Cardiac arrest is a common cause of coma with frequent poor outcomes. Palliative medicine teams are often called upon to discuss the scope of treatment and future care in cases of anoxic brain injury. Understanding prognostic tools in this setting would help medical teams communicate more effectively with patients’ families and caregivers and may promote improved quality of life overall. This article reviews multiple tools that are useful in determining outcomes in the setting of postarrest anoxic brain injury.

The outcome of 121 children who underwent palliative cardiac surgery at the Red Cross War Memorial Children's Hospital over a 5 year period, 1980 1984, was retrospectively examined. 79 children had systemic artery to pulmonary artery shunt operations (SPS), 40 had pulmonary artery bands (PAB) and 2 had surgical septectomies. SPS was most often done for children with Tetralogy of Fallot (TOF, 26 cases) or complex univentricular hearts with right ventricular outflow tract obstruction (27 cases). PAB was done chiefly for ventricular septa! defects, alone (VSD, 8 cases) or with coarctation of the aorta (9 cases). Children were referred from a wide area with 63 cases being referred from other major centres and foreign countries. Overall, 36 children died (30 % mortality): 5 died at surgery, 6 within 48 hours of surgery, a further 5 within 31 days; and 20 died after 31 days. SPS and PAB had the same early mortality rates ( 13 % ) • SPS had higher late and overall mortality rates (20 and 33 %) than PAB (10 and 23 %). Age at operation was found to be the most significant determinant of the overall mortality rate: children less than six months had a mortality of 42 % and those over 6 months, 13 % • The children were grouped into those with lesions which were probably correctable and those that were unlikely to be so, based on diagnosis and age at surgery: those with correctable lesions had a lower overall mortality (22 %) than those with uncorrectable lesions (43 %). Where the surgery was performed as an emergency, there was a higher overall and early mortality (55 and 35 respectively), compared to those operations which were performed electively ( 25 and 9 % ) • The presence of other medical conditions, for example congenital abnormalities and infections, was also a determinant of death (44 % mortality if other medical condition present, 26 % if absent). sex, population group, home address and type of surgery performed did not significantly affect mortality when examined by multivariate analysis. Using routine methods of follow up, it was initially thought that 17 % of all patients (22 % of survivors) were lost to follow up. An important determinant of this was the referral centre. 31 % of cases from other major centres and 20 % of foreign cases were lost, as compared to 8 % of cases from smaller towns near Cape Town and 2 % of children from Cape Town. Population group (35 % Blacks, 14 % Coloureds and 7 % Whites were lost), and palliative operation (23 % SPS, and 5 % PAB lost) were also significant determinants. It was possible to trace 12 of the 20 children who were thought to be lost to follow. 8 had died, 3 were still awaiting correction and 1 was traced and received corrective surgery. The records of the children who underwent cardiac surgery in 1987 were also analysed. There was no difference in the demographic characteristics of either group, and the early mortality was the same. This study shows that the outcome after palliative cardiac surgery is poor, with a high mortality rate and children often being lost to follow up. The decision to palliate rather than to correct a congenital heart defect must be made after balancing these risks with those of early correction for the particular surgical team. Should palliative surgery be undertaken, careful follow up is essential to ensure that complications of palliation do not set in and that corrective surgery is done at the optimal time.

Background: The field of perinatal palliative care aims to support the unique needs of parents who choose to continue pregnancy following the diagnosis of a life-limiting fetal condition (LLFC). As parents navigate this challenging trajectory, the support they receive from healthcare providers is crucial in shaping parental experiences. Objective: to critically reflect on existing literature and to reveal a deeper understanding of the experience of continuing pregnancy in the presence of a LLFC Design: Qualitative meta-synthesis Methods: The primary search strategy consisted of multiple searches within four electronic databases. The analysis was guided by thematic analysis. Results: This meta-synthesis included 29 qualitative studies. Three main themes were identified; time, uncertainty and relationships. These concepts exist concurrently within this trajectory and continuously influence each other as well as the overall experiences of parents. Conclusion: Nurses are encouraged to acknowledge the significance of the interconnectedness between these key concepts and to critically reflect on how their everyday interactions become part of parents’ lived experiences.

Introduktion/Bakgrund: Cancer i sen palliativ fas innebär ett stort lidande för många människor.Copingstrategier kan hjälpa patienter att minska lidande och öka livskvalitet. Sjuksköterskor har en viktiguppgift i att identifiera och stötta val av copingstrategiSyfte: Syftet med denna litteraturstudie är att undersöka copingstrategier hos patienter med cancer i senpalliativ fas.Metod: Polit och Becks nio steg användes för denna litteraturstudie. Systematisk databassökning gjordes föratt finna artiklar att basera resultat på. Deduktiv ansats som utgick från Lazarus och Folkmans teorier omcopingstrategier användes för att kategorisera resultat.Resultat: Patienterna använde sig av problemfokuserad coping för att aktivt bibehålla sin autonomi samt tainitiativ till att söka råd och stöd från vårdpersonal och närstående. Känslofokuserad coping användes för attvända situationen emotionellt till något positivt, ofta med hjälp av närstående, mindfullness eller meditering.Meningsfokuserad coping delas in i existentiell- och acceptansfokuserad coping. Dessa strategier hjälptepatienter att använda sig av sin religiösa grundsyn samt acceptera sin situation för att minska lidande.Slutsats: En stor mängd olika val av copingstrategier och upplevelser kopplade till dessa kunde identifierashos patienter med cancer i sen palliativ fas.

Neonatal palliative care (NPC) is an emerging subset of care in United States (US) neonatal intensive care units (NICUs) that provides relief for both infants and families at the end of life for infants with terminal diagnoses. Families play a large role in the decision-making process for their infant, but their experiences with and perceptions of the support and care provided to them via NPC is unclear. This literature review summarizes the state of knowledge on parents' perspectives of NPC while focusing on the specific factors that influence their experiences and satisfaction with NPC. This literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings of the literature review broadly include the importance of consistent communication with providers, parental involvement in the care process, and the minimization of infant suffering. Providers must focus on these important quality indicators to ensure they provide the best care possible to the patients and families that they serve. Further research must be done to investigate parent satisfaction and needs in relation to NPC more deeply and to develop interventions and protocols that better incorporate these needs.

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Thesis advisor: Andrea Vicini / Thesis advisor: Daniel Daly / Thesis (STL) — Boston College, 2023. / Submitted to: Boston College. School of Theology and Ministry. / Discipline: Sacred Theology.

When looking at the natural course of life, death is the natural conclusion. Majority of the time, people do not choose when and how they die. Death and dying are topics that are difficult to discuss for many individuals. However, when one decides to choose the context of their death, it raises many ethical considerations. Psychiatry, as a field, looks at the psychodynamics of death and dying for individuals. It is also poised to comment on the growing use of physician-assisted suicide and euthanasia for psychiatric disorders. Through a review of the literature, theories in psychiatry regarding the dying process are used to better understand an individual's choice for choosing euthanasia as a medical intervention to end their suffering from a long-standing psychiatric illness. The use of palliative care in conjunction with psychiatry is also explored. / Urban Bioethics

Family/friend caregivers of persons with dementia often do not feel prepared for end-of-life, which contributes to high rates of complicated grief, depression and anxiety in bereavement. This mixed methods study used an exploratory sequential design to explore the core concepts and indicators of preparedness, develop and evaluate a multidimensional questionnaire aimed at measuring caregiver preparedness for end-of-life for persons with dementia. In Phase 1, a qualitative study with an interpretive descriptive design was used to explore the core concepts and indicators of preparedness with 16 bereaved family caregivers recruited from six long-term care homes located in Ontario, Canada. In Phase 2, a quantitative, cross-sectional Delphi-survey was conducted with 5 caregivers and 12 diverse professional experts to select preparedness indicators/items and develop the Caring Ahead questionnaire. Lastly in Phase 3, the self-report, paper format questionnaire was evaluated for evidence of validity and reliability using a quantitative cross-sectional design. In this final phase, the questionnaire was completed through the postal mail by 134 caregivers from over 50 long-term care homes/residential care facilities, primarily in Ontario, Canada. Evidence for internal structure and concurrent validity was generated along with reliability coefficients suggesting internal consistency and stability in a test-retest. Findings from this study contributed to the conceptualization and operationalization of preparedness and produced the new, multidimensional questionnaire titled Caring Ahead: Preparing for End-of-Life with Dementia with preliminary evidence for validity and reliability. This questionnaire aims to fill an existing gap expressed by researchers who aim to design and evaluate interventions promoting preparedness through a palliative approach. In addition, policy-makers should benefit from introduction of the Caring Ahead questionnaire as an outcome measure to monitor and evaluate the effectiveness of policies surrounding a palliative approach. / Thesis / Candidate in Philosophy / Providing care to a family member or friend with dementia can be very challenging and different than caring for persons with other disorders. Healthcare providers should provide a palliative approach to care which focuses on quality-of-life and helping family caregivers prepare for end-of-life. However, many family caregivers do not feel prepared for death and this can lead to serious mental health problems in bereavement. This thesis explores what feeling prepared for death means and describes the development and testing of a questionnaire to assess how prepared family caregivers feel for the end-of-life of someone with dementia. Through interviews and surveys with caregivers and professional experts, we developed and tested the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire. Use of the new Caring Ahead questionnaire aims to help us understand how prepared family caregivers are feeling for end-of-life and what supports are needed.

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