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BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADS$_{tot}$ ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADS$_{tot}$ of patients in the intervention group remained stable over the pre-post period, the control group's HADS$_{tot}$ increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter

Healthcare is presently experiencing a global workforce crisis, marked by the inability of hospitals to retain qualified healthcare workers. Indeed, poor working conditions and staff shortages have contributed to structural collapse and placed a heavy toll on healthcare workers' (HCWs) well-being, with many suffering from stress, exhaustion, demoralization, and burnout. An additional factor driving qualified HCWs away is the repeated experience of moral distress, or the inability to act according to internally held moral values and perceived ethical obligations due to internal and external constraints. Despite general awareness of this crisis, we currently lack an organized understanding of how stress leads to poor health, wellbeing, and performance in healthcare workers. To address this critical issue, we first review the literature on moral distress, stress, and health in HCWs. Second, we summarize the biobehavioral pathways linking occupational and interpersonal stressors to health in this population, focusing on neuroendocrine, immune, genetic, and epigenetic processes. Third, we propose a novel Psychoneuroimmunological Model of Moral Distress and Health in HCWs based on this literature. Finally, we discuss evidence-based individual- and system-level interventions for preventing stress and promoting resilience at work. Throughout this review, we underscore that stress levels in HCWs are a major public health concern, and that a combination of system-level and individual-level interventions are necessary to address preventable health care harm and foster resilience in this population, including new health policies, mental health initiatives, and additional translational research.

As a mode of study, philology has a long history, yet the way the term has been used, and the attitude of scholars to both the study of orthography and the meaning of orthographic variation, has changed substantially over time. This chapter outlines the origins and history of philology, from its roots in the Classical period to the present day, and discusses how far philological approaches pertain to the study of historical orthography. Philology’s focus on material, historical and manuscript contexts makes it an especially fruitful way of interrogating historical texts, and philological methods have long been viewed as a particularly apt way of dealing with (among other features) the wide orthographic variation naturally present in medieval works. To illustrate the concerns and approaches of present-day philologists to the study of historical orthography, the chapter presents two case studies. The first focuses on scribal practices in Old English and provides an example of a manuscript-centered analysis of orthography. The second focuses on the scripting of Old English and Old High German and illustrates how historical orthographies can be analyzed by mapping spelling onto an etymological sound reference system.

This chapter investigates medieval English glossaries via the lens of Mark Sebba’s framework for a multimodal analysis of multilingual texts. The analysis focuses on the visual/spatial arrangement of bi- and multilingual material in six glossaries dating from the 7th to the 13th centuries. Glossaries, the medieval precursors of modern dictionaries, represent a text genre with a highly salient layout. They systematically exploit visual/spatial features as a semiotic resource to identify different information categories or to highlight different codes and thus rely on complex literacy practices. The very different layouts attested in medieval glossaries reveal different conceptualisations of the glossary text.

BACKGROUND AND INTRODUCTION The place of last care carries importance for patients at the end of life. It is influenced by the realities of the social welfare and healthcare systems, cultural aspects, and symptom burden. This study aims to investigate the place of care trajectories of patients admitted to an acute palliative care unit. MATERIALS AND METHODS The medical records of all patients hospitalized on our acute palliative care unit in 2019 were assessed. Demographic, socio-economic and disease characteristics were recorded. Descriptive and inferential statistics were used to identify determinants for place of last care. RESULTS A total of 377 patients were included in this study. Median age was 71 (IQR, 59-81) years. Of these patients, 56% (n = 210) were male. The majority of patients was Swiss (80%; n = 300); about 60% (n = 226) reported a Christian confession; and 77% had completed high school or tertiary education. Most patients (80%, n = 300) had a cancer diagnosis. The acute palliative care unit was the place of last care for 54% of patients. Gender, nationality, religion, health insurance, and highest level of completed education were no predictors for place of last care, yet previous outpatient palliative care involvement decreased the odds of dying in a hospital (OR, 0.301; 95% CI, 0.180-0.505; p-value < 0.001). CONCLUSION More than half of patients admitted for end-of-life care died on the acute palliative care unit. While socio-economic factors did not determine place of last care, previous involvement of outpatient palliative care is a lever to facilitate dying at home.

Aufgrund der oft limitierten Lebenserwartung von Patientinnen und Patienten in der Palliative Care stellt sich insbesondere in Bezug auf die Behandlung möglicher psychischer Störungen wie Depression oder Angst die Herausforderung rasch wirksamer und möglichst einfach zu applizierender Medikamente. Ziel dieser Arbeit ist es, die aktuelle Literatur und ausgewählte Leitlinien in Hinblick auf Evidenz bezüglich Einsatz von Ketamin und Esketamin als Medikamente zur Behandlung von Depression und Angststörung bei palliativen Patientinnen und Patienten zu untersuchen.

Some of the bawdy details of Chaucer’s Canterbury Tales continue to pose challenges to translators, who must find renderings that are both descriptively and stylistically adequate. The Miller’s Tale provides an illustrative case study, in which the drunken narrator describes Nicholas’s rather physical wooing of the carpenter’s wife Alisoun in graphic detail. Existing translations of the key term queynte range from the flowery euphemism to the straightforward vulgarism. An appropriate translation into present-day English needs to be based not only on sound philological analysis, but also on a careful evaluation of the register of the original Middle English expression. This article offers a corpus-based assessment of relevant candidate expressions in order to propose a translation that captures the appropriate level of (im)politeness, both of the narrator towards his fellow pilgrims and of Chaucer towards his readers.