PACE completed. Those for whom PACE was completed reported significantly higher satisfaction with symptom control, and the honesty and consistency of information from staff (Mann–Whitney U -test ranged from 616 to 1247, P -values ranged from 0.041 to 0.010) compared with those who did not. Conclusions PACE is a feasible interventional tool that has the potential to improve communication, information consistency, and family perceptions of symptom control.

Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

Ending preventable newborn deaths is a top priority under the United Nations' Sustainable Development Goals for 2030. According to the World Health Organization, two-thirds of newborn deaths can be prevented with simple and affordable solutions, such as neonatal resuscitation and early skin-to-skin contact between mother and newborn. Project HOPE, in cooperation with Project HOPE Germany, supports the delivery of these life-saving interventions in Romania and Hungary through strengthening the countries' health workforces to deliver essential and emergency newborn care. Project HOPE's work in Romania and Hungary demonstrates the effectiveness of low-cost, evidence-based interventions in improving newborn health outcomes. Investing in the development of a skilled health workforce can be the means of saving countless newborns during their riskiest time of life.

ObjectivesTo understand healthcare professionals’ perceptions of the benefits and potential harms of integrated care pathways for end-of-life care, to inform the development of future interventions that aim to improve care of the dying.DesignQualitative interview study with maximum variation sampling and thematic analysis.Participants25 healthcare professionals, including doctors, nurses and allied health professionals, interviewed in 2009.SettingA 950-bed South London teaching hospital.Results4 main themes emerged, each including 2 subthemes. Participants were divided between (1) those who described mainly the benefits of integrated care pathways, and (2) those who talked about potential harms. Benefits focused on processes of care, for example, clearer, consistent and comprehensive actions. The recipients of these benefits were staff members themselves, particularly juniors. For others, this perceived clarity was interpreted as of potential harm to patients, where over-reliance on paperwork lead to prescriptive, less thoughtful care, and an absolution from decision-making. Independent of their effects on patient care, integrated care pathways for dying had (3) a symbolic value: they legitimised death as a potential outcome and were used as a signal that the focus of care had changed. However, (4) a weak infrastructure, including scanty education and training in end-of-life care and a poor evidence base, that appeared to undermine the foundations on which the Liverpool Care Pathway was built.ConclusionsThe potential harms of integrated care pathways for the dying identified in this study were reminiscent of criticisms subsequently published by the Neuberger review. These data highlight: (1) the importance of collecting, reporting and using qualitative data when developing and evaluating complex interventions; (2) that comprehensive education and training in palliative care is critical for the success of any new intervention; (3) the need for future interventions to be grounded in patient-centred outcomes, not just processes of care.

Teams included a mix of child welfare and teen pregnancy prevention professionals and were selected through a competitive application process. Since February 2012, teams from Alameda County (California), Hawaii, Minnesota, North Carolina, and Rhode Island have been working to implement the adapted program with youth in their care. Since their selection, the participating teams have attended four meetings to be trained in organizational effectiveness and change management strategies.

Delay discounting (DD) is the choice of a smaller immediate reward over a larger delayed reward, which has been associated with a number of maladaptive behaviors. Episodic future thinking (EFT), the ability to project oneself into the future, is an intervention designed to reduce DD. EFT has reliable effects on DD, but the size of the effect varies, which could be due in part to the use of different control groups. Episodic recent thinking (ERT) serves as a common control for many EFT studies, but the temporal window of \"recent\" cues ranges from 24 hours ago to 12 days past. Since prior research has shown that retrospection can lead to prospection, it may be important to ensure that EFT controls do not inadvertently lead to prospection for some participants thereby increasing the variability of the control condition. The present study sought to develop a comparison group that standardizes the time frame and experiences that are the basis for the recent thinking control. Participants (n = 53, 18-45) were randomized to one of three conditions: EFT, ERT, or standardized episodic thinking (SET). Participants attended a laboratory appointment where they played mobile application games, created cues, and completed a DD task. There was a significant difference between groups (p<0.05), with EFT reducing discounting more than either control (p<0.05), and no differences between ERT and SET (p>0.05). This study established that SET provides an alternative control in EFT studies and provides the advantage of standardizing the participant's recent experience without changing the relationship between EFT and recent thinking controls.

\"I'm not only getting an education for myself, but I'm doing it for my family as well,\" Nolte said. \"It not only increases the well-being of my family, but I want to be an example for my three kids, of the importance of going to school.\" \"It's nice that they get to see where mom and dad are during the week,\" [Bryan Eldredge] said. \"Whatever we do, it's implicit, but always expected that you bring whoever you like.\" \"We always hope that we'll maintain the most family-friendly ranking,\" said Craig Merrill, director of the BYU Marriott School of Management MBA program. \"The students in our program work really hard to make sure that's the case.\"

Lack of diversity in IDD research is typically conceptualized only in terms of (1) recruitment of samples that do not appropriately represent the sociodemographics of the population, or (2) the limited number of researchers from historically marginalized backgrounds. Critically, the field also suffers from over-reliance on perspectives and social systems of dominant culture—both in how disability is regarded and in relation to other dimensions of identity and culture. These lenses lead to research findings that reinforce, rather than reduce, social inequities. We propose a framework that minimizes reliance on diagnostic categories, shifts from deficit- to person-centered models, acknowledges people’s multiple identities, and includes self-advocates and diverse communities as partners in the research enterprise. The systems change necessary to support this framework is described.