bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of palliative care in intubated patients with metastatic cancer: A 10-year nationwide analysis.
Authors: Gupta Arjun , Das Avash , Bhulani Nizar , Tariq Raseen , Frank Ryan D. , Khanna Sahil , Beg Muhammad Shaalan 
Published: November 2017

69 Background: Due to improved survival, an increasing number of patients with advanced cancer are eligible for aggressive ICU care, including intubation. The American Society of Clinical Oncology recommends early integration of palliative care in patients with advanced cancer. We analyzed 10-year trends in the utilization of palliative care, and predictors of palliative care use in patients with metastatic cancer undergoing intubation using the National Hospital Discharge Survey database from 2001-2010. Methods: Diagnosis and procedure codes were utilized to identify adult patients with metastatic cancer who underwent intubation, and received palliative care. Demographics, diagnoses, length of stay (LOS), and discharge information were extracted. T-tests and χ^2 tests were used to compare medians and proportions respectively in patients that did or did not receive palliative care. Multivariate regression models with weighted analysis were conducted to study predictors of palliative care use. Results: Over the 10-year study period, 200,350 patients with metastatic cancer and intubation were identified, mean age 65.3 years, 46.2% male. Of these, 6690 (3.3%) received palliative care. There was a significant increase in the use of palliative care from 2001 (0%) to 2010 (17.4%), p for trend < 0.001. In multivariate analysis, patients who received palliative care were more likely to have age > 65 years, be white vs non-white, be hospitalized in 2009-2010 vs 2000-2001, and be admitted to hospitals in the Western part of the US. The overall inpatient mortality rate was 57.3%, discharge to a care facility (DTCF) rate was 15.2%, and mean LOS was 11.1 days. The LOS and DTCF rates were similar in patients with and without palliative care. Patients with palliative care had higher rates of inpatient mortality (adjusted OR 9.6, 95% CI 2.2- 42.0). Conclusions: There was a dramatic increase in the use of palliative care in intubated patients with metastatic cancer. Studies to address the racial and geographic discrepancies in palliative care use are warranted. The higher mortality in palliative care group suggests it is being used for the sickest patients. Early (vs end of life) palliative care may be more beneficial.
Patients' perspectives on participation in clinical trials and palliative end-of-life care for management of advanced cancers in Nigeria.
Authors: Egwim Jideuma Ikenna , Palejwala Smita 
Published: November 2017

78 Background: Advanced cancers remain a major cause of mortality in Nigeria. Participation in clinical trials (PCTs) and palliative end-of-life care (PEOLC) are two approaches to incurable cancer management in the developed nations but these have been less adopted in Nigeria. This study set out to determine patients’ preferred approach between PCTs and PEOLC for management of advanced cancers in Nigeria. Methods: A survey of 120 advanced cancer patients was conducted using a questionnaire with 5-point Likert scale, variables of interest included demographic information, knowledge and perception about PCTs and PEOLC. Results: Majority of the patients (84%) agree PCTs is an option in management of incurable cancer but just about half accept it is beneficial and will improve their QOL, as against PEOLC, where all the patients considered it an option and deem it beneficial; with 99% and 98% respectively agreeing it will enhance their QOL and that of family members. About 56% believe PCTs carries a risk of burdensome interventions and 52% increased hospital stay at EOL while 47% are of the opinion it will increase cost of care with 45% stating it will lead to increased ICU death. Sixty-nine percent (69%) and 63% respectively agree PCTs increases the suffering of patients and family members while 43% believe it carries a net negative risk-benefit profile, nevertheless, 83% are ready to overlook the risk of PCTs for possible therapeutic benefit while for 87%, the primary motivation for PCTs is personal cure. Majority (58%) believe PCTs does not improve quality of dying/death contrary to PEOLC where 88% believe it would improve the quality of dying/death. Overall, by direct comparison 78%:13% prefer PEOL to PCTs; {X2(p-value), 40.26(0.001)}. Conclusions: Both modalities are acceptable to advanced cancer patients but the study reveals several ethical issues with PCTs including risk of burdensome interventions, suffering of patients, therapeutic misconception and misperception of curability. A major determinant to accepting PEOL is its positive impact on patients’ QOL. Concerted efforts are needed to significantly enhance access of PEOLC to cancer patients.
What gives your life meaning (WGYLM)? Strategies to encourage advanced care planning.
Authors: Madani Catherina Anne , Yi Cassia , Edmonds Kyle , Hamill Sharon 
Published: November 2017

8 Background: Conversations regarding healthcare decisions are central to patient-and-family-centered care. Early and regular advanced care planning (ACP) conversations benefit the patient, family, multidisciplinary team, and healthcare system. Initiatives targeting employee’s participation in their own ACP may extend to improvement in patients’ ACP utilization. Methods: A social experiment entitled, “What gives your life meaning” (WGYLM?) initially developed at California State University, San Marcos to increase student’s awareness of ACP was adapted to focus health system’s employees’ attention on ACP over the course of a 3-month campaign that culminated during National Healthcare Decisions week. Results: 55 volunteers were involved in the campaign. Over 10,000 workstation screensavers displayed campaign slogans. A system-wide newsletter with 12,500 subscribers included a campaign write-up. The local newspaper featured a front-page color article. Almost 1,700 post-its with comments of what gives their life meaning were collected. More than 1500 ACP packets with ACP resources were distributed with over 1200 people signing a pledge to have an ACP discussion with a loved one within 30 days. Of the 664-successful follow-up email sent to pledge participants: 77 (12%) of respondents responded to the survey; 44% were nurses, and 12% were physicians; 41% reported already having an AD in place, while 21% did not currently have a designated person to make healthcare decisions on their behalf; 66 (85%) reported talking with someone about what gives their own life meaning. Of these, 51% reported it was their spouse they spoke with and 34% reported it was a coworker; 5% created an AD, and 8% edited an AD since the campaign; 73% agreed it helped them think about ACP in a less scary way; 83% agreed it increased their interest in thinking about future healthcare preferences; and 79% agreed it motivated them to talk about healthcare they would want to receive at EOL with a loved one. Conclusions: ACP conversations can be used to prepare anyone regardless of age, sex, culture, or disease. Asking heath care providers, “What gives your life meaning” may familiarize them with the process of ACP and emboldened them to encourage patients to have these same crucial conversations.
A picture of early death after admission in patients with advanced cancer at the end-of-life.
Authors: Hiramoto Shuji , Kikuchi Ayako , Tetsuo Hori , Yoshioka Akira , Tamaki Tomoko 
Published: November 2017

80 Background: Little is unknown about a picture of early death after admission in terminal phase of advanced cancer patients. Previous studies have reported that approximately 14.3% of patients with cancer enroll in hospice in the last 3days of life. Methods: We retrospectively analyzed data for 510 advanced cancer patients at the end of life between August 2011 and August 2016, and contained deceased 83 (16.3%) patients within 3days after admission in our institute. We divided into deceased patients within 3days and more than 4days after admission. Primary endpoints are to compare each symptom (delirium, cancer pain, dyspnea, nausea and vomiting, fatigue) and intervention (hydration, continuous sedation, opioid) at the end of life. Secondary endpoints are association between prognostic factor and early death (within 3days) after admission. Results: Symptoms about delirium, cancer pain, dyspnea, nausea and vomiting were no significant difference between deceased patients within 3days and more than 4days after admission. Mean hydration at the end of life was more significantly volume of infusion for patients in within 3days (0.34 Litters/day) than in over 4 days (0.20 Litters/day). Continuous sedation was significantly less for patients within 3days (4.82%) than in over 4 days (28.64%). Mean of opioid use was significantly less for patients within 3days (Oral morphine dose 23.54mg/day) than in over 4 days (41.11mg/day). In univariate analysis primary site of cancer was tend to (p = 0.086), and number of metastatic site (p = 0.018) and consciousness level ( < 0.0001) and performance status ( < 0.0001) were significantly associated with early death. In multivariate analysis number of metastatic site (p = 0.057) and consciousness level ( < 0.0001) and performance status (p = 0.0004) were significantly associated with early death. Conclusions: We reports a picture of early death after admission in advanced cancer patients at the end-of-life, and number of metastatic site and consciousness level and performance status might be predictors for short-term prediction model.
An evaluation of the QUAL-EC in the clinical care of patients with advanced cancer.
Authors: Wilkinson Anne , Slatyer Susan , Nowak Anna , Pienaar Cathy , Tandon Anil 
Published: November 2017

85 Background: We piloted the Quality of Life at the End of Life (QUAL-E) in Australian palliative care in-patients (N = 52) and demonstrated feasibility, acceptability and face validity. An unexpected finding was the potential for the QUAL-E to prompt psycho-social-spiritual discussion when conducted as an interview, indicating opportunities for enhanced support.We compared a 17-item QUAL-E-Cancer (QUAL-EC) to the Distress Thermometer Screening Tool (DT) and participants’ experience when the QUAL-EC was conducted as an interview. Methods: A cross-sectional, mixed methods design was used. Convenience sampling recruited patients (N = 50) with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the DT, followed by the QUAL-EC which was digitally recorded as an interview. Results: Correlational and thematic analysis found that 39.6% of participants reported severe distress (score ≥7) while 40% reported moderate distress (score 4-6) on the DT. Levels of distress significantly correlated with two QUAL-EC domains: symptom control ( r= 0.52, p < 0.001) and preparation for end of life ( r= 0.32, p < 0.05). Qualitative analysis identified six themes: the health care team; family issues; approaching death; worry; coping and QUAL-EC experience. Feasibility: completion of the QUAL-EC ranged from 3-14 minutes (M = 7.37 minutes, SD 3.05 minutes). Acceptability: Participants overwhelmingly found the questions to be clear and did not find the questions hard to understand, hard to answer or stressful. Ninety per cent of participants agreed or strongly agreed that they were glad they took part. Conclusions: Patient distress was associated with either symptom burden or concerns about their family/loved ones. When distress is identified on screening, the QUAL-EC offers good potential for nuanced, versus vague, assessment of globalised distress (e.g., DT) as an aid in targeting patient-centered clinical/psycho-social interventions.
How do clinics perform across multiple end of life metrics?
Authors: Panattoni Laura Elizabeth , Fedorenko Catherine R. , Greenwood-Hickman Mikael Anne , Sun Qin , Walker Julia Rose , Kreizenbeck Karma L. , McDermott Cara L. , Conklin Ted , Smith Bruce , Lyman Gary H. , Ramsey Scott David 
Published: November 2017

86 Background: National bodies have proposed a number of metrics to measure quality of care at the end of life (EOL). MACRA legislation allows clinics to select the metrics they report to CMS. The self-selection of reported metrics leaves open questions about how representative certain measures, particularly in isolation, may be of overall EOL care in community settings. We examined the consistency of clinical-level performance across three common EOL metrics. Methods: We linked cancer registry records for solid tumor cancer patients diagnosed in Washington State from 2013-2016 with claims from two regional commercial insurers. Representing national recommendations, we compiled 3 EOL quality metrics for each clinic: 1) Chemotherapy in last 14 days of life (DoL); 2) More than 1 ED visit in last 30 DoL; and 3) Admission to ICU in last 30 DoL. Consistency was measured by comparing performance in the top and bottom 3rd across metrics. We compared consistency based on unadjusted rates and risk-standardized rates calculated following CMS methods. Results: The study included 1,535 patients across 12 clinics (median 110 [IQR: 54 – 199] patients/clinic). The clinic rates are below. (See Table.) According to both unadjusted and adjusted rankings, no clinics ranked in the top 3rd across all metrics. Half of clinics (6 of 12) simultaneously ranked in the top 3rd and bottom 3rd of a metric, i.e. high/low performers. The number of high/low performers varied when examining discrete pairs of metrics. The overall pattern was mainly driven by inconsistency between performance in the chemotherapy and ED metrics. Of the other discrete pairs, ICU/Chemo and ICU/ED, clinics were more consistent in performance. Conclusions: We found that clinic performance was not consistently in the highest or lowest tertile across common EOL metrics, suggesting that requiring clinics to report a standard set of metrics may provide a more accurate indication of quality. Furthermore, different population management strategies may be required to improve care targeted by each measure. Future work should focus on the development of multi-dimensional EOL quality performance measures. [Table: see text]
Entre profesor, artista y sanador
Authors: Alfonso Morales Luis 
Published: November 2017

En la actual coyuntura de agotamiento y cambios en proceso en los modelos sociales, económicos y de paradigmas del conocimiento, se ha dado una confluencia de saberes de diferente orden: científico, ancestral y metafísico. Como resultado de ello, se podría afirmar que grupos humanos de diversa índole están buscando de una u otra manera el despertar de laconciencia, el salto cuántico o bien la evolución espiritual. Esto se podría explicar en parte por los conocimientos que nos da la etnofarmacognosia de un lado, pero a su vez, nos podemos apoyar en estudios basados en la neurociencia para explicar el fenómeno chamánico. Estas condiciones extraordinarias, podrían ser el detonante que por varias décadas el mundo del arte había estado esperando para no seguir en la espiral de mutación y flexibilización de roles a que nos habíamos visto abocados los artistas para replantear nuestro papel en el mundo; en esta época convulsionada se están cimentando condiciones para cambios realmente drásticos y de fondo que transformarán los roles y el sentido de las creaciones.
AUDIT HAK KEKAYAAN INTELEKTUAL SEBAGAI BAGIAN PENGELOLAAN RISIKO KERUGIAN BISNIS BAGI PERUSAHAAN
Authors: . Kusnandi , Santoso Budi 
Published: November 2017

Aset Hak Kekayaan Intelektual (HKI) saat ini masih dipandang sebelah mata oleh sebagian besar perusahaan di Indonesia. Apabila mengingat terhadap nilai ekonomi yang dihasilkan dari aset tersebut jauh lebih menguntungkan dibandingkan dengan aset berwujud lainnya (tangible assets). Namun disamping nilai ekonomi yang didapat, tidak jarang aset HKI tersebut memunculkan beragam potensi risiko seperti risiko hukum dalam bentuk pelanggaran atau kejahatan HKI apabila aset HKI tersebut tidak dikelola dengan baik dan benar. Dalam hal ini, konsep audit HKI menjadi salah satu solusi untuk mengantisipasi dan/atau meminimalisasi risiko kerugian bisnis terhadap aset perusahaan. Penelitian menganalisis mengenai konsep Audit HKI yang berbasis pada risiko kerugian bisnis yang diakibatkan dari ketidakmampuan perusahaan dalam mengelolaan aset-aset HKI miliknya. Penelitian ini dilakukan dengan menggunakan metode pendekatan yuridis normatif. Hasil Penelitian menunjukan bahwa Audit HKI berbasis risiko dapat digunakan oleh perusahaan sebagai strategi kebijakan internal perusahaan dalam mengantisipasi beragam risiko kerugian. Fenomena risiko muncul dari pemeliharaan dan penjagaan aset hak kekayaan intelektual yang tidak dikaji secara spesifik dan terukur. Berdasarkan penelitian perlu diadakannya suatu usaha untuk mengkaji kembali terhadap posisi tawar yang diberikan dari audit HKI yang lebih mengedepankan risiko-risiko bisnis dimana secara bersamaan akan menghasilkan nilai dan keuntungan ekonomi bagi pemilik perusahaan. dan secara praktisi, para pengusaha perlu membuat divisi/departemen khusus dalam struktur organisasinya menjadi bagian dalam pengelolaan aset perusahaan dalam bentuk kekayaan intelektual serta membangun sistem perlindungan secara mandiri terhadap aset HKI tersebut untuk mencegah atau meminimalisir risiko-risiko kerugian yang timbul akibat dari pelanggaran-pelanggaran hukum HKI.
PERLINDUNGAN HAK EKONOMI TERHADAP PENGGUNAAN MEREK DALAM PERJANJIAN WARALABA
Authors: Hayuningrum Yulia Widiastuti , Roisah Kholis 
Published: November 2017

Waralaba sebagai jalur distribusi yang sangat efektif untuk mendekatkan merek produk kepada konsumen sekaligus sebagai sarana eksploitasi hak ekonomi merek bagi pemiliknya. Penelitian membahas perlindungan hak ekonomi atas penggunaan merek dalam perjanjian waralaba dan cara pemberi waralaba mengeksploitasi hak ekonomi mereknya. Metode penelitian ini menggunakan metode yuridis normative. Hasil penelitian menunjukkan Upaya perlindungan dan eksploitasi hak ekonomi atau kepemilikan eksklusif bagi pemilik merek melalui perjanjian waralaba dilakukan dengan mengatur hak dan kewajiban yang jelas perjanjian waralaba antara pemilik merek produk dan penerima waralaba. Kewajiban penerima waralaba untuk menggunakan setiap unsur tanda merek dan menggunakan memproduksi produk merupakan upaya menjaga reputasi dan ekuitas kepemilikan hak merek pemberi waralaba. Perjanjian waralaba merupakan salah satu cara pemilik merek mengeksploitasi hak atas mereknya juga memperluas distribusi produk yang berkaitan dengan mereknya. Eksploitasi hak ekonomi melalui perjanjian waralaba secara ketat tidak selalu pada merek terkenal, bahwa merek terkenal CFC tidak terlalu rigit dalam mengatur klausula-klausula perjanjian penggunaan dan pemenfaatan hak mereknya sedangkan merek nasional “Ayam Bakar Wong Solo” mengatur pemanfaatan hak mereknya tersusun amat detail dan rapi dalam perjanjian waralabanya.
IMPLIKASI UNDANG-UNDANG CUKA! TERHADAP KETAATAN PENGUSAHA PABRIK ROKOK DALAM MEMBAYAR CUKAI (STUDI DI KANTOR PENGAWASAN DAN PELAYANAN BEA DAN CUKAI TIPE A2 KUDUS)
Authors: Hardjito Yohanes R. Sri Agoeng 
Published: November 2017

Cukai adalah pungutan negara yang fungsi utamanya membatasi peredaran barang kena cukai. Sebagai konsekuensi dan fungsi tersebut, cukai memberikan kontnbusi penerimaan negara yang cukup berarti. Sebagai pungutan Negara, cukai diatur dalam Undang-Undang Cukai yaitu Undang-Undang Nomor 11 tahun 1995 tentang Cukai sebagaimana diubah dengan Undang-Undang Nomor 39 Tahun 2007. KPPBC Kudus merupakan salah satu kantor yang menyumbang penerimaan cukai terbanyak, di samping jumlah industn rokoknya menempati jumlah tertinggi dibandingkan KPPBC lainnya. Peredaran rokok illegal di wilayah pengawasan KPPBC Kudus juga mengalami peningkatan sehingga dikhawatirkan berpengaruh terhadap penerimaan Negara di sektor cukai..Penelitian ini bertujuan menjawab permasalahan-permasalahan sebagai berikut: (i) bagaimana fungsi utama Undang-Undang Cukai dalam membatasi peredaran rokok tanpa hams meniadakan fungsi budgeter? (ii) Pengusaha rokok seperti apa yang tidak taat dalam membayar cukai? (iii) Bagaimana penegakan hukum jajaran DJBC dalam mengantisipasi peredaran rokok illegal? (iv) Apakah ketentuan pidana yang terdapat dalam Undang-Undang Cukai mampu menjawab permasalahan peredaran rokok illegal? dan (v) Bagaimana implikasi Undang-Undang Cukai terhadap ketaatan pengusaha rokok dalam membayar cukai?Metode pcndekatan yang digunakan pada penelitian mi adalah pendekatan yuridis normatif, yang ditunjang dengan pendekatan yuridis sosiologis. Pendekatan yuridis normatif merupakan pendekatan utama dalam penelitian ini. karena titik tolaknya adalah mengungkapkan kaedah-kaedah normatif. menelaah materi muatan. landasan filosofis dan ratio legis dan Undang-Undang Cukai. Pendekatan yuridis sosiologis digunakan untuk menggali asas-asas, latar belakang pernikiran dan nilai-nilai yang mendasari adanya pungutan cukai serta peran masyarakat terutama kelompok pengusaha pabrik rokok dalam membayar cukaiKata kunci: Undang-Undang Cukai - Rokok Ilegal— Pengusaha Tidak Membayar Cukai
EKSEKUSI HAK TANGGUNGAN SEBAGAI KONSEKUENSI JAMINAN KREDIT UNTUK PERLINDUNGAN HUKUM BAGI KEPENTINGAN KREDITUR DI MUNGKID
Authors: . Ngadenan 
Published: November 2017

Peningkatan laju perekonomian akan menimbulkan tumbuh dan berkembangnya usaha yang dilakukan oleh masyarakat yang berupaya menambah modal usahanya dengan cara melakukan pinjaman atau kredit langsung dengan perbankan. Dimana kredit yang banyak berkembang dalam masyarakat adalah kredit dengan Hak Tanggungan, meskipun di dalam hukum jaminan dikenal juga beberapa lembaga jaminan seperti Fidusia, Gadai. Secara umum undang-undang telah memberikan jaminan atau perlindungan kepada Kreditur, sebagaimana diatur dalam pasal 1131 KUHPerdata, yaitu : “Segala harta kekayaan debitur, baik yang bergerak maupun yang tidak bergerak , baik yang sekarang ada maupun yang akan ada dikemudian hari menjadi tanggungan/jaminan atas hutang-hutangnya”. Jaminan yang diatur dalam pasal 1131 KUHPerdata tersebut bersifat umum, sehingga apabila jaminan tersebut dijual maka hasilnya dibagi secara seimbang sesuai besarnya piutang masing-masing Kreditur (konkurent). Dalam praktek perbankan, jaminan yang bersifat umum ini belum memberikan perlindungan hukum (kurang menimbulkan rasa aman) untuk menjamin kredit yang telah diberikan. Bank memerlukan jaminan yang ditunjuk dan diikat secara khusus untuk menjamin hutang debitur dan hanya berlaku bagi bank tersebut. Jaminan ini dikenal dengan jaminan khusus yang timbul karena adanya perjanjian khusus antara Kreditur dan debitur. Biasanya dengan jaminan berupa tanah yang kemudian dibebani dengan Hak Tanggungan sebagai jaminan kreditnya kepada bank perlu adanya perumusan masalah guna mempermudah pembahasan selanjutnya. Adapun permasalahan yang akan dikemukakan adalah sebagai berikut : 1. Bagaimana eksekusi Hak Tanggungan sebagai jaminan kredit untuk perlindungan hukum bagi kepentingan Kreditur? 2. Hambatan-hambatan apakah yang dihadapi dan upaya pemecahannya dalam eksekusi Hak Tanggungan sebagai jaminan kredit untuk perlindungan hukum bagi kepentingan Kreditur? Tujuan penelitian penyusunan tesis ini adalah sebagai berikut : 1. Untuk mengetahui dan menganalisis bagaimana eksekusi hak tanggungansebagai jaminan kredit untuk perlindungan hukum bagi kepentingan Kreditur. 2. Untuk mengetahui dan menganalisis hambatan-hambatan yang timbul dalam eksekusi hak tanggungan sebagai jaminan kredit untuk perlindungan hukum bagi kepentingan Kreditur dan upaya pemecahannya.