Background. The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. Purpose. To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic. Methods. A retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the over 280-item interRAI PC instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14th, 2019 to March 16th, 2020) and COVID cohort (March 17th, 2020 to May 18th, 2021). A propensity score analysis was used to match on 21 covariates, resulting in a sample size of 2479 unique interRAI PC assessments per cohort. Alternative propensity score methods were explored as part of a sensitivity analysis. Results. After matching the pre-COVID and COVID cohorts (using nearest neighbour matching), five of the 16 QIs had statistically-significant differences in the QI rates. The two alternative propensity score methods produced slightly different results with fewer statistically-significant differences between the cohorts. However, in examining the effect sizes, the results of all propensity score methods were found to be not clinically meaningful. High rates of the prevalence of shortness of breath with activity, no advance directives, and fatigue were observed in both cohorts and across all three propensity score methods. Discussion. This study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. Key limitations in interpreting the results include a limited understanding of the typical variation in QI rates over time and reliance on the comparison of a single proportion (the QI) in judging potential differences in quality. Importantly, a strength of this study was that these QIs focused on outcomes of care and were mainly symptom-focused as aspects of high-quality care valued by home care clients and families and in contrast to previous studies focusing on structure and processes of care. These QIs also indicated how frequently quality concerns may be occurring for those receiving palliative and end-of-life home care. Conclusion. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries and in creating benchmarks to project acceptable rates of different QIs. / Thesis / Master of Science in Nursing (MSN)

Background: Palliative care aims to improve the quality of life for patients with limited time remaining. In the transition to end-of-life care, the complete focus is on relieving symptoms and easing the patient's pain. It has emerged that patients experience inadequate communication from nurses during their hospital stay, while nurses perceive insufficient knowledge regarding conversations with relatives. Engaging with relatives' experiences at the end of life contributes to a greater understanding of their preferred approach. Aim: To create an overview of relatives' experiences in palliative care. Method: Involves a general literature review that included eight qualitative and four quantitative articles. Results: The articles results pointed to three main themes: the importance of communication for relatives, the impact of the care environment on their palliative care experience, and how the illness affected life outside of caregiving. Conclusion: Insufficient support and communication were crucial factors in relatives the end-of-life experiences. Positive health outcomes were observed in relatives receiving support, information, and discussions in the end-of-life stage. Relatives experienced that the attitude of nurses, influenced their well-being, leading to difficulties in balancing everyday life while maintaining strength in front of the patient.

This dissertation examines the relationship among practices and policies of waste/ing and economic structures to make visible the implications of vehicle disposal policies for environmental policy and theory. Consequently, I attempt to build upon the small body of literature that is now critically engaging with waste production and resulting actions/inaction in the form of policies of management. In doing this I use waste as a lens to examine the interrelationships among environmental degradation and economic and political structures. Further, I examine these phenomena in relation to a physical object, the automobile, to add materiality to abstract notions of waste as it relates to both the political and the economic. Through vehicle recycling policies, I analyze how underlying economic structures in contemporary capitalism result in specific responses to the "problems" of waste as well as how the related responses, or "solutions" perpetuate an un-ecological industrial system which severely restricts the possibilities of making substantial change in the production of environmental harms. / Ph. D.

"Nothing endures but change" - Heraclitus. Buildings are designed and built to house a specific program for a set period of time. The end of a building's life marks a change in its use. In today's building practices, some building owners opt to demolish an entire building prior to constructing a new one. Unfortunately, this world-wide attitude results in the production of millions of tons of waste every year and is not an ecologically sustainable practice. However, as green building methods become more valued in today's society, building owners and designers are becoming more conscious of buildings' end lives. Construction methods are increasingly involving concepts of designing for disassembly, wherein parts and materials can be easily taken apart for reuse or recycling. Such practices are vital in minimizing the unnecessary production of construction waste. Everything on earth exhibits change. This thesis explores the development of a newly constructed building and its transformation at the end of its life into a new building. The project consists of two designs; the program of the first was predetermined while the program of the second was chosen by the committee at the concluding stage of the first design. This thesis seeks to develop a position on architectural design and construction methods that acknowledges the fact that buildings are not permanent objects and that they will, at some point in time, change. / Master of Architecture

京都大学 / 新制・論文博士 / 博士(人間健康科学) / 乙第13614号 / 論人健博第14号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 古田 真里枝, 教授 宮下 美香, 教授 片岡 仁美 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

No

No / Fatigue is a complex symptom commonly experienced by people with life-limiting illnesses. It has been identified in patients with, for example, cancer, heart failure, respiratory conditions, acquired immunodeficiency syndrome and renal failure. It is often rated by patients as having a greater effect on quality of life than pain. This article will explore the manifestations and consequences of fatigue. It will propose a minimum standard for its assessment and management and describe the implementation and evaluation of an audit, conducted in a hospice environment, designed to evaluate achievement of this standard. Although this audit was carried out in a hospice setting, the aim of the article is also to raise awareness of fatigue in all healthcare settings and to improve the assessment of this debilitating symptom.

No / Depression in patients receiving palliative and end-of-life care is difficult to distinguish from grief and sadness. However, there are some important distinctions and it is a clinical condition that is treatable and should not be considered a necessary or normal part of the dying process. This article examines the nature of depression and describes the stress vulnerability model of depression, linking it to recent developments in the neurobiology of depression. It also discusses how to distinguish depression from other symptoms that patients may be experiencing.

No / This article presents a review of key issues around caring for people in the last hours and days of life. The aim is that community nurses will be able to support patients and families, and to provide and explain decisions and interventions to promote comfort and dignity based on current evidence.

No / Laura Middleton-Green, lecturer and researcher in palliative and end of life care, writes about how attitudes to death influence care of the dying.