Background. There is a variation in dialysis withdrawal rates, but reasons for this variation across European countries are largely unknown. We therefore surveyed nephrologists' perceptions of factors concerning dialysis withdrawal and palliative care and explored relationships between these perceptions and reports of whether withdrawal actually occurred in practice. Methods. We developed a 33-item electronic survey, disseminated via an email blast to all European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) members. In our data analyses, we distinguished those respondents who reported occurrence from those reporting no dialysis withdrawal in their unit. With multilevel logistic regression, we investigated the association between respondents' characteristics and perceptions and whether they reported occurrence of dialysis withdrawal or not. Results. Five hundred and twenty-eight nephrologists from 45 countries completed the questionnaire; 42% reported occurrence of withdrawal in their unit in the past year, and 56% perceived that stopping life-prolonging treatment in terminally ill patients was allowed. Few respondents reported presence in their unit of protocols on withdrawal decision making (7%) or palliative care (10%) or the common involvement of a geriatrician in withdrawal decisions (10%). The majority stated that palliative care had not been part of their core curriculum (74%) and that they had not recently attended continuous medical education sessions on this topic (73%). Respondents from Eastern and Southern Europe had a 42 and 40% lower probability, respectively, of reporting withdrawal compared with those from North European countries. Working in a public centre [odds ratio (OR), 2.41; 95% confidence interval (CI), 1.36-4.25] and respondents' perception that stopping life-prolonging treatment in terminally ill patients was allowed (OR, 1.96; 95% CI, 1.23-3.12), that withdrawal decisions were commonly shared between doctor and patient (OR, 1.97; 95% CI, 1.26-3.08) and that palliative care was reimbursed (OR, 1.81; 95% CI, 1.16-2.83) increased the odds of reporting occurrence of withdrawal. Conclusion. Reports of dialysis withdrawal occurrence varied between European countries. Occurrence reports were more likely if respondents worked in a public centre, if stopping life-prolonging treatments was perceived as allowed, if withdrawal decisions were considered shared between doctors and patients and if reimbursement of palliative care was believed to be in place. There is room for improvement regarding protocols on withdrawal and palliative care processes and regarding nephrologists' training and education on end-of-life care.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 26 Φεβρουαρίου 2016
Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey
When deception becomes easy: the effects of task switching and goal neglect on the truth proportion effect
Lying is typically more cognitively demanding than truth telling. Yet, recent cognitive models of lying propose that lying can be just as easy as truth telling, depending on contextual factors. In line with this idea, research has shown that the cognitive cost of deception decreases when people frequently respond deceptively, while it increases when people rarely respond deceptively (i.e., the truth proportion effect). In the present study, we investigated two possible underlying mechanisms of the truth proportion effect. In Experiment 1 (N = 121), we controlled for the impact of switch costs by keeping the number of switches between deceptive and truthful responses constant. We found that people who often responded deceptively made fewer errors when responding deceptively than people who only occasionally responded deceptively, replicating the truth proportion effect. Thus, while the truth proportion effect in earlier studies may be partially driven by the cost of switching between truthful and deceptive responses, we still found evidence for the truth proportion effect while controlling for switch costs. In Experiment 2 (N = 68), we assessed whether the truth proportion effect is influenced by goal neglect. According to this view, the truth proportion effect should be reduced if participants are cued to maintain the task goals, while it should be larger when participants are allowed to neglect the task goals. In line with this hypothesis, we found a smaller truth proportion effect when participants were cued with the task goals compared to when they were not cued. This study shows that the truth proportion effect is influenced by goal neglect, implying that frequent deceptive responding strengthens the goal of responding deceptively. Our findings imply that the accuracy of lie detection tests could be increased by using a majority of truth items (i.e., induce the truth proportion effect), and that the truth proportion effect should be maximized
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Selecting a strategy for prevention of contrast-induced nephropathy in clinical practice: an evaluation of different clinical practice guidelines using the AGREE tool
Background. Contrast-induced acute kidney injury (CI-AKI) is a potential complication of radio-contrast investigations. Many organisations have published guidance documents on the prevention of CI-AKI. Our aim is to explore the scope, content, consistency, practicality in clinical practice and reasons for eventual underlying discrepancies of these documents. Methods. We searched the literature for guidance documents developed to guide prevention of CI-AKI up to 09/2014. Four reviewers appraised guideline quality using the 23-item AGREE-II instrument, which rates reporting of the guidance development process across six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence. Total scores were calculated as standardised averages by domain. Results. Twenty-four guidance documents were evaluated. The guidance documents were produced by radiologists (N = 7), intensivists (N = 2), nephrologists (N = 6) or multidisciplinary teams (N = 9). One document did not mention the background of the authors. Only guidance documents (N = 15) that were not mere adaptations of existing guidelines were evaluated more in depth, using the AGREE tool. Overall, quality was mixed: only one clinical practice guidance document obtained an average score of >50% for all domains. The evidence was rated in a systematic way in only 11, and only 7 graded the strength of the recommendations. The Kidney Diseases Improving Global Outcomes guideline was the only one recommended without adaptions by all assessors. The guidance documents agreed in recommending pre-hydration as the main preventive measure, but there was difference in recommended total volumes, composition, rate and duration of the infused solutions. There was no consensus on the use of NaHCO3, with eight recommending it, six considering it and one not. Five guidance documents mentioned oral pre-hydration as a possibility, and none recommended N-acetylcysteine as solitary preventive-measure. More recent guidance documents recommend avoiding hypertonic contrast media, but did not recommend preference of iso-osmolar over low-osmolar contrast media. Most guidance documents recognised pre-existing chronic kidney disease, diabetes, age and cardiovascular comorbidity as risk factors. Conclusions. There seems to be a relative consensus on the need for adequate pre-hydration to avoid CI-AKI, but recommendations to define at-risk populations for whom these measures should be applied and how they should be implemented differ substantially. Based on accumulating evidence, more recent guidelines do not recommend iso-osmolar over low-osmolar contrast media, whereas all recommend avoiding hypertonic agents.
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Generalizing attentional control across dimensions and tasks: evidence from transfer of proportion-congruent effects
Three experiments investigated transfer of list-wide proportion congruent (LWPC) effects from a set of congruent and incongruent items with different frequency (inducer task) to a set of congruent and incongruent items with equal frequency (diagnostic task). Experiments 1 and 2 mixed items from horizontal and vertical Simon tasks. Tasks always involved different stimuli that varied on the same dimension (colour) in Experiment 1 and on different dimensions (colour, shape) in Experiment 2. Experiment 3 mixed trials from a manual Simon task with trials from a vocal Stroop task, with colour being the relevant stimulus in both tasks. There were two major results. First, we observed transfer of LWPC effects in Experiments 1 and 3, when tasks shared the relevant dimension, but not in Experiment 2. Second, sequential modulations of congruency effects transferred in Experiment 1 only. Hence, the different transfer patterns suggest that LWPC effects and sequential modulations arise from different mechanisms. Moreover, the observation of transfer supports an account of LWPC effects in terms of list-wide cognitive control, while being at odds with accounts in terms of stimulus–response (contingency) learning and item-specific control.
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21st century education, care and support for children and adults with a disability in Flanders (Belgium)
At the turn of the 2l st century, substantial changes are taking place in Flanders (Belgium) with regard to the organization of education, care and support for people with disabiliîies. Overall, these changes are the result of new theoreticat insighr ãnd changed perspectives on disabilities: shift towards q social-ecological approach, supports paradigm and quality of life. The so-called "M-Decree" and Perspective 2020 qre the two most important reforms currently taking place in Flanders. The "M-Decree", a reþrm plan for special education which was approved in the Flemish Parliament in 2014, now wants to make a radical shift and aims at mainstreaming students with special needs in primary and se:condary education. Untilt now, the r"gr"gãrcd rpecial school remained the dominant type of education. Second, Perspective 2020, a policy plan lounched in 2010, aims at the active inclusion andfull participation of peopte with disabilities in society. This plan contains a centralfocus on the client and his/her network, stimulates person-centered support processes and plans through more individualizedfunding and induces a shiftfrom a supply-oriented model of care and support towards a demand-oriented model. Both ìeþrms are currently being implemented and will result in important changes, opportunities and challenges during the coming years.
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