Aims and objectives. To examine the experiences of relatives of a spouse or parent who suffers from dementia and examines whether there are similarities or differences between these experiences. Background. Dementia is an increasing illness in the world. Dementia affects not only the person with dementia but also the relatives. There is a lack of knowledge about the experience of being a relative to a dementia-suffering person. Design and methods. Twenty-one stories from relatives were included in this study, and these stories were analysed by employing Kirsti Malterud's method 'systematic text condensation'. The relatives were divided into four groups: sons, husbands, daughters and wives. Results. Eight themes were identified in their stories, two in each of the four groups. From these eight themes, it was identified that they all experienced change, grief and negative personal sentiments. However, differences were also found, one of them being that the sons found it easier to adapt to new roles during the course of the illness, while the daughters found it more difficult. The husbands experienced being attacked by the people around them, while the wives were found to submit their dementia-suffering husbands to physical abuse. The wives also suffered from self-criticism. Conclusions. The similarities between the four groups are more significant than the differences. Sons, husbands, daughters and wives of a person suffering from dementia should be considered on an equal basis in terms of their experiences of grief, change and personal negative sentiments. Relevance to clinical practice. Relatives play a significant role in the well-being of their parent or spouse suffering from dementia. Therefore, professionals need to focus on both relatives and patient when they meet a person with dementia in clinical practice.
The present study explores patients' experiences of transitions during courses of incurable cancer. So far, qualitative studies have primarily contributed with insight on what it is like living with incurable cancer related to predefined areas in patients' lives. Studies rarely focus on transition experiences and none have explored patients' transition experiences throughout the course of illness. Focusing on transitions in palliative care is important as it facilitates possibilities for healthcare professionals to support patients when needed. Method: Ten patients living with incurable cancer were included from a specialised palliative care team and participated in individual semi-structured interviews conducted in participants' private homes. The study takes a phenomenological-hermeneutic approach and data analysis and interpretation were inspired by the French philosopher Paul Ricoeur. Results: Two main themes were identified: "Everyday life changes" and "Approaching end of life". In total, seven sub-themes were identified. Three related to the first main theme: "Normal life changes", "People changing attitude", "Changes hurting loved ones" and four related to the second main theme: "Approaching death", "Preparing for leaving", "Holding on to life" and "Connecting with places and belongings". Conclusion: Patients experienced multiple transitions within their everyday lives and in the process of approaching end of life. These transitions involved experiences of both suffering and well-being..
The Arctic will be especially affected by climate change, resulting in altered seasonal timing. Anadromous Arctic char (Salvelinus alpinus) is strongly influenced by sea surface temperature (SST) delimiting time periods available for foraging in the sea.Recent studies of salmonid species have shown variation at phenology-related loci associated with timing of migration and spawning. We contrasted genetic population structure at 53 SNPs versus four phenology-related loci among 15 anadromous Arctic char populations from Western Greenland and three outgroup populations. Among anadromous populations, the time period available for foraging at sea (>2°C) ranges from a few weeks to several months, motivating two research questions: (a) Is population structure compatible with possibilities for evolutionary rescue of anadromous populations during climate change? (b) Does selection associated with latitude or SST regimes act on phenology-related loci? In Western Greenland, strong isolation by distance at SNPs was observed and spatial autocorrelation analysis showed genetic patch size up to 450 km, documenting contingency and gene flow among populations. Outlier tests provided no evidence for selection at phenology-related loci. However, in Western Greenland, mean allele length at OtsClock1b was positively associated with the time of year when SST first exceeded 2°C and negatively associated with duration of the period where SST exceeded 2°C. This is consistent with local adaptation for making full use of the time period available for foraging in the sea. Current adaptation may become maladaptive under climate change, but long-distance connectivity of anadromous populations could redistribute adaptive variation across populations and lead to evolutionary rescue. K E Y W O R D S Arctic char, climate change, clock gene, phenology, sea surface temperature, spatial autocorrelation | 171 MADSEN Et Al.
Aim: The aim of this review was to explore experiences of patients and significant others concerning existential, psychosocial and organisational transitions during the course of incurable cancer.Methods: The search was based on 5 databases (PubMed, CINAHL, Scopus, PsycInfo and Embase) and 50 studies were finally included and critically appraised. The review was inspired by the methods of Joanna Briggs Institute, Kvale and Brinkmann and illustrated with effect size, inspired by Sandelowski and Barroso.Results: Based on experiences from 496 patients and 320 significant others, 3 main themes with 3 subthemes each were identified and, from these, a meta-synthesis was developed. Patients experience major changes in life and significant others struggle with caregiving during the course of incurable cancer. Main themes: 1. Patients living with incurable cancer experience major changes in life; 2. Patients’ experiences of both living and dying; 3. Significant others living and loosing. Relating findings to the theory of Irvin D. Yalom revealed that patients and significant others experience transitioning into living most of life in an ontological mode of existence.Conclusion: This review underlines the complexity within planning individualised palliative care and contributes with evidence-based knowledge relevant to healthcare professionals in palliative cancer care.
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