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The prospect of death influences people's thoughts about and how they deal with their remaining time. We aimed to understand whether patients with progressive, life-limiting diseases are oriented in the past, present, or future and how they deal with temporality. We conducted 57 in-depth interviews with end-of-life patients in 10 countries using thematic analysis at three levels (i.e., locally in three countries, with codes shared in the three-country subgroup, and in all 10 countries with a codebook that we developed). We found that the patients' thoughts were oriented toward all three time levels (i.e., past, present, and future). Complementing these levels, we identified another, namely, the future after death. Each time level included patients actively and passively dealing with their thoughts. Past themes were remorse and regret , nostalgia , and coming to terms with past choices ; present themes were feeling grateful for being alive , a time for farewells , and living for the day ; future themes were worries about the future , to miss out , hope , ideas about death and dying , and planning the near future ; and future after death themes were not being there , worries about loved ones , and preparations for a future after death . A changed view on lifetime and avoidance of thinking about a certain time level related to several time levels, while desire to die fluctuated between levels and between acting on and feeling about it. Living for the day, worries about the future , and worries about the well-being of loved ones were common themes in all countries., Competing Interests: Declaration of Conflicting InterestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent., Aim: To determine the consistency with which the Surprise Question is used., Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]-100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213., Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes., Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries ( p  = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries ( p  = 0.53)., Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.

Crime victimization is one of the most pressing public health concerns in Latin America. Young people in the region are at particularly high risk of victimization. The present study examined exposure to crime victimization as a risk factor for depressive symptoms and suicidal ideation, and the protective effects of familism and social support in a community sample of Colombian college students. Data ( N = 424) came from the Juventud Project (The Emergent Adults Project), a cross-sectional study of college students, 18 to 29 years old ( M = 20.8, SD = 2.5; 63% female; 75.5% lived with their families), attending an urban public university in Southern Colombia. Data were collected between March and June of 2014 through anonymous, self-administered surveys. Conditional process analysis was used to test a model in which crime victimization was directly and indirectly associated with suicidal ideation via depressive symptoms, with familism and social support as moderators of this association while controlling for gender, age, and socioeconomic status. Overall, 58.9% of participants reported at least one crime victimization event in the past year. The most common types of victimization were being robbed without the threat of harm (29.8%) and being robbed with a weapon (24.8%). Male participants reported more instances of crime victimization than female participants. Levels of depressive symptoms that could be clinically significant were reported by 30.2% of participants, and suicidal ideation was reported by 31% of participants. The association between crime victimization and suicidal ideation was fully mediated by depressive symptoms. Social support, but not familism, moderated this association; social support weakened the link between depressive symptoms and suicidal ideation. Findings suggest that crime victimization may be a significant risk for depressive symptoms and suicidal ideation among college students in Colombia, and that social support may protect from the harmful mental health effects of crime victimization.

Background: Intervention trials confirm that patients with advanced cancer receiving early palliative care experience a better quality of life and show improved knowledge about and use of palliative care services. To involve patients in future health-care decisions, health professionals should understand patients' perspectives. However, little is known about how patients' experience such interventions., Aim: To explore advanced cancer patients' experiences with a structured early palliative care intervention, its acceptability and impact on the patients' life including influencing factors., Design: Qualitative content analysis of in-depth, semi-structured interviews., Setting/participants: Patients with various advanced cancer diagnoses were enrolled in a multicenter randomized controlled trial (NCT01983956), which investigated the impact of "Symptoms, End-of-life decisions, Network, Support," a structured early palliative care intervention, on distress. Of these, 20 patients who underwent the intervention participated in this study., Results: Participants received the intervention well and gained a better understanding of their personal situation. Patients reported that the intervention can feel "confronting" but with the right timing it can be confirming and facilitate family conversations. Patients' personal background and the intervention timing within their personal disease trajectory influenced their emotional and cognitive experiences; it also impacted their understanding of palliative care and triggered actions toward future care planning., Conclusion: Early palliative care interventions like "Symptoms, End-of-life decisions, Network, Support" may provoke emotions and feel "confrontational" often because this is the first time when issues about one's end of life are openly discussed; yet, advanced cancer patients found it beneficial and felt it should be incorporated into routine care.

Background: Fifth metatarsal base fractures of the metaphyseal-diaphyseal watershed junction (Jones fracture) are commonly treated with surgical fixation in athletes. Intramedullary screw fixation remains the most utilized construct, although plantar-lateral plating is an alternative. Purpose/Hypothesis: The purpose was to compare the mechanical strength of fracture fixation between an intramedullary screw and plantar-lateral plating. The hypothesis was that plantar-lateral plate fixation would allow for more cycles and higher peak loads before failure, as well as less fracture gapping, than would an intramedullary screw in cadaveric foot specimens with simulated Jones fractures exposed to cantilever bending., Study Design: Controlled laboratory study., Methods: Twelve pairs of male cadaver feet were separated into 2 groups (plate or screw) to conduct contralateral comparative testing of 2 devices with equally numbered right and left feet. For each fifth metatarsal, an osteotomy with a microsagittal saw was created to simulate a Jones fracture. The plate group underwent fixation with a 3.0-mm 4-hole low-profile titanium plate placed plantar-laterally with 3 locking screws and 1 nonlocking screw. The screw group underwent fixation with a 40- or 45-mm × 5.5-mm partially threaded solid titanium intramedullary screw. After fixation, the metatarsals were excised for biomechanical testing. Cyclic cantilever failure testing was conducted with a gradient-cycle method. Sinusoidal loading forces were applied, increasing by 5.0-pound-force increments per 10 cycles, until each specimen experienced mechanical failure of implant or bone. Failure mode, number of cycles to failure, peak failure load, gap width at the last mutual prefailure loading, and video data were recorded. Paired 2-tailed t test (α = 0.05) was used to compare groups ( P < .05 set for significance)., Results: Failure mode in both groups occurred predominantly at the bone-implant interface. Plate fixation resulted in significantly higher mean ± SD values for cycles to failure (63.9 ± 27.0 vs 37.3 ± 36.9, P = .01) and peak failure load (159.2 ± 60.5 N vs 96.5 ± 45.8 N, P = .01), with a significantly lower mean gap width (0.0 ± 0.0 mm vs 3.2 ± 2.4 mm, P < .01)., Conclusion: As compared with intramedullary screw fixation, plantar-lateral plating allowed for greater cycles to failure and peak load before failure, as well as less gap width, when applied to cadaver foot specimens with simulated Jones fractures exposed to cantilever bending in a load frame., Clinical Relevance: Early return to play among athletes before Jones fracture union is associated with increased risk of failure. This study introduces a plantar-lateral plating construct that performed more favorably than intramedullary screw fixation when applied to simulated Jones fractures in cadaveric foot specimens. Further clinical comparative studies are needed to assess the clinical use of this construct.

Unlabelled: In Colombia, most palliative care is provided in acute care hospitals. In those settings, a palliative care approach could be limited because of a disease-oriented approach instead of patient-centered care., Purpose: To know the framework of a typical Colombian university hospital that provides palliative care services., Material and Methods: In a retrospective manner, the medical records of deceased patients during 2006 were revisited., Results: Most patients were not treated by palliative care specialists, so curative-oriented treatment were common among these patients., Conclusion: In acute hospitals, palliative care teams should participate in the care of patients at the start of treatment.