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End
Kinds of End Terms modified by End Selected AbstractsHigh-Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?DERMATOLOGIC SURGERY, Issue 4 2007JUAN-CARLOS MARTINEZ MD PURPOSE The beneficial role of elective neck dissection (END) in the management of high-risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node-negative (N0) high-risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence-based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high-risk CSCC of the head and neck. CONCLUSIONS Appropriate work-up for occult nodal disease may occasionally be warranted in patients with high-risk CSCC. END may play a role in only a very limited number of patients with high-risk CSCC. [source] SCIENCE WILL UNCOVER THE MYSTERIES OF ADDICTION IN THE ENDADDICTION, Issue 1 2010DOUG SELLMAN No abstract is available for this article. [source] COMPARING BUPRENORPHINE ,TAPERS',TO WHAT END?ADDICTION, Issue 8 2009ROBERT G. NEWMAN No abstract is available for this article. [source] SOCIALITY IN THERIDIID SPIDERS: REPEATED ORIGINS OF AN EVOLUTIONARY DEAD ENDEVOLUTION, Issue 11 2006Ingi Agnarsson Abstract Evolutionary ,dead ends' result from traits that are selectively advantageous in the short term but ultimately result in lowered diversification rates of lineages. In spiders, 23 species scattered across eight families share a social system in which individuals live in colonies and cooperate in nest maintenance, prey capture, and brood care. Most of these species are inbred and have highly female-biased sex ratios. Here we show that in Theridiidae this social system originated eight to nine times independently among 11 to 12 species for a remarkable 18 to 19 origins across spiders. In Theridiidae, the origins cluster significantly in one clade marked by a possible preadaptation: extended maternal care. In most derivations, sociality is limited to isolated species: social species are sister to social species only thrice. To examine whether sociality in spiders represents an evolutionary dead end, we develop a test that compares the observed phylogenetic isolation of social species to the simulated evolution of social and non-social clades under equal diversification rates, and find that sociality in Theridiidae is significantly isolated. Because social clades are not in general smaller than their nonsocial sister clades, the spindly phylogenetic pattern,many tiny replicate social clades,may be explained by extinction rapid enough that a nonsocial sister group does not have time to diversify while the social lineage remains extant. In this case, this repeated origin and extinction of sociality suggests a conflict between the short-term benefits and long-term costs of inbred sociality. Although benefits of group living may initially outweigh costs of inbreeding (hence the replicate origins), in the long run the subdivision of the populations in relatively small and highly inbred colony lineages may result in higher extinction, thus an evolutionary dead end. [source] STRAIN GAGE HISTORY AND THE END OF THE TWENTIETH CENTURYEXPERIMENTAL TECHNIQUES, Issue 2 2001Peter K. Stein No abstract is available for this article. [source] Proton collisions with the water dimer at keV energiesINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 2 2009O. Quinet Abstract Proton collisions with the water dimer are studied using a nonadiabatic, direct, time-dependent approach called electron nuclear dynamics (END). Fragmentation of the water dimer in collisions with protons at energies of 5.0, 1.0 keV and 200 eV is the primary aim of this initial study of water clusters using END. We report on the initial fragmentation dynamic, that is, for times less than 200 fs. © 2008 Wiley Periodicals, Inc. Int J Quantum Chem, 2009 [source] Nonadiabatic evolution of electronic states by electron nuclear dynamics theoryINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 5 2005Frank Hagelberg Abstract The problem of how to determine the nonadiabatic content of any given dynamic process involving molecular motion is addressed in the context of Electron Nuclear Dynamics (END) theory. Specifically, it is proposed to cast the dynamic END wave function into the language of static electronic configurations with time dependent complex-valued amplitudes. This is achieved by adiabatic transport of an electronic basis along the classical nuclear trajectories of the studied molecular system, as yielded by END simulation. Projecting the dynamic wave function on this basis yields a natural distinction between adiabatic and nonadiabatic components of the motion considered. Tracing the evolution of the leading configurations is shown to be a helpful device for clarifying the physical nature of electronic excitation processes. For illustration of these concepts, dynamic configuration analysis is applied to the scattering of a proton by a lithium atom. © 2005 Wiley Periodicals, Inc. Int J Quantum Chem, 2005 [source] GLOBAL JUSTICE WITHOUT END?METAPHILOSOPHY, Issue 1-2 2005John Tasioulas Abstract: John Rawls argued in The Law of Peoples that we should reject any principle of international distributive justice, whether in ideal theory or nonideal theory. Instead, he advocated a duty of assistance on the part of well-ordered societies toward burdened societies. I argue that Rawls is correct that we should endorse a principle with a target and cut-off point rather than a principle of international distributive justice. But the target and cut-off point he favors is too undemanding, because it can be met by assisting a burdened society to become a decent people. Instead, only a society that respects the right to an adequate standard of living, and not simply a right to subsistence, can be an acceptable target. Rawls is prevented from drawing this conclusion by a failure to disentangle issues of intervention and assistance, a failure bound up with his flawed, intervention-driven account of human rights in defining a decent people. [source] Can the combination of flaxseed and its lignans with soy and its isoflavones reduce the growth stimulatory effect of soy and its isoflavones on established breast cancer?MOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 7 2007Krista A. Power Abstract Consumption of phytoestrogen (PE)-rich foods (i. e., soy and flaxseed (FS)) is increasing because of their suggested health benefits. However, recent studies raise concern over the safety of soy and its isoflavones, particularly genistein (GEN), for postmenopausal breast cancer (BC), due to their potential stimulatory effects on human breast tissue and on the growth of existing tumors in rodents. FS, rich in PE lignans, which is metabolized to the mammalian lignans enterolactone (ENL) and enterodiol (END), has consistently been shown to have tumor inhibitory effects in a human clinical trial as well as rodent BC models. Using the preclinical athymic mouse postmenopausal BC model, combining FS with soy protein or GEN with END and ENL, was found to negate the tumor stimulatory effects of soy protein or GEN alone. The mechanism may be related to the modulation of estrogen receptor and MAPK signaling pathways. If these studies can be confirmed in clinical trials, then consumption of combined soy and FS, or their PEs, may reduce the tumor growth stimulatory effect of soy or GEN. This may indicate that if soy is consumed with lignan-rich foods, it may continue to induce its other beneficial health effects, without inducing adverse effect on postmenopausal BC. [source] Role of dietary lignans in the reduction of breast cancer riskMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 7 2007Niina M. Saarinen Abstract Lignans are a large group of fiber-associated phenolic compounds widely distributed in edible plants. Some of the ingested plant lignans are converted by intestinal microbiota to enterolignans, enterodiol (END) and enterolactone (ENL), the latter of which has been thought to be the major biologically active lignan, and suggested to be associated with low risk of breast cancer. In line with this, administration of plant lignans which are further metabolized to ENL, or ENL as such, have been shown to inhibit or delay the growth of experimental mammary cancer. The mechanism of anticarcinogenic action of ENL is not yet fully understood, but there is intriguing evidence for ENL as a modulator of estrogen signaling. These findings have generated interest in the use of lignans as components of breast cancer risk reducing functional foods. Identification of target groups, who would benefit most, is of pivotal importance. Therefore, further identification and validation of relevant biomarkers, which can be used as indicators of lignan or ENL action and breast cancer risk reduction at different stages of the disease, are of importance. [source] LOOKING TOWARD THE END: REVISITING AQUINAS' TELEOLOGICAL ETHICSTHE HEYTHROP JOURNAL, Issue 3 2010JOSEPH A. SELLING First page of article [source] RELATIONSHIP BETWEEN THE COLORATION AND THE FIRING TECHNOLOGY USED TO PRODUCE SUSA GLAZED CERAMICS OF THE END OF THE NEOLITHIC PERIOD*ARCHAEOMETRY, Issue 5 2009S. LAHLIL Ancient decorated potteries from Susa (Mesopotamia) dating from 4200 to 3700 bc, were studied in order to determine the origin and the nature of the raw materials used, and to identify the technological processes applied to make the ceramic bodies and their decorations. Bulk compositions were determined by particle induced X-ray emission (PIXE), while the microstructure and the mineralogical phases were studied using scanning electron microscopy (SEM), energy dispersive X-ray analyses (EDX) and X-ray powder diffraction (XRD). The results showed that the raw materials used to elaborate these potteries were similar for all the ceramic bodies (carbonates and iron and magnesium-rich clays containing sand), and for all the decorations (iron oxides, silica, potassic and alumina sources). The variations of coloration of the ceramics and of their decorations were due to different firing temperatures. The ranges of firing temperatures used by potters were evaluated on the basis of mineral stability domains. [source] INVOCATION TO LIBERTY AND INVECTIVE OF DOMINATUS AT THE END OF THE ROMAN REPUBLIC,BULLETIN OF THE INSTITUTE OF CLASSICAL STUDIES, Issue 1 2007VALENTINA ARENA First page of article [source] PROPERTY AS LEGAL KNOWLEDGE: MEANS AND ENDSTHE JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE, Issue 4 2004Annelise Riles This article takes anthropologists' renewed interest in property theory as an opportunity to consider legal theory-making as an ethnographic subject in its own right. My focus is on one particular construct , the instrument, or relation of means to ends, that animates both legal and anthropological theories about property. An analysis of the workings of this construct leads to the conclusion that rather than critique the ends of legal knowledge, the anthropology of property should devote itself to articulating its own means. [source] Teaching the Fuzzy Front End of Innovation: Experimenting with Team Learning and Cross-Organizational IntegrationCREATIVITY AND INNOVATION MANAGEMENT, Issue 3 2009Miia Martinsuo How can the extremely uncertain front end of innovation , managing the fuzzy front end , be taught to graduate students? This paper describes and analyses experiments with experiential, problem-based learning focused on the front end of innovation. The focus is on the learning and cross-organizational integration of student teams; factors that have been identified as central to the success of teams involved in the front end of innovation. An experiential course, ,From an idea to a business plan in product development', was developed in conjunction with an actual company, and piloted with four student groups in 2007 and 2008. Data on this novel course were collected through participant observation, team self-assessment and questionnaires. This paper reports favourable results for the effectiveness of the course design; it discusses the impact of team size and cross-organizational team composition on team performance; and identifies the implications for teaching the front end of innovation. [source] Towards a New Logic for Front End Management: From Drug Discovery to Drug Design in Pharmaceutical R&DCREATIVITY AND INNOVATION MANAGEMENT, Issue 2 2007Maria Elmquist Under pressure to innovate and be cost-effective at the same time, R&D departments are being challenged to develop new organizations and processes for Front End activities. This is especially true in the pharmaceutical industry. As drug development becomes more risky and costly, the discovery departments of pharmaceutical companies are increasingly being compelled to provide strong drug candidates for efficient development processes and quick market launches. It is argued that the Fuzzy Front End consists less of the discovery or recognition of opportunities than of the building of expanded concepts: the notion of concept generation is revisited, suggesting the need for a new logic for organizing Front End activities in order to support sustainable innovative product development. Based on an in-depth empirical study at a European pharmaceutical company, this paper contributes to improved understanding of the actual management practices used in the Front End. Using a design reasoning model (the C-K model), it also adds to the growing body of literature on the management of Front End activities in new product development processes. [source] Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of deathEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2010B. JACK phd, bsc (econ), head of research, scholarship JACK B. & O'BRIEN M. (2010) European Journal of Cancer Care19, 636,642 Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death Giving patients with cancer a choice in where they want to die including the choice to die at home if they so wish, underpin the recent UK government policies and is embedded in the End of Life Care Programme. However, this presents increasing challenges for the informal carers particularly with an increasingly aging population. Despite the policy initiatives, there remain a persistent number of patients with cancer who had chosen to die at home being admitted to hospital in the last days and hours of life. A qualitative study using two focus group interviews with community nurses (district nurses and community specialist palliative care nurses) was undertaken across two primary care trusts in the north-west of England. Data were analysed using a thematic analysis approach. The results indicated that informal carer burden was a key reason for prompting hospital admission. Recommendations for the development of a carer assessment tool with appropriate supportive interventions are made. [source] Reflections on Family and Consumer Sciences Research at the End of the Millennium: An Introduction and Editorial NoteFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 2 2001Wendy L. Way Editor No abstract is available for this article. [source] Does History End with Postmodernism?FAMILY PROCESS, Issue 4 2001Toward an Ultramodern Family Therapy Although the end of history has often been announced, human thought continues to renew itself, always incorporating, in each of its stages, important aspects of what has come before. In this sense, neither family therapy in general, nor its more particular postmodern orientations, have led to a radical break with the past. Neither can they claim to have reached a comfortable, definitive position. The subjectivist turn that introduced postmodernism into the systemic model has enriched it with important theoretical and practical elements, such as the critique of a therapist's supposed objectivity, circular and reflexive questioning, or the technique of externalization. This article proposes to take the renewal of systemic family therapy farther by addressing still unresolved issues, such as the role of the individual in relational systems, the place of emotions, or the construction of a relational psychopathology. The term "ultramodern family therapy" is proposed until such time as there is agreement upon a better one. [source] Bridging the Realist/Constructivist Divide: The Case of the Counterrevolution in Soviet Foreign Policy at the End of the Cold WarFOREIGN POLICY ANALYSIS, Issue 1 2005Robert S. Snyder The surprising end of the Cold War has led to a debate within international relations (IR) theory. Constructivists have argued that the end of the Cold War is best explained in terms of ideas and agency,specifically Soviet president Mikhail Gorbachev's new thinking. A few realists have countered that Soviet material decline was "endogenous" to the new ideas. Can these two theoretical perspectives be reconciled with respect to this case? They can be partially integrated with a path-dependent strategy that places an emphasis on "institutions." Nevertheless, explaining the end of the Cold War largely requires a theory of Soviet foreign policy and its relation to the state. As a former or ossified revolutionary state, Soviet foreign policy for at least several years was largely based on the principle of externalization: outside threats were used to rationalize radical centralization, repression, and the dominance of the Party. In using the USSR's institutionalized legacy as a revolutionary state, Gorbachev acted as a counterrevolutionary and reversed this process with his revolution in foreign policy. In creating a new peaceful international order, he sought,through the "second image reversed",to promote radical decentralization, liberalization, and the emergence of a new coalition. The case examines how Gorbachev's domestic goals drove his foreign policy from 1985 to 1991. [source] Dementia and Medicare at Life's EndHEALTH SERVICES RESEARCH, Issue 2 2008Vicki L. Lamb Objective. To determine the effect of a diagnosis of Alzheimer's disease or related dementias (ADRD), and the timing of first ADRD diagnosis, on Medicare expenditures at end of life. Data Sources. Monthly Medicare payment data for the 5 years before death linked to the National Long-Term Care Survey (NLTCS) for decedents between 1996 and 2000 (N=4,899). Data Extraction Methods. Medicare payment data for the 5 years before death were used to compare 5-year and 6-month intervals of expenditures (total and six subcategories of services) for persons with and without a diagnosis of ADRD during the last 5 years of life, controlling for age, gender, race, education, comorbidities, and nursing home status. Covariate matching was used. Principal Findings. On average, ADRD diagnosis was not significantly associated with excess Medicare payments over the last 5 years of life. Regarding the timing of ADRD diagnosis, there were no significant 5-year total expenditure differences for persons diagnosed with dementia more than 1 year before death. Payment differences by 6-month intervals were highly sensitive to timing of ADRD diagnosis, with the highest differences occurring around the time of diagnosis. There were reduced, non-significant, or negative total payment differences after the initial diagnosis for those diagnosed at least 1 year before death. Only those diagnosed with ADRD in the last year of life had significantly higher Medicare payments during the last 12 months of life, primarily for acute care services. Conclusions. ADRD has a smaller impact on total Medicare expenditures than previously reported in controlled studies. The significant differences occur primarily around the time of diagnosis. Although rates of dementia are increasing per se, our results suggest that long-term (1+ year) ADRD diagnoses do not contribute to greater total Medicare costs at the end of life. [source] Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of LifeHEALTH SERVICES RESEARCH, Issue 2 2004Amber E. Barnato Objective. Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. Data Source. The 1985,1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. Study Design. We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. Data Collection. The data were collected by the Centers for Medicare and Medicaid Services. Principal Findings. Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. Conclusions. Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred. [source] U.S. High-Performance Work Practices at Century's EndINDUSTRIAL RELATIONS, Issue 4 2006JOSEPH R. BLASI This study examines the incidence, industry differences, and economic environment of work practices in the United States in 1994 and 1997 using census data from a nationally representative random sample of establishments. Self-managed work teams were used by a majority of workers in some sites. Work-related meetings had higher incidence. A high-performance work organization is used in about 1 percent of establishments. There were significant industry differences associated with globalization, namely, imports and exports. [source] National Enterprises, National States and Labour Relations after the End of GlobalizationINTERNATIONAL JOURNAL OF URBAN AND REGIONAL RESEARCH, Issue 2 2001Bob Jessop Books reviewed in this essay: Edwards, Paul and Tony Elger (eds.) The global economy, national states, and the regulation of labour Waddington, Jeremy (ed.) Globalization and patterns of labour resistance Rugman, Alan The end of globalization [source] Because People Matter: Studying Global Political EconomyINTERNATIONAL STUDIES PERSPECTIVES, Issue 4 2001Ronnie D. Lipschutz The 1990s were hard on our traditional theories of International Relations and International Political Economy, and the Millennium has brought the End of Meta-Narrative as We Know It. In this article, I discuss and dissect three of the past decade's meta-narratives, and show how they were no more than failed efforts to shore up the decomposing corpus of mainstream theories. In their stead, I offer a preliminary description of a contextual and contingent approach to thinking about and analyzing global political economy. I place people at the center of my framework, and use the tools of historical materialism, feminist theory, and agency-structure analysis to generate an understanding of the relationship between what I call the "social individual" and global politics and political economy. [source] Caspase-8 in Apoptosis: The Beginning of "The End"?IUBMB LIFE, Issue 2 2000Marieke Kruidering Abstract Caspase-8 is a member of the cysteine proteases, which are implicated in apoptosis and cytokine processing. Like all caspases, caspase-8 is synthesized as an inactive single polypeptide chain zymogen procaspase and is activated by proteolytic cleavage, through either autoactivation after recruitment into a multimeric complex or trans-cleavage by other caspases. Thus, ligand binding-induced trimerization of death receptors results in recruitment of the receptor-specific adapter protein Fas-associated death domain (FADD), which then recruits caspase-8. Activated caspase-8 is known to propagate the apoptotic signal either by directly cleaving and activating downstream caspases or by cleaving the BH3 Bcl2-interacting protein, which leads to the release of cytochrome c from mitochondria, triggering activation of caspase-9 in a complex with dATP and Apaf-1. Activated caspase-9 then activates further "downstream caspases, " including caspase-8. Knockout data indicate that caspase-8 is required for killing induced by the death receptors Fas, tumor necrosis factor receptor 1, and death receptor 3. Moreover, caspase-8-/- mice die in utero as a result of defective development of heart muscle and display fewer hematopoietic progenitor cells, suggesting that the FADD/caspase-8 pathway is absolutely required for growth and development of specific cell types. [source] SSSR Presidential Address, 2004: Putting an End to Ancestor WorshipJOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION, Issue 4 2004RODNEY STARK First page of article [source] Global Restructuring and Liberalization: Côte d 'Ivoire and the End of the International Cocoa Market?JOURNAL OF AGRARIAN CHANGE, Issue 2 2002Bruno Losch The restructuring of the world cocoa market has concluded with the liberalization of the sector in the world's leading producing country, Côte d'Ivoire, clearing the way for domination by an oligopoly of global companies. This paper describes how Côte d'Ivoire's share of world production created an illusion but not the reality of market power. In the 1990s, in the wake of failed attempts to influence the world market, the Ivorian cocoa sector experienced a series of upheavals that were both pivotal to broader changes in the global market and a refiection of them. The converging strategies of new Ivorianfirms and of the major global grinding companies resulted in increased vertical integration in Côte d'Ivoire, exemplified in the development of ,origin grinding '. Later, financial difficulties encountered by Ivorian firms led to global companies taking control. Amongst the results of these changes are a decline in the role of traders, a redefinition of the relationship between grinders and chocolate manufacturers, and a standardization of cocoa quality around an average ,bulk' level. This signals the end of ,the producing countries' and of the global market. [source] Length of Stay for Older Adults Residing in Nursing Homes at the End of LifeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010Anne Kelly MSW OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1,20) and 13.7±18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. [source] Good Deaths, Bad Deaths, and Preferences for the End of Life: A Qualitative Study of Geriatric OutpatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Elizabeth K. Vig MD OBJECTIVES: Patient involvement in decision-making has been advocated to improve the quality of life at the end of life. Although the size of the oldest segment of the population is growing, with greater numbers of older adults facing the end of life, little is known about their preferences for the end of life. This study aimed to explore the attitudes of older adults with medical illness about the end of life, and to investigate whether current values could be extended to end-of-life preferences. DESIGN: Descriptive study with interviews using open- and closed-ended questions. SETTING: Patients attending two university-affiliated geriatric clinics were interviewed in a private conference room near the clinic they attended or in their homes. PARTICIPANTS: Sixteen older men and women identified by their physicians as having nonterminal heart disease or cancer. MEASUREMENTS: The interview contained open-ended questions such as: "What are the most important things in your life right now?" and "What would you consider a good/bad death?" The interview also contained closed-ended questions about symptoms, quality of life, and health status. Additional questions elicited preferences for the end of life, such as location of death and the presence of others. The open-ended questions were tape-recorded, transcribed, and analyzed using qualitative methods. The closed-ended questions were analyzed using descriptive statistics. RESULTS: Patients with heart disease and cancer provided similar responses. Participants' views about good deaths, bad deaths, and end-of-life scenarios were heterogeneous. Each participant voiced a unique combination of themes in describing good and bad deaths. Because each participant described a multifaceted view of a good death, for instance, no theme was mentioned by even half of the participants. Participants provided differing explanations for why given themes contributed to good deaths. Currently valued aspects of life were not easily translated into end-of-life preferences. For example, although the majority of participants identified their family as being important, many gave reasons why they did not want their family members present when they died. CONCLUSIONS: Because of the heterogeneity of views and the difficulty in inferring end-of-life preferences from current values, older adults should be asked not only questions about general values, but also specific questions about their end-of-life choices and the reasons for these choices. A thorough understanding of an individual's end-of-life preferences may help health professionals working with older adults develop patient-centered care plans for the end of life. [source] | |||||||||||||||||||||||||||||||||||||