1,720,972 research outputs found
Managing a good death in critical care: can health policy help?
No full textAim: This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy.Background and context: EoLC is an important international critical care issue, and currently provides a key focus for health care policy in the UK. While society holds that critical care is delivered in a highly technical area with a strong focus on cure and recovery, mortality rates in this speciality remain at approximately 20%. When patient recovery is not an outcome, discussions with patient, family and extended care teams turn towards futility of treatment and end-of-life management. However, there arespecific barriers to overcome in EoLC for the critically ill.Conclusion: A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose
Conflict rationalisation: how family members cope with a diagnosis of brain stem death
No full textBrain death, whether it be brain stem death in the UK, or whole-brain death in the USA, is a prerequisite for heart beating organ donation. Understanding how brain death is perceived by family members approached about organ donation, its significance to them, and if it is accepted by them, are, therefore, important issues to explore as biomedicine expands the range of end of life technologies that blur the demarcation between life and death. To explore the concept of brain stem death and its meaning to family members the following research questions were posed: (i) what does the diagnosis of death based on brain stem testing mean to bereaved family members who have been approached and asked to consider a donation from a deceased relative, and (ii) how do family members understand the concept of brain stem death? To address these research questions, a secondary analysis of 28 interviews sorted from two primary datasets was carried out. The primary datasets contained longitudinal and crosssectional interviews carried out in the UK with family members who had been approached about organ donation and agreed to donate their relatives’ organs. Data analysis was guided by constructionist grounded theory method and resulted in the theory of Paradoxical Death. In this process, family members and health professionals engage in a series of practical and psychological activities aimed at rationalising real or potential emotional and cognitive conflict resulting from a brain-based diagnosis of death, whilst faced with the physical image of a functioning body. Rationalising emotional and cognitive conflict is how family members and health professionals appeared to process this paradoxical death, a death that is contrary to conventional opinion
Information sharing: its impact on donor and nondonor families' experiences in the hospital
No full textObjective: To illustrate the methods used to convey complicated information regarding the critical injury, and death diagnosed by means of brainstem testing, to the next of kin of potential organ donors.Design: 3 year, prospective, longitudinal study.
Participants and Setting: Forty-three family members who chose to donate their deceased relatives’ organs were recruited via 4 transplant coordinating centres, and 3 family members who chose not to donate were recruited via 1 intensive care unit.Method: Face-to-face qualitative interviews were carried out with 46 family members of 43 individuals who died between June and December 2000. Family members who agreed to donation were interviewed during and after their next of kin’s admission to hospital and 3 to 5 months, 13 to 15 months, and 18 to 26 months after bereavement. Three participants who chose not to donate were interviewed on 1 occasion only. Interviews were audio-recorded, and the transcribed reports were analyzed using a comparative, thematic approach focusing on the detection of similarities and differences between cases.Results: Participants who were offered verbal information supported by complementary methods of communication had (1) a greater understanding of the critical injury sustained by their next of kin, and (2) fewer questions over time regarding brainstem testing.Conclusion: Better methods of communicating complicated information are needed, as the sheer load of information shared makes demands of next of kin at a time when they are cognitively and emotionally poorly equipped to respond
Why relatives do not donate organs for transplants: 'sacrifice' or 'gift of life'?
No full textAim. This paper is a report of a study to explore the reasons family members declined organ donation from a deceased relative.Background. In the United Kingdom family members’ consent is usually sought before organ donation from their deceased relative can proceed. Knowledge of the concerns that may influence families’ decision-making could be helpful to nurses supporting bereaved family members.Method. A convenience sample of 26 family members, who declined donation of their deceased relatives’ (n = 23) organs, were recruited via three media campaigns in large conurbations and from four intensive care units in the United Kingdom. Data were collected in 2005 using interviews.Findings. Donation decisions depended on a number of converging factors in a particular situation and not necessarily on the views of relatives about donation, or the reported wishes of the deceased in life, except if the person had stated that they did not wish to be an organ donor. Therefore, reported pro-donation views held by the family, or the deceased in life, did not guarantee donation. Protecting the dead body, which related to keeping the body whole and intact was the most frequently-recurring theme, being reported in 15 interviews.Conclusion. Families’ wishes to protect the dead body may stimulate tension between the notions of ‘gift of life’ as supported by transplant policy and ‘sacrifice’ of the body, which must be made if organ donation is to proceed. This could account for the decision of participants to decline donation even if their deceased relative previously held positive views about organ donation
What does a diagnosis of brain death mean to family members approached about organ donation? A review of the literature
No full textBackground - What a diagnosis of brain stem death (the term used in the United Kingdom) or brain death (the term used in the United States) means to the family members of potential organ donors is an important issue to explore as biomedicine moves to expand the range of end-of-life technologies that, potentially, blur the demarcation between life and death.Objective - To provide some insights into how a diagnosis of brain stem death or brain death may be perceived by family members approached about organ donation.Methods - A review of the literature regarding organ donation was carried out.Results - Although most publications do not focus specifically on the concept of brain death, those that do so made a valuable contribution, offering potential theoretical frameworks to aid our understanding of what the diagnosis of death by brain-based criteria means to family members of potential organ donors. The diagnosis of brain death is intricately linked to the issue of organ donation and may influence family members' decision making. Also, the perception that death has occurred differs from one person to another.Conclusions - A sustained increase in the number of organs available for transplantation may never be achieved until the concepts of brain death, brain stem death, and now non-heart beating death (1) are debated more widely within society; (2) a greater degree of consensus is reached within health care; and (3) bereaved family members approached to donate the organs of their deceased relative have a better understanding of what these diagnoses mean
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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