This study examines the importance of relevance criteria in end-user evaluation of valuable or high relevant information.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Background: The End of Life Care Strategy stated that there should be a reduction of expected deaths in the acute setting. In order to achieve this goal, when it has been identified that where the patient's preferred place of care is home, clinicians need to be able to recognise when a patient is dying in order to achieve their preferred place of death. The aims of this study were to identify any factors that help or hinder a clinician when they are determining when irreversible dying begins and to seek consensus on which of these topics would be useful to include in an education programme. Method: A 3 stage mixed methods study was developed. Phase 1was a Systematic Review of current primary research in order to provide an evidence base for the study. Phase 2 involved unstructured interviews with clinicians in the acute setting utilising the Grounded Theory approach to the analysis identify potential factors. Phase 3 was a Delphi study used to identify which of these factors would be useful in an education programme. Conclusions: The Systematic Review identified four themes "Patient Observation", "Knowledge of the Patient", "Communication" and "Attitudes of the Clinician". These were confirmed by the interviews and a further theme "Experience" identified. The over-arching theme emerging from the findings of the interviews was that clinicians have a fear of getting the timing of the recognition of irreversible dying wrong because the decision making process is so complex and this is exacerbated by fear of missing the treatable. Many factors identified in the interviews were acknowledged as factors that could be included in an education package. It was also identified that there is the need for a culture shift in society regarding death and dying and a change in the philosophy of care for health care professionals.

Background: To be the close relative of a terminally ill person, who is receiving special palliative care, is a life changing experience. According to the guide lines for palliative care both the patients and their family members have the right to support, and to be part of the caring process. For nurses to be able to meet the needs of relatives, understanding their experience of special palliative care is crucial. Aim: To highlight the family´s experience of palliative care from specialist palliative operations. Method: A method based on the analysis of qualitative research was used, in order to contribute to evidence-based care. Ten scientific articles were analysed. Results: Emotions of guilt and relief were common amongst family members. The family members experienced that the nurses where a safe harbor when the family members received the support they needed. Sometimes the family members felt as if their homes and their private sphere became a workplace. Conclusion: Honest, straight, and clear communication was of great importance. For family members to be able to ask nurses for help and to feel supported in different situations was also important. The physical symptoms of death approaching became symbols of grief and sorrow.

Background: Nurses continuously meets and cares for dying patients, which can be perceived as both rewarding and stressful. To manage death and dying patients adequately, nurses need to reflect on what death means and her/his own perception of death and dying. Research showed that many nurses felt that they had a lack of knowledge and practical skills regarding end of life care. Objective: The purpose of this study was to illuminate nurses’ experiences of caring for patients in end-of-life care. Method: A literature-based study was used, based on analysis of qualitative data. Thirteen articles were analysed according to Friberg´s five-step model. The analysis resulted in four themes and eight subthemes. Results: Four main themes emerged from the analysis: 1) Deficient environment and organization 2) Deficient knowledge and practical skills 3) Support is an important factor 4) Response to end-of-life care. Conslusion: Education and training in end-of-life care was important. This should be implemented more, both in nursing education and in clinical practice. Support from management and colleagues was highly valued by nurses and should occur to a greater extent, as a way of preventing negative effects, such as burnout, and as a way of improving the care of dying patients and their relatives.

Thesis advisor: Megumi Inoue / End-of-life care planning is an opportunity for people to express how they want to spend the final stage of their lives by directing what type of medical treatment they wish or do not wish to receive. The completion of such planning is a way to exercise their autonomy, which is one of the fundamental ethical principles in medicine in the United States. Many older adults in the U.S., however, do not have such a plan or even discuss the topic with anyone. In order to understand the circumstances in which end-of-life planning is enacted, this study investigated two important research questions: (1) What are the sociodemographic and psychosocial factors that enhance or impede the completion of end-of-life planning? (2) How consistent is the content of a living will with the person's actual dying experience? These research questions were developed and examined as an application of expectancy theory, which explains the concepts of motivation and action. A series of logistic regression analyses were conducted. This study analyzed data from the Health and Retirement Study (HRS), which is a nationally representative sample of Americans over the age of 50. The analytic subsample included those who died between 2000 and 2010 (N = 6,668). The study found that persons who were older, who identified themselves as White, who had higher levels of income and education, and who were widowed or separated were more likely to be motivated to complete end-of-life planning. A higher level of sense of mastery was specifically relevant to documentation of living wills. On the other hand, a lower level of religiosity was specifically associated with having a durable power of attorney for health care. In addition, there was a clear connection between a request for palliative care and less troubling pain. Implications include conducting a community- or workplace-based public educational campaign, incorporating a culturally tailored approach for racial/ethnic minorities (e.g. faith-based interventions), using advance directives written in easy to understand language (e.g. Five Wishes), and funding Medicare provision for end-of-life care consultations between doctors and patients during annual physical exams. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Thesis advisor: Kathleen McInnis-Dittrich / Cancer caregivers are key stakeholders across the cancer trajectory, particularly in the final weeks of life and the bereavement period that follows. Current measures are limited in capturing caregiver assessment of the quality of end-of-life (EOL) care. Because none include caregiver perception of patient suffering or prolongation of death, the author sought to develop and validate a new measure of caregiver-perceived quality of EOL care that includes these dimensions. Data for this study comes from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). CwC investigators interviewed cancer patients and caregivers prior to the patient's death, and then caregivers again following the patient's death, on a range of psychosocial issues related to EOL care and bereavement. The present study represents a refinement of the author's previous work in developing and validating the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a comprehensive measure of caregiver-perceived quality of EOL care. Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The author examined the new measure's factor structure, and evaluated its reliability (using Cronbach's α) and convergent validity (via associations between CEQUEL and key EOL outcomes). CEQUEL and its subscales showed moderate to acceptable Cronbach's α (range: 0.52-0.78). Higher scores (indicating better perceived quality of care) were positively associated with therapeutic alliance (ρ=.13; p≤.05) and hospice enrollment (z=-2.09; ≤;.05), and negatively associated with bereaved caregiver regret (ρ=-.36, p≤.001) and a diagnosis of Posttraumatic Stress Disorder (z=-2.06; p≤.05). Scores did not vary by caregiver characteristics other than religious affiliation, with Catholics scoring lower than non-Catholics, and those without religious affiliation scoring lower than those with an affiliation. Models predicting CEQUEL scores were compared using multiple regression analysis and AICc values. In unadjusted analyses, dying in a hospital, inpatient hospice length of stay (LOS) < 1 week, patients feeling seen as a whole person by their physician, and caregiver religiosity predicted CEQUEL scores. Only dying in a hospital (B=-1.65, SE=0.42, p=0.000) and inpatient hospice LOS < 1 week (B=-1.87, SE=-.69, p=0.008) remained significant in adjusted analysis. These findings suggest that CEQUEL is a brief, valid measure of quality of EOL care from the caregiver's perspective. This study also identifies key factors that can be modified to improve caregiver evaluation of quality of care and associated bereavement outcomes. CEQUEL is the first scale of its kind to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment. Implications for research, clinical practice and policy are discussed. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

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Neste trabalho, iremos analisar o livro A cidade e as serras, de Eça de Queirós, mediante os discursos referentes às estéticas de fin-de-siècle, que se estabelecem na França entre os anos de 1880 e 1900. Tentaremos observar, como o autor aproveita-se dos discursos para construir a personagem de Jacinto e como os manipula ironicamente a fim de estabelecer sua visão crítica sobre o período. Além disso, pretendemos mostrar como Eça de Queirós observa a mudança de perspectiva que acontece no campo cultural francês, ou ainda, no mundo no fim do século XIX, isto é, de um ponto de vista positivista, passando pelo decadente e pessimist, para o idealista. Acreditamos que através da manipulação irônica desse quadro histórico e do horizonte discursivo e estético que constitui o imaginário do homem do fim do século, Eça de Queirós irá estabelecer uma versão mais refinada do realismo praticada em seus livros da última fase / In this paper, we will examine the book The city and the mountains, Eça de Queirós, through the discourses concerning aesthetic of fin-de-siècle, which are established in France between the years 1880 and 1900. We will try to observe, as the author takes advantage of speeches to build character Jacinto and how ironically manipulates to establish his critical view of the period. Furthermore, we intend to show how Eça de Queirós notice the change in perspective that happens in the French cultural fields, besides in the world in the late nineteenth century, that is, a positivist point of view, through the decadent and pessimist, for idealistic. We believe that by manipulating this ironic historical context and the discursive and aesthetic which is the imaginary of man in the end of the century, Eça de Queirós horizon will establish a more refined version of realism practiced in his books of the last phase

A técnica de perfilagem gama de colunas de destilação já está no mercado há pelo menos 30 anos. Acompanhando o desenvolvimento tecnológico mundial, a técnica e a indústria prosperaram e se difundiu, podendo ser encontrada em diversos países e sendo implementada por diversas empresas comerciais e centros de pesquisa. Todavia, apesar das melhorias na qualidade dos resultados bem como na rapidez e praticidade da tomada de dados; o conceito básico da técnica permaneceu inalterado. Este trabalho condensa como o aprendizado de 20 anos, em gamma scan e tomografia industrial, propiciou fundamentos para uma técnica inovadora, testada em laboratório e depois efetivamente aplicada em condições reais de campo, que permitiu obter resultados nunca antes obtidos numa perfilagem de coluna. / Distillation column gamma scanning has been in the market for more than 30 years. Following world\'s technology development the industry grew and spread worldwide. Nowadays gamma scanning can be found in many countries performed by commercial companies and research centers either. However, in spite of all development achieved, resulting in high quality data and easy data sampling; the technology concepts remains the same. This works condense how 20 years apprentice ship in gamma scanning and industrial tomography, rise up fundaments for an innovative technique, tested in laboratory scale and effectively applied in real field conditions; culminated in results that have never been obtained with a gamma scan.