El objetivo de la presente investigación fue describir los atributos conceptuales de la muerte desde la óptica de la enfermera como cuidadora del paciente oncológico en fase terminal Chiclayo, 2023. El método propuesto para el estudio fue cualitativo-descriptivo. La Población lo conformó 20 enfermeros de la Red Lambayeque. La selección de los participantes se realizó por conveniencia, con muestra no probabilística, determinada por saturación y redundancia de los discursos. La técnica de recojo de información fue la entrevista semiestructurada con preguntas abiertas a profundidad, validada por juicio de expertos y registrada en un grabador de voz. El procesamiento de los datos se realizó mediante la Teoría fundamentada. Se garantizó la calidad científica y rigor ético de la investigación. Resultados: Se obtuvo tres Categorías: Categoría I: El sentir ante la muerte, subcategorías: límite natural, frustración ante las pérdidas, afectividad perturbada, rechazo a la muerte y descanso a sus sufrimientos. Categoría II: Espiritualidad y cuidado, subcategorías: La Espiritualidad en Enfermería: Separación de la Dualidad Cuerpo-Alma, Resignación ante la Voluntad Divina, Esperanza de una Vida Mejor. Coexistir con la Muerte mediante el Cuidado: Identificación y Acompañamiento, Cuidado Humanizado como un Arte de Cuidar y Descanso a sus Sufrimientos. Categoría III: Resiliencia de la enfermera, subcategorías: Evolución del significado de la muerte, valorar la vida y preparado para morir. La muerte es un hecho trascendental y único, es así como para el personal de enfermería que cuida del paciente oncológico tiene una conceptualización singular resultado de sus experiencias previas, saber y costumbres. / The objective of this research was to describe the conceptual attributes of death from the perspective of the nurse as caregiver of the terminally ill cancer patient Chiclayo, 2023. The method proposed for the study was qualitative-descriptive. The population was made up of 20 nurses from the Lambayeque Network. The selection of participants was made for convenience, with a non-probabilistic sample, determined by saturation and redundancy of the discourses. The information-gathering technique was a semi-structured interview with in-depth open questions, validated by expert judgement and recorded on a voice recorder. Data processing was carried out using Grounded Theory. The scientific quality and ethical rigor of the research were guaranteed. Results: Three categories were obtained: Category I: Feeling in the face of death, subcategories: natural limit, frustration in the face of losses, disturbed affectivity, rejection of death and rest from their sufferings. Category II: Spirituality and Care, subcategories: Spirituality in Nursing: Separation of Body-Soul Duality, Resignation to the Divine Will, Hope for a Better Life. Coexisting with Death through Care: Identification and Accompaniment, Humanized Care as an Art of Caring and Resting from their Sufferings. Category III: Nurse resilience, subcategories: Evolution of the meaning of death, valuing life and preparing to die. Death is a transcendental and unique event, which is how for the nursing staff who take care of the cancer patient it has a unique conceptualization resulting from their previous experiences, knowledge and customs.

ITC/USA 2005 Conference Proceedings / The Forty-First Annual International Telemetering Conference and Technical Exhibition / October 24-27, 2005 / Riviera Hotel & Convention Center, Las Vegas, Nevada / The terminal phase telemetry data acquisition has always been a challenging task especially for long and medium range test launches. The task becomes more complicated if the article under test describes a very low altitude cruise terminal phase trajectory. Generally, for long and medium range missions test fired into sea the terminal phase data is acquired by deploying instrumented ships in the vicinity of impact point but beyond the safety corridor. But for long range missions with low altitude cruise terminal phase trajectory and wide safety corridor this conventional approach will not work out because of limitation of LOS from the ship platforms. Hence, for such applications an air borne telemetry receiving system is also to be added to the down range instrumentation network. This paper describes a typical and cost effective air borne system realized utilizing the Commercial Off The Shelf (COTS) products and technology. This paper also addresses as to how the signal scattering problems are tackled in the design implementation.

Bakgrund; Historiskt sett har palliativ vård varit en del av sjuksköterskans ansvarsområde. Sjuksköterskans roll inom palliativ vård är relationsskapande, stödjande, kommunikativ och koordinerad. Syfte; Syftet i den föreliggande litteraturstudien var att beskriva sjuksköterskors upplevelser av att arbeta med patienter i ett palliativt skede samt att beskriva undersökningsgruppen i de inkluderande studierna. Metod; Denna litteraturstudie har en deskriptiv design och baseras på tolv vetenskapliga studier med kvalitativ ansats publicerade mellan år 2006-2016. De vetenskapliga studierna identifierades i databaserna PubMed och Cinahl. Studiernas innehåll granskades utifrån likheter och olikheter. Antal deltagare, bortfall, ålder, könsfördelning samt yrkesverksamma år som sjuksköterska granskades i den medologiska aspekten. Huvudresultat; Fyra huvudteman identifierades av författarna; Svårigheter att bibehålla sin professionella roll, Upplevelser vid etiska dilemman, Krävande och givande upplevelser i mötet mellan sjuksköterska och patient och Upplevelser av otillräcklighet och osäkerhet. Gällande granskning av studiernas undersökningsgrupper påvisades att majoriteten av deltagarna var kvinnor. Slutsats; Enligt tidigare studier upplevde sjuksköterskorna det krävande att arbeta med patienter i ett palliativt skede. I denna litteraturstudie framkom det tydliga kunskapsluckor hos sjuksköterskorna gällande patienters symtom, behandling samt hur olika svåra situationer skulle hanteras. Detta påvisar att det behövs mer kontinuerlig utbildning inom palliativ vård. / Background; Historically palliative care has been a part of the nurse's responsibility. The nurse's role in palliative care is relationship-building, supportive, communicative and coordinated. Aim; The aim of the present literatur review was to describe nurses' experiences of working with patients in a palliative stage and to describe the investigation group in the including studies. Methods; This literature review has a descriptive design and is based on twelve scientific studies with a qualitative approach and were published between the years 2006-2016. The scientific studies were found in the databases PubMed and Cinahl. The content of the studies were reviewed on the basis of their similarities and differences. Number of participants, dropout, age, gender and number of years in work as a nurse were reviewed in the methodological aspect. Results; Four main themes were identified by the authors; Difficulties to maintain their professional role, Experiences of ethical dilemmas, Demanding and rewarding experiences in the meeting between the nurse and patient and Experiences of inadequacy and insecurity. The current review of the studies investigation group showed that the majority of participants were women. Conclusions; According to previous studies, the nurses experiences were demanding while working with patients in a palliative stage. This literature review showed clear gaps in the nurses knowledge regarding patient symptoms, treatment and how different difficult situations should be handled. This demonstrates the need for more continuous education in palliative care.

Crohn's disease is a chronic inflammatory bowel disease which may affect any part of the gastrointestinal tract with a preference for the terminal ileum and ileocaecal region. The disease was first described in 1932 and has increased during the last decades. The clinical manifestations could be referred to as inflammation, malabsorption and obstruction. The annual incidence of Crohn's disease in the county of Västerbotten, North Sweden, was found to be 4.9/105 inhabitants. In a study of 87 patients in a medical gastrointestinal unit, 23% of non-operated patients and 66% of resected patients had increased fecal fat excretion. D-xylose test and lactose tolerance test were abnormal 1n 19% and 24% respectively of the non-operated patients. No clear relation could be found between the outcome of these malabsorption tests and localization, extension or activity of the disease. This suggests the cause of malabsorption 1n Crohn's disease to be complex and multi- factorial . The morphology of jejunal biopsies from 18 patients with Crohn's disease elsewhere 1n the gastrointestinal tract demonstrated an abnormal picture 1n 13 patients when assessed by light microscopy and scanning electron microscopy. A high proportion of these patients had abnormal Intestinal absorptive tests. Skeletal muscle biopsies were performed 1n 13 patients showing a depletion of muscle potassium content and more Infrequently low skeletal muscle magnesium content. This depletion 1s not reflected by subnormal plasma concentration. In the Initial clinical assessment of a new gamma labelled synthetic bile ac1d-SeHCAT, 45 patients, 19 of whom had Crohn's disease, were studied. The outcome of the test correlated well with the excretion of fecal bile acids. It was possible to discriminate patients with terminal Ileal disease from other patient groups. In a follow-up study, the SeHCAT test was modified as to make it simpler and to shorten the test period. Nine patients with Crohn's disease were tested, showing a suffi cent accuracy of the outcome of the test within 48 hours, using simple equipment available in many hospitals. The elimination of radioactivity was calculated as WBR50*» the time for 50% of the administered dose to be excreted. This gives information as to the rate of excretion, reflecting the degree of terminal ileal malfunction. / <p>S. 1-41: sammanfattning, s. 43-115: 5 uppsatser</p> / digitalisering@umu

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The National Cancer Association of South Africa estimates that over 80,000 of South Africans currently die from cancer each year, whilst statistics show an increase in newly diagnosed cancer cases. Despite an improvement in cure rates, cancer, because of its association with pain, suffering and death, still affects human beings in their totality. It has been demonstrated that effective psychosocial care, as provided by oncology nurses, improve the outcomes for cancer patients. Therefore, nurses’ attitudes towards caring for patients that are dying are of vital importance to the quality of care provided to these patients. Attitudes towards caring for patients that are dying may be influenced by the demographic factors of oncology nurses, such as age, workplace and years of experience in oncology. It may also depend on the degree of work satisfaction and by the nature of the work environment, particularly regarding the level of support being offered to the nurse. The purpose of this study hence was to explore the influences of demographic and work environment factors on nurses’ attitudes towards caring for patients that are dying in oncology settings in the Western Cape Metropole. The objectives of this study were to determine oncology nurses’ attitudes towards caring for patients that are dying, to determine the degree of work satisfaction experienced by these nurses, to determine the perceived supportive nature of their work environments, and to establish and examine any relationships between oncology nurses’ attitudes towards caring for patients that are dying and demographic factors, work satisfaction and a supportive work environment. This study was theoretically underpinned by Paterson and Zderad’s (quoted in Praeger, 2002) humanistic nursing theory and Peplau’s (quoted in Belcher & Brittian Fish, 2002) interpersonal relations in nursing theory, because of their relevance to palliative care. A quantitative research approach, with a descriptive design, was selected to conduct the study. The target population was all the oncology nurses, caring for patients that are dying in palliative and oncology settings in the Western Cape Metropole. A convenience sample of 127 oncology nurses was selected in three different, but typical oncology settings, namely a state hospital, a private hospital and three hospices. Data was collected by means of a selfreporting questionnaire. A pilot study was done, in order to assure the validity and reliability of the data collection instrument. Ethical approval was obtained in advance from the Ethical Research Committee of the Faculty of Health Sciences of the University of Stellenbosch. Written consent was obtained beforehand from the managers of the three oncology settings where the research was conducted, as well as from the participants. The main findings of this study were that the majority of the respondents displayed positive attitudes towards caring for patients that are dying. In addition, most of the respondents experienced a high degree of work satisfaction and also regarded their work environments as supportive. Significant relationships were found between positive attitudes towards caring for patients that are dying and: • hospice settings; • higher age and; • rank of the professional nurse. The overall recommendation that was made was that continuing education in all aspects of palliative care be regarded as an essential strategy in maintaining and further enhancing positive attitudes amongst oncology nurses towards caring for patients that are dying. In addition, coping strategies needed to be widely implemented to help oncology nurses cope with their emotions and anxieties. / AFRIKAANSE OPSOMMING: Die Nasionale Kankervereniging van Suid-Afrika beraam dat meer as 80,000 Suid-Afrikaners huidig jaarliks aan kanker sterf, terwyl statistieke ‘n toename in die aantal nuwe gevalle van kanker toon. Ten spyte van ‘n toename in die sukses van behandeling, beïnvloed kanker, weens sy assosiasie met pyn, lyding en die dood, steeds die mens in sy totaliteit. Dit is bewys dat effektiewe psigososiale versorging deur onkologiese verpleegkundiges die uitkomstes van pasiënte met kanker verbeter. Daarom is die ingesteldhede van verpleegkundiges, jeens die versorging van pasiënte wat sterwend is, van kardinale belang in die kwaliteit van versorging wat aan hierdie pasiënte gebied word. Sodanige ingesteldhede mag deur demografiese faktore, soos ouderdom, werkplek, en jare ondervinding in onkologie, beїnvloed word. Dit mag ook van die mate van werksbevrediging en van die aard van die werksomgewing, spesifiek met betrekking tot die mate van ondersteuning wat aan die verpleegkundige gebied word, afhang. Die doel van hierdie studie was dus om die invloed van demografiese en werksomgewingsfaktore op die ingesteldhede van onkologiese verpleegkundiges, jeens die versorging van pasiënte wat sterwend is in onkologiese afdelings in die Wes-Kaapse Metropool, te ondersoek. Die doelwitte van hierdie studie was om die ingesteldhede van verpleegkundiges jeens die versorging van pasiënte wat sterwend is te bepaal, om hulle mate van werksbevrediging te bepaal, om hul persepsie van die ondersteunende aard van hul werksomgewing te bepaal, en om enige verband tussen onkologiese verpleegkundiges se ingesteldhede jeens die versorging van pasiënte wat sterwend is en demografiese faktore, werksbevrediging en die aard van ‘n ondersteunende werksomgewing te bepaal en te ondersoek. Hierdie studie is teoreties, vanweë hul relevansie tot palliatiewe sorg, deur Paterson en Zderad (aangehaal in Praeger, 2002) se humanistiese teorie en Peplau (aangehaal in Belcher & Brittian Fish, 2002) se interpersoonlike verhouding in verplegingsteorie, onderskraag. ‘n Kwantitatiewe navorsingsbenadering, met ‘n beskrywende ontwerp, is gekies om die studie mee uit te voer. Die populasie het al die onkologiese verpleegkundiges, wat sterwende en palliatiewe pasiënte in kankerafdelings in die Wes-Kaapse Metropool versorg, ingesluit. ‘n Gerieflikheidsteekproef van 127 onkologiese verpleegkundiges, in drie verskillende, maar tipiese kankerinstellings, is gekies, naamlik ‘n staatshospitaal, ‘n privaathospitaal en drie hospitiums. Datainsameling is deur middel van ‘n self-gerapporteerde vraelys gedoen. ‘n Loodsstudie is uitgevoer om die geldigheid en betroubaarheid van die vraelys te verseker. Etiese goedkeuring is vooraf vanaf die Etiese Navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch verkry. Skriftelike toestemming is ook vooraf vanaf die bestuur van die instellings, waar die navorsing gedoen is, sowel as van die deelnemers verkry. Die hoofbevindings van hierdie studie was dat die meerderheid van die respondente positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is openbaar het. Boonop het die meeste respondente ’n hoë mate van werksbevrediging ervaar en hul werksomgewing as ondersteunend beskou. Beduidende verbande is getrek tussen positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is, en: • versorging in hospitiums; • hoër ouderdom en; • rang van professionele verpleegkundige. Die algemene aanbeveling wat gemaak kon word was dat deurlopende opleiding in alle aspekte van palliatiewe sorg, as ‘n grondliggende strategie beskou moet, ten einde positiewe ingesteldhede ten opsigte van die versorging van pasiënte wat sterwend is onder onkologiese verpleegundiges te behou en verder aan te moedig. Voorts behoort strategieë geïmplementeer te word om onkologiese verpleegkundiges te help met die hantering van hul emosionale behoeftes en vrese.

Chronic non-terminal pain (CNTP) is defined as pain lasting longer than three months, serves no functional role in healing, lasts beyond normal tissue recovery time and is unresolved despite appropriate treatment. CNTP triggers a complex set of central nervous system responses and a decline in social function. Opioids have been used to treat moderate to severe pain when non-opioid analgesics have not been sufficient. Multiple factors have led to increased use and higher prescribing dosages of opioids to manage CNTP in primary care. Higher dosages of opioids are associated with higher risk of adverse events, including death. Nationally, between 1999 and 2011, opioid related deaths rose over 300%. In Arizona, 41% of drug mortality is attributed to opioids and in 2011, the state ranked fifth in the nation for opioid prescribing rates. Statewide, a multi-professional, multi-agency strategy has been initiated to address this problem. The impact evaluation of the prescribing initiative led by the Arizona Criminal Justice Commission has been positive but little information exists regarding prescribers' practice patterns, prescribers' knowledge of evidence based recommendations synthesized in the guidelines, or the barriers to safe opioid prescribing in Arizona. The Statewide Interprofessional Practice-Based Research Network (IP PBRN) identified chronic pain management as a top research priority during their planning conference in 2012. The purpose of this project was to create and formalize a survey, eliciting responses that describe current practice patterns and identify implementation barriers to evidence-based recommendations for prescribing and monitoring opioids for patients with CNTP in Arizona primary care settings.

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The experience of dealing with end-stage cancer in a family member has been reported to be stressful. One source of stress experienced by family members may be dissatisfaction with care received by the patient and themselves. For health professionals to provide care that promotes family satisfaction, it is essential to measure this phenomenon and understand the elements that contribute to satisfaction. An examination of the literature revealed four competing explanatory theories of satisfaction, none of which has solid empirical support. Moreover, these theories had not been tested with families or those experiencing cancer care in particular. Therefore, the aim of this research was to test these alternative theories using theoretical and empirical modeling with the expectation that a useful model would be identified to guide clinical practice of families in terminal care situations. The theories tested were: (1) Vroom's Fulfillment Theory, (2) Porter's Discrepancy Theory, (3) Thibaut and Kelley's Social Comparison Theory, and (4) Ajzen and Fishbein's Expectancy Value Theory. A correlational design with a causal modeling methodology was used. One hundred and nine family members of patients with advanced cancer were obtained from three different palliative care services. Five instruments were used to collect data: (1) FAMCARE Scale, (2) F-Care Needs Scale, (3) F-Care Expectations Scale, (4) F-Care Perceptions Scale, and (5) a short demographic questionnaire. Data analysis included use of descriptive statistics to summarize the sample in terms of demographic variables, reliability and validity testing of the instruments, and theoretical and empirical model testing using multiple regression techniques and residual analysis. Of the four theories tested, Discrepancy theory was the most credible, accounting for 68 percent of explained variance in family care satisfaction. Empirical modeling resulted in identification of the Family Care Satisfaction Model, which explained 78 percent of the variance in care satisfaction. Implications for theory construction and clinical practice are presented and recommendations for further research offered. The family constitutes perhaps the most important social context within which health and illness occur. As more families are required to care for dependent or ill members at home, understanding the needs, expectations, and satisfactions with care experienced by families will become increasingly important.

For a Fano variety V with at most Kawamata log terminal (klt) singularities and a finite group G acting bi-regularly on V , we say that V is G-exceptional (resp., G-weakly-exceptional) if the log pair (V,∆) is klt (resp., log canonical) for all G-invariant effective Q-divisors ∆ numerically equivalent to the anti-canonical divisor of V. Such G-exceptional klt Fano varieties V are conjectured to lie in finitely many families by Shokurov ([Sho00, Pro01]). The only cases for which the conjecture is known to hold true are when the dimension of V is one, two, or V is isomorphic to n-dimensional projective space for some n. For the latter, it can be shown that G must be primitive—which implies, in particular, that there exist only finitely many such G (up to conjugation) by a theorem of Jordan ([Pro00]). Smooth G-weakly-exceptional Fano varieties play an important role in non-rationality problems in birational geometry. From the work of Demailly (see [CS08, Appendix A]) it follows that Tian’s αG-invariant for such varieties is no smaller than one, and by a theorem of Tian such varieties admit G-invariant Kähler-Einstein metrics. Moreover, for a smooth G-exceptional Fano variety and given any G-invariant Kähler formin the first Chern class, the Kähler-Ricci iteration converges exponentially fast to the Kähler form associated to a Kähler- Einsteinmetric in the C∞(V)-topology. The termexceptional is inherited from singularity theory, to which this study enjoys strong links. We classify two-dimensional smooth G-exceptional Fano varieties (del Pezzo surfaces) and provide a partial list of all G-exceptional and G-weakly-exceptional pairs (S,G), where S is a smooth del Pezzo surface and G is a finite group of automorphisms of S. Our classification confirms many conjectures on two-dimensional smooth exceptional Fano varieties.

Bakgrund: Den palliativa vården ska bygga på symtomlindring och livskvalité för den döende. Den ska också finnas som ett stöd till anhöriga som är en viktig pusselbit i den palliativa vården. Omvårdnadsteoretikern Joyce Travelbee har använts som grund i litteraturstudien vilket innebär att se människan utifrån en helhetssyn och veta att människan är en unik varelse. Syfte: Att utifrån aktuell forskning belysa anhörigas situation inom palliativ vård. Metod: En litteraturöversikt som baseras på 13 vetenskapliga artiklar med kvalitativ metod. Resultat: Resultatet visade på att de anhöriga var omgivna av många känslor som till exempel osäkerhet och medlidande. Det visade sig också att många anhöriga var i behov av att få prata med vårdpersonal kring döden. Deltagarna tyckte också det var viktigt med en personal som visade empati och att det var kontinuitet bland vilka i personalen som tog hand om patienten. Konklusion: För att kunna ge de anhöriga en bra upplevelse av vården vid livets slut bör de erbjudas samtal om döden. Vårdpersonalen bör vara kompetent och empatisk. Det är också viktigt för de anhöriga att det var samma personer från personalen som tog hand om deras anhörige då det skapar en känsla av trygghet. / Background: Palliative care should be based on symptom relief and quality of life for the dying. The care should also be available as a support to families, they are an important part of the palliative care. Nursing theorist Joyce Travelbee was the basis of this study. Travelbee use a holistic approach and says that a person is a unique being. Aim: Illuminate family members' situation in palliative care based on current research. Method: A literature review based on 13 scientific articles with qualitative method. Result: The result showed that the relatives experienced many different emotions, such as insecurity and compassion. It was also found that many families wished to communicate about death with professionals. Relatives wished that the proffesionals would be competent and empatic. It was also good with professionals that were periodic, it created a sense of security for the relatives. Conclusion: In order to give the families a good experience of care at end of life, they must be offered conversation about death. The nursing staff should be empathetic, continuous and competent.