Background: End-of-life (EOL) communication plays a critical role in ensuring that patients receive care concordant with their wishes and experience high quality of life. As the baby boomer population ages, scalable models of end-of-life communication will be needed to ensure that patients receive appropriate care. Information and communication technologies (ICTs) may help address the needs of this generation; however, few resources exist to guide the use of ICTs in EOL care.Objective: The primary objective was to identify the ICTs being used in EOL communication. The secondary objective was to compare the effectiveness of different ICTs in EOL communication.Methods: The study was a systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched seven databases for experimental and observational studies on EOL communication between doctors and patients using ICTs, published in 1997–2013.Results: The review identified 38 relevant articles. Eleven types of technology were identified: video, website, telephone, videoconferencing, e-mail, telemonitoring, Internet search, compact disc, fax, PalmPilot, and short message service (SMS) text messaging. ICTs were most commonly used to provide information or education, serve as decision aids, promote advance care planning (ACP), and relieve physical symptom distress.Conclusions: The use of ICTs in EOL care is a small but growing field of research. Additional research is needed to adapt older, analog technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for e-health applications in related fields should guide future interventions in EOL care.

Data from a transect of four cores collected in the Makepeace Cedar Swamp, near Carver, Massachusetts, record past changes in deposition, vegetation, and water level. Time series of palynological data provide a 14,000-yr record of regional and local vegetation development, a means for biostratigraphic correlation and dating, and information about changes in water level. Differences in records among cores in the basin show that water level decreased at least 1.5 m between ∼10,800 and 9700 cal yr B.P., after which sediment accumulation was slow and intermittent across the basin for about 1700 yr. Between 8000 and 5600 cal yr B.P., water level rose ∼2.0 m, after which slow peat accumulation indicates a low stand about the time of the hemlock decline at 5300 ± 200 cal yr B.P. Dry conditions may have continued after this time, but by 3200 cal yr B.P., the onset of peat accumulation in shallow cores indicates that water level had risen to close to its highest postglacial level, where it is today. Peat has accumulated across the whole basin since 3200 cal yr B.P. Data from Makepeace and the Pequot Cedar Swamp, near Ledyard, Connecticut, indicate an early Holocene dry interval in southern New England that began 11,500 yr ago near the end of the Younger Dryas interval. The dry conditions prevailed between 10,800 and 8000 cal yr B.P. and coincide with the arrival and later rise to dominance of white pine trees (Pinus strobus) both regionally and near the basins. Our results indicate a climatic cause for the “pine period” in New England.

No abstract

Background: There are few predictors of difficult mask ventilation and a simple, objective, predictive system to identify patients at risk of difficult mask ventilation does not currently exist. We present a retrospective - subgroup analysis aimed at identifying predictive factors for difficult mask ventilation (DMV) in patients undergoing pre-operative airway assessment before elective surgery at a major teaching hospital. Methods: Data for this retrospective analysis were derived from a database of airway assessments, management plans, and outcomes that were collected prospectively from August 2008 to May 2010 at a Level 1 academic trauma center. Patients were stratified into two groups based on the difficulty of mask ventilation and the cohorts were analyzed using univariate analysis and stepwise selection method. Results: A total of 1399 pre-operative assessments were completed with documentation stating that mask ventilation was attempted. Of those 1399, 124 (8.9%) patients were found to be difficult to mask ventilate. A comparison of patients with and without difficult mask ventilation identified seven risk factors for DMV: age, body mass index (BMI), neck circumference, history of difficult intubation, presence of facial hair, perceived short neck and obstructive sleep apnea. Although seven risk factors were identified, no individual subject had more than four risk factors. Conclusion: The results of this study confirm that in a real world clinical setting, the incidence of DMV is not negligible and suggest the use of a simple bedside predictive score to improve the accuracy of DMV prediction, thereby improving patient safety. Further prospective studies to validate this score would be useful.