E. van Leeuwen

Comparing end-of-life practices in different policy contexts: a scoping review

Objectives End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts. Our aim was to assess the feasibility of comparing similar end-of-life practices in different policy contexts. Methods This is a scoping review of empirical studies on medical end-of-life practices. We developed a descriptive classification of end-of-life practices that distinguishes practices according to their legal status. We focused on the intentional use of lethal drugs by physicians because of international variations in the legal status of this practice. Bibliographic database searches were supplemented by expert consultation and hand searching of reference lists. The sensitivity of the search strategy was tested using a set of 77 articles meeting our inclusion criteria. Two researchers extracted end-of-life practice definitions, study methods and available comparisons across policy contexts. Canadian decision-makers were involved to increase the policy relevance of the review. Results In sum, 329 empirical studies on the intentional use of lethal drugs by doctors were identified, including studies from 19 countries. The bibliographic search captured 98.7% of studies initially identified as meeting the inclusion criteria. Studies on the intentional use of lethal drugs were conducted in jurisdictions with permissive (62%) and restrictive policies (43%). The most common study objectives related to the frequency of end-of-life practices, determinants of practices, and doctors’ adherence to regulatory standards. Large variations in definitions and research methods were noted across studies. The use of a descriptive classification was useful to translate end-of-life practice definitions across countries. A few studies compared end-of-life practice in countries with different policies, using consistent research methods. We identified no comprehensive review of end-of-life practices across different policy contexts. Conclusions It is feasible to compare end-of-life practices in different policy contexts. A systematic review of international evidence is needed to inform public deliberations on end-of-life policies and practice.

Independent research needed to inform end-of-life policy choices

In their CMAJ editorial, Flegel and Fletcher[1][1] call for a national dialogue on end-of-life care, arguing that policy change should not be the result of a single court decision.[1][1] In Canada, different medical end-of-life practices, such as treatment withdrawal, use of medication justified by

Mechanisms and Sites of Transepithelial Ca2+ Transport in Kidney Cells

In epithelial cells, possible mechanisms involved in active transcellular Ca2+ transport are: a passive entry step at the apical membrane, diffusion through the cytoplasm, and active extrusion mechanisms located in the basolateral membrane (van Os, 1987). The latter mechanisms, i.e. Ca2+-ATPase and Na+/Ca2+ exchange, have been studied extensively in basolateral membranes from the kidney.

The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review

AIM The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD Three electronic databases, PubMed, CINAHL and EMBASE, and reference lists of included studies were searched for studies in English, Dutch or German between January 2002 and August 2015. Studies were included if they presented data about EOLC in the adult ICU, and the role of ICU nurses around EOLC. Quantitative and qualitative studies and opinion articles were extracted. Inductive content analysis was carried out to analyse and categorise the data. RESULTS Twenty studies were included. Four categories emerged: care for the ICU patient, care for the family, environmental aspects of EOLC and organisational aspects of EOLC. Regarding the care triad, a gap exists between theoretical models and the actual care provided by ICU nurses during EOLC. The relational aspect of care, like aimed with care triad, is absent. CONCLUSION The literature clearly indicates that the role of ICU nurses concerns care for the patient, family and environment. It described which care should be given, but it remains unclear how care should be given (attitude). Therefore, it is difficult for ICU nurses to provide this care. Further, it seems that care provided to family mainly consists of giving advice on how to care for the patient; care for family members themselves was only mentioned in a few studies. Therefore, it seems that family does not always receive adequate care yet, which may be helpful in preventing problems like depression, anxiety or post-traumatic stress disorder. It can be concluded that it is important for ICU nurses to be aware of the existing relationships; however, comparing the literature, care triad does not appear to be reached.

Clinical guidelines may need ethical component.

The AGREE collaboration has introduced a new research-based version of its instrument to assess the quality of clinical guidelines and the reporting of the underlying development process. [1][1],[2][2] This version maintains the same six quality-defining domains that underpinned the original AGREE

Within and beyond the communal turn to informed consent in industry-sponsored pharmacogenetics research: merits and challenges of community advisory boards

The one-size-fits-all paradigm of drug development fails to address inter-individual variability in drug response. Pharmacogenetics research aims at studying the role of genotypic differences in drug response. Recently, the pharmaceutical industry has shown interest to embed pharmacogenetics studies in the process of drug development. Nevertheless, population-based and commercial aspects of such future-oriented studies pose challenges for individually based informed consent (IC). As an exemplar of the communal turn to IC procedures, community advisory boards (CABs) have been integrated into different types of medical research. CABs hold the promise of organizing the relationship between participants and researchers in a more reciprocal and participatory way, offering possible means of overcoming the lapses of individualistic IC. However, the involvement of CABs with pharmacogenetics research might be rife with difficulties, uncertainties, and challenges. The current study first reviews the existing literature to discuss added values and challenges of relying on CABs as a supplement to individually based IC. Then, the particular moral and regulatory landscape of pharmacogenetics research will be delineated to argue that community engagement is both necessary and promising beyond the communal turn to IC processes. Three main features of the landscape include (1) new supportive stances that some regulatory bodies have adopted toward pharmacogenetics research, (2) the motivation of the industry to draw reception and trust from the subpopulations, and (3) the important role of the society in generating and embedding pharmacogenetics knowledge. Finally, some points to consider will be discussed to contextualize relying on CABs within this landscape.

Phosphor-covered junction CCD x-ray sensor for dental imaging

X-ray imaging devices for dental applications must have an image area of at least 3 X 4 cm2. MOS CCDs cover an area of about only 1.5 X 2.5 cm2, in this case the x-ray image should be reduced to these smaller dimensions. This can be realized by tapered optical fibers after the x-radiation has been converted into light. This procedure results in a rather bulky construction. Junction CCDs can be realized in the desired image area of 3 X 4 cm2, thus making the taper construction unnecessary. Experiments on a linear array Junction CCD covered with a phosphorescent layer have been carried out. These experiments show, that only 3.2 mR for one exposure is needed. This results in a very low radiation load for the patient. The radiation load for the sensor itself is very low too, which makes a high number of exposure possible during the lifetime of the device.

Junction CCD-based x-ray sensor for dental applications

Charge-Coupled Devices are used as x-ray sensors. For dental purposes it is important to have an image area of roughly 3 X 4 cm2. In case of direct imaging with an MOS Charge-Coupled Device one is restricted to image areas of about 1.5 X 2.5 cm2. The reason for this is that in commercially available CCDs one aims at getting a high spatial resolution on a small area. This article will show, that Junction Charge-Coupled Devices do not have this restriction, which makes these devices perfectly suited for dental purposes.