Search

Background: Many persons and their families are burdened by serious chronic illness in late life. How to best support quality of life is an important consideration for care. Purpose: To assess evidence about interventions to improve palliative and end-of-life care. Data Sources: English-language citations (January 1990 to November 2005) from MEDLINE, the Database of Abstracts of Reviews of Effects, the National Consensus Project for Quality Palliative Care bibliography, and November 2005 to January 2007 updates from expert reviews and literature surveillance. Study Selection: Systematic reviews that addressed 'end of life,' including terminal illness (for example, advanced cancer) and chronic, eventually fatal illness with ambiguous prognosis (for example, advanced dementia), and intervention studies (randomized and nonrandomized designs) that addressed pain, dyspnea, depression, advance care planning, continuity, and caregiving. Data Extraction: Single reviewers screened 24 423 titles to find 6381 relevant abstracts and reviewed 1274 articles in detail to identify 33 high-quality systematic reviews and 89 relevant intervention studies. They synthesized the evidence by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) classification. Data Synthesis: Strong evidence supports treating cancer pain with opioids, nonsteroidals, radionuclides, and radiotherapy; dyspnea from chronic lung disease with short-term opioids; and cancer-associated depression with psychotherapy, tricyclics, and selective serotonin reuptake inhibitors. Strong evidence supports multi-component interventions to improve continuity in heart failure. Moderate evidence supports advance care planning led by skilled facilitators who engage key decision makers and interventions to alleviate caregiver burden. Weak evidence addresses cancer-related dyspnea management, and no evidence addresses noncancer pain, symptomatic dyspnea management in advanced heart failure, or short-acting antidepressants in terminal illness. No direct evidence addresses improving continuity for patients with dementia. Evidence was weak for improving caregiver burdens in cancer and was absent for heart failure. Limitations: Variable literature indexing for advanced chronic illness and end of life limited the comprehensiveness of searches, and heterogeneity was too great to do meta-analysis. Conclusion: Strong to moderate evidence supports interventions to improve important aspects of end-of-life care. Future research should quantify these effects and address the generalizability of insights across the conditions and settings of the last part of life. Many critical issues lack high-quality evidence.

The strategic plan developed by the Akron Police Department, to control crime in Akron community, is presented. The details of protective measures included in the plan for enhancing the quality of life, and promoting safety to the community, are also discussed.

Under the leadership of the police department and with coordinated efforts of other services departments, and community involvement, good quality of life is provided to citizens of El Monte, California. The benefits derived under the Impact (Improving and Maintaining Public Awareness and Community Teamwork) are presented with specific instances.

Quality management is an important aspect with regard to every activity in our personal as well as professional lives. In order to maintain the required quality one has to set standards and use check list to measure the process and its progress. Methods to cope up with the set quality standards are suggested.

There comes a time when only the audacity of a parable and a symbol can make the fact live as a truth. Therefore, to realize the integrity of man in […]

How Texas lawyer and former alcoholic John McShane has changed his life is described. McShane now practices family and criminal law and handles professional and license discipline matters. He has cut back on his work schedule and practices regular meditation. How McShane has brought about the changes in his life are the topic of his lectures to lawyer groups throughout the US.

Research on the effectiveness of interdisciplinary geriatric primary care management after a 2-year time period is presented. Results indicate quality of life for aged patients improved and that such an approach to health care management is effective.

My own idea of what makes for a good place to work is laughably simple: Pay a living wage or better; require about 30 hours of work a week; then [...]

If we were to choose a symbol for our great nation, why not the waffle iron? It's a pefect fit: Indecision has become our national pastime. It's now bigger than [...]