Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients.The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health (...) and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians , the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a “checklist of considerations” . Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline . The accordingly adapted “checklist of considerations” was tested in a pilot study , after which all experts endorsed the checklist .The resulting “checklist of considerations” structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

When I was seven years old I discovered that I had been seeing the world differently from other people. My senses were joined. I was a synesthete. Over the years, I learned quite a bit about my synesthesia, but I was surprised in 2013 when I suddenly began to have another kind of vision, hypnagogic images. At first, I thought these new visions were part of my synesthesia, that I was seeing a new form, one I didn’t have a name (...) for. But synesthesia needs a trigger, a trigger that causes us to see what we see. This form did not have a trigger, and that concerned me. In this paper I will explore the visual similarities and differences between my synesthetic photisms and my hypnagogic visions. I will compare the triggers or lack thereof, where I see the images, the ways in which the shapes I see appear, their colors, and their commonalities. I will discuss how the hypnagogic visions have changed, along with the fact that now both synesthetic and hypnagogic visions occur during the same experience, and that I have found other synesthetes who also have both synesthesia and hypnagogia. À l’âge de sept ans j’ai découvert que je voyais le monde différemment des autres. Mes sens étaient reliés. J’étais une synesthète. Avec les années, j’ai beaucoup appris sur ma synesthésie mais j’ai été surprise en 2013 quand soudain j’ai commencé à voir une autre sorte de vision, des images hypnagogiques. Au début j’ai pensé que ces nouvelles visions faisaient partie de ma synesthésie, que j’en voyais une nouvelle forme, dont j’ignorais le nom. J’ai commencé à être préoccupée par cette forme qui n’avait pas de déclencheur. Dans cet article j’explorerai les similarités visuelles et les différences entre mes photismes synesthétiques et mes visions hypnagogiques. Je comparerai les déclencheurs ou leur absence, les espaces où je vois les images et de quelles manières apparaissent les formes que je vois, leurs couleurs et leurs points communs. J’examinerai comment changeaient les visions hypnagogiques et le fait que je vois des visions à la fois synesthésiques et hypnagogiques se produire dans la même expérience, et que j’ai trouvé d’autres synesthètes qui eux aussi ont à la fois la synesthésie et l’hypnagogie. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists....

Consistent application of dialectical materialism leads Marxism-Leninism to the assertion that matter is infinite in its properties. However, the history of physics shows that the various levels of matter possess geometric dimensions that originate at the lowest level and continue through the others. The search for absolute natural constants -- which Planck called the most pleasant task of physics -- shows the conviction of the physicists that there is a limit to the parameters, a limit beyond which matter is no (...) longer divisible. (shrink)

The Database on Ethics Related Legislation and Guidelines was launched in March 2007 as the fourth database of the UNESCO Global Ethics Observatory system of databases in ethics of science and technology. The database offers a collection of legal instruments searchable by region, country, bioethical themes, legal categories and applicability to specific articles of the UNESCO Universal Declaration on Bioethics and Human Rights and International Declaration on Human Genetic Data. This paper discusses the background and rationale for the database and (...) its role as a consultative and comparative resource hub for the study of ethics related legal instruments across the world, with the purpose of informing and inspiring relevant stakeholders on the implementation of the principles contained within the UNESCO declarations on bioethics. (shrink)