Home or hospital as the place of end-of-life care and death: A grounded theory study of parents' decision-making.

BACKGROUND: While several studies have examined 'what' families want with regard to the place of a child's end-of-life care and death, few have explored 'how' parents reach a decision. AIMS: (1) to develop a model explaining how parents of a child with a life-threatening illness in Greece decide about the place of end-of-life care and death; (2) to identify the factors affecting decision-making; (3) to consider the implications for clinical practice. DESIGN: Grounded theory study of bereaved parents using semi-structured open-ended interviews following Strauss and Corbin's principles of data collection and analysis. SETTING/PARTICIPANTS: Semi-structured interviews with 36 bereaved parents of 22 children who died at home (n = 9) or in a paediatric hospital (n = 13) in Athens, Greece. RESULTS: (1) Decisions regarding place of care and death were reached in one of four ways: consensus, accommodation, imposition of professional decisions on parents or imposition of parents' decisions without including professionals. (2) Six factors were identified as affecting decisions: awareness of dying, perceived parental caregiving competence, perceived professional competence, parents' view of symptom management, timing of decision-making, and being a 'good parent'. (3) Decisions were clear-cut or shifting. Few parents did not engage in decisions. CONCLUSION: Parents' decisions about place of end-of-life care and death are affected by personal, interpersonal, timing and disease-related factors. Parents are best supported in decision-making when information is presented clearly and honestly with recognition of what acting as 'good parents' means to them, and opportunities to enhance their caregiving competence to care for their child at home, if they choose so.

The Parieto-Occipital Artery Revisited: A Microsurgical Anatomic Study.

BACKGROUND: The parieto-occipital artery (PoA) is the terminal posterior cerebral artery branch, which typically runs in the parieto-occipital sulcus. Previous studies have highlighted variation in the PoA origin and branching pattern and their clinical implications. Nevertheless, PoA anastomoses have not been systematically investigated. The present study aimed to assess whether putative variation in PoA origin and its branching as well as anastomotic pattern is associated with differences in demographic/anthropometric variables. METHODS: In 15 cadaveric heads, PoA anatomic features were quantified and assessed in relation to demographic/anthropometric variables. RESULTS: The mean distance of PoA origin from the posterior limit of the splenium and the occipital pole (OP) is 3.1 and 53.1 mm, respectively. The latter is significantly longer in taller individuals. The PoA supplies a mean of 10.5 and 9.1 branches to the precuneus and cuneus, respectively. PoA anastomoses primarily involve the precuneal artery complex (PAc) and the calcarine artery. The analysis indicated significant, positive correlations between the distance of PoA origin from the OP and the number of PoA anastomoses and between the number of PoA precuneal and cuneal branches. CONCLUSIONS: Although the PoA invariably supplies the precuneus and almost always the cuneus, its direct contribution to the former seems inferior to PAc. Nevertheless, the PoA frequently shows putative collateral supply networks to the precuneus and cuneus via anastomoses with the PAc and calcarine artery, respectively. The distance between PoA origin and OP varies with an individual's height; the frequency of intrahemispheric PoA anastomoses varies with its site of origin.

Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new: technical note and preliminary results.

AIM: Conventional ventricular catheters have proven to be ineffective in the drainage of the cerebrospinal fluid in the long run in terms of infection rates. Consequently, the development and clinical evaluation of new catheters is urgently needed. MATERIAL AND METHODS: We implanted a ventricular needle made of stainless steel in 3 neurosurgical patients in whom multiple conventional (silicon) ventricular catheters had been previously implanted. All of them developed persistent ventriculitis during the first 30 days post-admission. The infection did not respond to antibiotics neither intravenously nor intrathecally via conventional catheters. After the implantation of the needle, colistin mesilate sodium was administered (150,000 IU/day for 21 days) intrathecally, cerebrospinal fluid white blood cells were measured and cerebrospinal fluid cultures were obtained. RESULTS: Within 15 days after the implantation of the metal catheter, a significant decrease of the cerebrospinal fluid white blood cell count was noted and all cultures were negative. No operation related complications were observed. CONCLUSION: Our technique of a metal catheter implantation is safe and requires fewer reoperations. Moreover, it is cost-effective since metal catheters can be used for longer periods of time, can be reused in other patients, and are of low cost.

Attachment of Pseudomonas putida onto differently structured kaolinite minerals: a combined ATR-FTIR and 1H NMR study.

The attachment of Pseudomonas (P.) putida onto well (KGa-1) and poorly (KGa-2) crystallized kaolinite was investigated in this study. Batch experiments were carried out to determine the attachment isotherms of P. putida onto both types of kaolinite particles. The attachment process of P. putida onto KGa-1 and KGa-2 was adequately described by a Langmuir isotherm. Attenuated Total Reflection Fourier Transform Infrared Spectroscopy and Nuclear Magnetic Resonance were employed to study the attachment mechanisms of P. putida. Experimental results indicated that KGa-2 presented higher affinity and attachment capacity than KGa-1. It was shown that electrostatic interactions and clay mineral structural disorders can influence the attachment capacity of clay mineral particles.

Rapid magnetic heating treatment by highly charged maghemite nanoparticles on Wistar rats exocranial glioma tumors at microliter volume.

One of the most significant challenges implementing colloidal magnetic nanoparticles in medicine is the efficient heating of microliter quantities by applying a low frequency alternating magnetic field. The ultimate goal is to accomplish nonsurgically the treatment of millimeter size tumors. Here, we demonstrate the synthesis, characterization, and the in vitro as well as in vivo efficiency of a dextran coated maghemite (gamma-Fe(2)O(3)) ferrofluid with an exceptional response to magnetic heating. The difference to previous synthetic attempts is the high charge of the dextran coating, which according to our study maintains the colloidal stability and good dispersion of the ferrofluid during the magnetic heating stage. Specifically, in vitro 2 mul of the ferrofluid gives an outstanding temperature rise of 33 degrees C within 10 min, while in vivo treatment, by infusing 150 mul of the ferrofluid in animal model (rat) glioma tumors, causes an impressive cancer tissue dissolution.

Observations of coarsening of air voids in a polymer-highly-soluble crystalline matrix during dissolution.

A combination of magnetic resonance imaging and x-ray microcomputed tomography has been used to visualize the development of the internal micro-structure within compressed tablets made from a combination of insoluble particles (Eudragit, a polymer) and soluble particles (diltiazem hydrochloride, a drug), during dissolution in water. Air voids in the tablet are seen to coarsen. The size distribution of the air voids is well fitted by a log-normal distribution with a mean size that grows linearly with time. There is evidence for both diffusion of voids and sudden collapse of individual voids, presumably as they coalesce. The behavior of the voids is studied and compared with models of coarsening; the implications for tablet dissolution are considered.