Family caregiver descriptions of stopping chemotherapy and end-of-life transitions.

PURPOSE: The purpose of this study was to describe family caregivers' perspectives of the final month of life of patients with advanced cancer, particularly whether and how chemotherapy was discontinued and the effect of clinical decision-making on family caregivers' perceptions of the patient's experience of care at the end of life (EOL). METHODS: Qualitative descriptive design using semi-structured interviews collected from 92 family caregivers of patients with end-stage cancer enrolled in a randomized clinical trial. We used a phased approach to data analysis including open coding, focused coding, and within and across analyses. RESULTS: We identified three patterns of transitions characterizing the shift away from active cancer treatment: (1) "We Pretty Much Knew," characterized by explicit discussions about EOL care, seemingly shared understanding about prognosis and seamless transitions from disease-oriented treatment to comfort-oriented care, (2) "Beating the Odds," characterized by explicit discussions about disease-directed treatment and EOL care options, but no shared understanding about prognosis and often chaotic transitions to EOL care, and (3) "Left to Die," characterized by no recall of EOL discussions with transitions to EOL occurring in crisis. CONCLUSIONS: As communication and palliative care interventions continue to develop to improve care for patients with advanced cancer, it is imperative that we take into account the different patterns of transition and their unique patient and caregiver needs near the end of life. Our findings reveal considerable, and potentially unwarranted, variation in transitions from active treatment to death.

Survey of disbudding practice on Czech dairy farms.

Disbudding is a routine practice in many dairy herds due to the effort to decrease the risk of injuries. Although the disbudding practice is regulated, it can vary among farms. The variation may be caused by many factors, such as herd size or type of breed, but also by farmers' perception of pain caused by disbudding. Hence, the aim of this study was to specify the disbudding practice on dairy farms in the Czech Republic and to assess these practices, including the use of pain mitigation medication, by breed, herd size, and sex of the disbudded calves. We analyzed data from 106 Czech dairy farms, which were collected by a trained interviewer at dairy meetings in 2014-2015. The farmers answered questions regarding the farm's basic characteristics, disbudding practice, and his/her attitude to the pain caused by disbudding. To test the influence of breed, herd size, and sex of disbudded calves on different variables, logistic regression models were used. Disbudding was performed in 92.5% of the surveyed farms; 63.3% of dairy calves were disbudded before 4 wk of age, and Czech Fleckvieh calves were 2.8 times more likely to be disbudded before 4 wk of age than Holstein calves. The hot-iron method was the most used method (69.4%). Calves were 4.5 times more likely to be disbudded by hot iron in herds where both heifers and bulls were disbudded than in herds where only heifers were disbudded. Most (>90%) surveyed farms did not use any pre- or post-procedure medication to mitigate the pain caused by disbudding. The disbudding procedure was performed mainly by farm personnel (94.9%), who were trained by a veterinarian or veterinary technician (46.9%) or by other farm personnel (37.8%) or were not trained (15.3%). Two-thirds of farmers observed behavioral changes in calves after disbudding. Most farmers estimated the pain caused by disbudding to be mild or moderate (20.4 or 45.9%, respectively) and 15.3% of farmers estimated it to be severe. Almost a quarter of interviewed farmers were unable to assess the duration of pain, 39.8% farmers estimated that the pain lasts only several minutes, and 20.4% estimated that the pain lasts up to 6 h. We detected a tendency that farmers of larger herds estimated pain duration to be shorter (odds ratio = 1.2). To improve calves' welfare, training is needed in disbudding practice, focusing on the advantage of pain mitigation.

Survey of preweaning dairy calf-rearing practices in Czech dairy herds.

It is important to describe weaknesses in rearing calves not only to improve their welfare, but also to detect areas where current scientific knowledge is poorly integrated into practice. A survey of preweaning calf-rearing practices was conducted using a farmer questionnaire. The survey included 136 farms, representing 11.9% of all dairy cows in the Czech Republic. Mean herd size (± standard deviation) was 326 ± 131.4 cows, and mean milk production 7,413 ± 1,389.5 kg per cow per year. We evaluated 59 farms with Holsteins (H) and 77 with the Czech Fleckvieh breed (C). The survey revealed that (1) calving in group pens predominated (67.6% of farms); (2) no disinfection of calf navels occurred on 11.8% of herds; (3) pooled colostrum was fed on 15.4% of farms; (4) colostrum quality was controlled on only 44.1% of farms, and only 73.5% of farms had reserve colostrum stocks; (5) nonmarket waste milk was fed in 64.7% of herds but it was pasteurized in only in 6.8% of herds and acidified in 35.2% of herds; (6) milk replacer was mixed with nonmarket waste milk on 52.9% of farms; (7) 58.8% of farms enabled calves to obtain milk by sucking and 41.2% by drinking from a bucket; (8) the main criterion in weaning was calf age (61.7%), followed by acceptance of starter and concentrated feed (19.9%) and lack of housing capacity (18.4%); and (9) newborn calves were individually housed on 96.7% of farms and group-housed on 3.3% of farms. The most marked differences in calf-rearing management between Holstein and Czech Fleckvieh farms were (1) a higher proportion of operations calving in tie-stalls or stanchions in C (6.5%) versus H (1.7%) farms; (2) a higher proportion of untreated navels on C (15.6%) versus H (6.8%) farms; (3) a lower proportion of C (11.7%) versus H (20.4%) farms feeding pooled colostrum; (4) a lower proportion of C (39%) versus H (50.9%) farms monitoring colostrum quality; (5) sucking milk from nipple buckets predominated (61%) on C farms, whereas drinking from an open bucket was most common (64.4%) on H farms; (6) age was the main criterion in weaning calves of both breeds (C farms: 55.8%, H farms: 69.5%), whereas the second most important criterion was lack of housing capacity (28.6% of farms) on C farms and the amount of consumed starter (25.4%) on H farms. We observed a difference in duration of colostrum period between C herds (median 5d) and H herds (median 4d). A tendency was observed for age of calves at weaning (C herds: median at 9.1 wk, H herds: median at 10 wk).

[Biographical work in inpatient long-term care for people with dementia: potential of the DEMIAN nursing concept]. / Biographiearbeit in der stationären Langzeitpflege von Menschen mit Demenz: Potenziale des DEMIAN-Pflegekonzepts.

In nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.

Meibomian gland status comparison between active duty personnel and U.S. veterans.

PURPOSE: To evaluate the lid and meibomian gland status of active duty forces (ADF) and U.S. veterans (USV) to compare the prevalence of lid dysfunction and disease in each population. METHODS: One examiner observed 113 consecutive patients in both groups during a 2-week period at two federal service optometry clinics. All eyes were graded with regard to negative findings (or normal), meibomian gland dysfunction (MGD), and/or meibomitis from an established criterion. RESULTS: 90.3% of ADF had normal lid findings, 5.3% of ADF had MGD (all contact lens patients), and 4.4% of ADF had meibomitis; 28.9% of USV had normal findings, and 71.1% of USV had MGD or meibomitis (no patients wore contact lenses). CONCLUSION: Our findings reveal that a definite difference exists between ADF personnel and USV in eyelid physiology and pathophysiology. This difference should be noted by the clinician who evaluates such patients. This will affect the differential diagnosis of ocular symptomatology in the contact lens and non-contact lens patient.

Meibomian gland status and prevalence of giant papillary conjunctivitis in contact lens wearers.

PURPOSE: The purpose of this study was to determine the clinical prevalence of Meibomian gland dysfunction (MGD) and giant papillary conjunctivitis (GPC) in an active contact lens wearing population. METHODS: One examiner observed 105 consecutive adapted contact lens patients over a 3-month period at a stateside USAF Regional Hospital Optometry Clinic. All eyes were graded for MGD and for GPC as described in the literature. RESULTS: Twenty-three patients were identified as having MGD. No patients had Meibomianitis and no patients in the study had GPC. CONCLUSION: Although a relationship between MGD and GPC has found its way into the ophthalmic literature, this study population reveals no relationship existent between these conditions in healthy and successful contact lens-wearing patients.

High mutagenic activity of 3-azido-1,2-propanediol (azidoglycerol, AG) in strain D7 of Saccharomyces cerevisiae.

3-Azido-1,2-propanediol (azidoglycerol, AG) showed a high mutagenicity in strain D7 of Saccharomyces cerevisiae. At 5 mM it increased the spontaneous frequency of isoleucine revertants 3500 times and the frequency of gene convertants 3000 times during 24 h of growth, reducing the growth rate to 30%. In non-growth conditions, treatment with 150 mM of AG for 3 h reduced cell survival to 60% and enhanced the frequency of isoleucine revertants 490 times and tryptophan-independent convertants 50 times. At equal survival levels, AG was found to be 3000-fold more mutagenic and 200-fold more convertogenic than sodium azide.