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Minimal information is available about the quality of dying and death in Uganda and Kenya, which are African leaders in palliative care. We investigated the quality of dying and death in patients with advanced cancer who had received hospice care in Uganda or Kenya.
Methods
Observational study with bereaved caregivers of decedents (Uganda: n = 202; Kenya: n = 127) with advanced cancer who had received care from participating hospices in Uganda or Kenya. Participants completed the Quality of Dying and Death questionnaire and a measure of family satisfaction with cancer care (FAMCARE).
Results
Quality of Dying and Death Preparation and Connectedness subscales were most frequently rated as good to almost perfect for patients in both countries (45.5% to 81.9%), while Symptom Control and Transcendence subscales were most frequently rated as intermediate (42.6% to 60.4%). However, 35.4% to 67.7% of caregivers rated overall quality of dying and overall quality of death as terrible to poor. Ugandan caregivers reported lower Preparation, Connectedness, and Transcendence (p < .001). Controlling for covariates, overall quality of dying was associated with better Symptom Control in both countries (p < .001) and Transcendence in Uganda (p = .010); overall quality of death, with greater Transcendence in Uganda (p = .004); and family satisfaction with care, with better Preparation in Uganda (p = .004).
Significance of results
Findings indicate strengths in spiritual and social domains of the quality of dying and death in patients who received hospice care in Uganda and Kenya, but better symptom control is needed to improve this outcome in these countries.
Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic.
Methods:
Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care.
Results:
Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom’s follow-up was performed mainly by PHC.
Conclusion:
PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.
To compare the efficacy of computed tomographic angiography (CTA) to that of digital subtraction angiography (DSA) in the detection of secondary causes of intracerebral hemorrhage (ICH).
Methods:
Between January 2001 and February 2007 there were 286 patients that had both CTA and DSA for intracranial hemorrhage of all types. Those with primarily subarachnoid hemorrhage or recent trauma were excluded. Fifty-five patients formed the study cohort. Three reviewers independently analyzed the CTAs in a blinded protocol and classified them based on presence or absence of a secondary etiology. Results were compared with the reference standard DSA and kappa values determined for interobserver variability.
Results:
The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 89%, 92%, 91%, 91% and 91%, respectively. Kappa value for interobserver agreement ranged from 0.78 to 0.89. Two of four dural arteriovenous fistulas (dAVF) were missed on CTA by all three reviewers.
Conclusion:
CTA is nearly as effective as DSA at determining the cause of secondary intracerebral hemorrhage, but with a lower sensitivity for dAVFs. This supports the use of CTA as the first screening test in patients presenting with spontaneous ICH.
This article discusses recent cliometric contributions by German and non-German economic historians to the field of German economic history. After a brief attempt to describe the field in Germany I survey recent work in four specific topical areas – which thus serve as rough indices of the spread and development of econometric and quantitative techniques in the field. I conclude that a German ‘cliometric revolution’ has not yet taken place, but that promising beginnings have been made.
To discuss the role of banks and bankers in nineteenth-century Germany is to hallow one of that country's historiographical traditions. For the topic is an evergreen, as old as the German consciousness of industrial development as a national achievement itself. Entrepreneurs, and especially bankers, contributed to the literature from the start, but financial journalists, academic economists and even politicians spoke out as well. To point to the fact that many of these writers were engaged in special interest, pleading rather than attempting to write banking history as it ‘really was’, may be logically fallacious as criticism, but nevertheless relevant. That standard work on Germany's large banks, by Jacob Riesser (The German Great Banks and their Concentration), was a response to public criticism of those banks and their power for evil by a director of one of the largest banks, the Bank für Handel und Industrie zu Darmstadt. Heargued for a minimum of government regulation on the grounds that the banks ‘naturally’ operated in the public national interest without compulsion – an important part of his argument built on the belief that competition among banks remained intense, despite growing concentration at the top. About the same time (1909) Rudolf Hilferding's study, Finanz-Kapital appeared, covering some of the same ground as Riesser but focusing on the considerable degree of monopoly power he believed the banks to have over industry and integrating that phenomenon into are vision of Marxist theory (as part of the concept, ‘Organized Capitalism’). More on this question below.