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Background: Hospitals are the most frequent place of death in Germany (47%), but at the same time, the least preferred one - for both patients and their relatives. To optimize care in the dying phase by using a bottom-up approach, the StiK-OV project aims to implement and evaluate specific measures on different non-palliative wards at two university hospitals. In the first phase of the project, we assess the current state of care in the dying phase on different wards. Method(s): We conducted an online survey with national health care professionals consisting of seven open questions on important aspects, facilitators, barriers and needs for improvement as well as Covid-19 pandemic specifics regarding care in the dying phase. Qualitative data was analyzed thematically. Result(s): Of 67 participants, 66% work in clinical practice as nursing staff (52%) and physicians (30%) and 34% in management or administration. As relevant topics of care in the dying phase, we identified involvement of relatives, symptom control, patient-centeredness, professional competencies, as well as time, space and human resources. Participants state a need for improvement regarding these topics. During the pandemic, involvement of relatives and patient-centeredness were difficult to maintain due to visiting restrictions and higher workload, resulting in patient isolation and dying in loneliness. Discussion(s): The survey revealed common topics of importance which should be targeted by ward-specific measures. Difficulties due to the pandemic have to be accounted for to achieve optimal care in the dying phase under exceptional circumstances. Conclusion(s): The survey gave insights on care in the dying phase from the perspective of health care professionals that can help to develop and implement situation-specific measures to significantly improve the quality of care during the dying phase in hospitals. A bottom-up approach aims to increase the staff motivation to implement respective measures.
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The Covid - 19 upsurge has materially affected the operating abode of the banking sector worldwide. Its restrictions have interrupted its economic activities and caused grave commercial fallout for this sector. The present study evaluates the effect of Covid - 19 on the governance constitution and the firm performance of the Indian banking sector for the period 2019-2020. It compares the Covid - 19 impacts on the board's governance structures and the bank's performance in the pre and post-pandemic period. It also empirically examines their interrelationship during uncertain times. The results of the study establish that the board size is the sole prominent governance parameter that exerted a pragmatic influence on the bank's performance during the pandemic. The study's outcomes propound policymakers in designing a congruous governance framework for the corporate sectors during the pandemic. It proposes that the right balance of the stakeholder interests with effective risk strategies is essential in developing an effective governance framework. The study is pre-eminent in providing the empiric Covid - 19 repercussions on the governance procedures and corporate performance. It demonstrates the contemporary governance issues during the pandemic and unveils the avenues for subsequent research. © 2022 SCMS Group of Educational Institutions. All rights reserved.
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Ethics as applied to medico-dental practice and associated research is called bioethics. From the Journal's inception, contributing authors have explored recurrent themes pertaining to bioethics. This early interest is a tribute to the keen foresight and enduring pride in professionalism that has persisted throughout the evolution of orthodontics. Copyright © 2022 Ubiquity Press. All rights reserved.
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Aim: The aim of this study was to evaluate the need for analgesia in patients undergoing single-visit root canal treatment, within 2 days after COVID-19 immunisation. Method(s): Two days after receiving the COVID-19 vaccination, 50 patients undergoing Single visit root canal treatments for acute pulpits in molar teeth were divided into two groups of 25 each (Group M for males and Group F for females). Each patient was given a prescription for 650 mg of acetaminophen (Dolo 650 mg) tablets to be taken eight hours a day, with instructions to use the same only if needed for pain. They were instructed to keep a record of the number of tablets consumed as per record sheet 1, and if the pain did not subside then a stronger analgesic, Ketorolac DT 10 mg twice a day, had to be taken and recorded. Result(s): In Group M, the mean number of analgesic tablets required was 0.44+/-0.64 and in Group F, the mean number of analgesic tablets required was 0.80+/-1.09. Although the mean analgesic requirement was higher in females as compared to males, the difference of 0.80+/-1.09 between the two groups was not significant statistically (0.360). Conclusion(s): Within the limitations of this study, it is concluded that acetaminophen is effective in relieving post-obturation pain after a single-visit RCT in patients recently vaccinated against the CoVid-19. Copyright © 2022 Ubiquity Press. All rights reserved.
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The Internet has enormously expanded the domain of technology for diverse ages. The Internet poses enormous technological expansion potential. It can change not just how people accept and adopt knowledge, but also the traditional methodology and architecture of education systems. During the COVID-19 pandemic, e-learning is expanding and being recognized by higher education institutes for the benefit of society. Although e-learning has some shortcomings, it also has numerous benefits. Web-based education has made lifetime learning easier and erased geographical barriers by providing international-standard education. This improves the opportunity to learn and stay current with technology in a competitive environment. © The Author(s) 2022.
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The bioinformatics discipline seeks to solve problems in biology with computational theories and methods. Formal concept analysis (FCA) is one such theoretical model, based on partial orders. FCA allows the user to examine the structural properties of data based on which subsets of the dataset depend on each other. This article surveys the current literature related to the use of FCA for bioinformatics. The survey begins with a discussion of FCA, its hierarchical advantages, several advanced models of FCA, and lattice management strategies. It then examines how FCA has been used in bioinformatics applications, followed by future prospects of FCA in those areas. The applications addressed include gene data analysis (with next-generation sequencing), biomarkers discovery, protein-protein interaction, disease analysis (including COVID-19, cancer, and others), drug design and development, healthcare informatics, biomedical ontologies, and phylogeny. Some of the most promising prospects of FCA are identifying influential nodes in a network representing protein-protein interactions, determining critical concepts to discover biomarkers, integrating machine learning and deep learning for cancer classification, and pattern matching for next-generation sequencing.
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The COVID-19 pandemic has impacted almost all companies and people across all sectors. Working from home (WFH) has become the new norm in many countries and companies since the COVID-19 pandemic. There is a growing trend around the globe for having more people working from home, particularly in the current COVID-19 pandemic. The present review-based paper is mainly collected from important databases like Scopus and Web of Science from the years 2020, 2021, and 2022. The main aim of this paper is to understand the concept of Working from home and to study various Working from home (WFH) associated opportunities and challenges during the period of pandemic. Increased work productivity, increased job satisfaction, and greater flexibility were some of the opportunities whereas increased levels of stress, longer working hours, and lack of designated office space were foundsome challenges related to Working from home (WFH) during the pandemic. Despite many challenges and operational difficulties in WFH, many organizations are still positive and developing a new hybrid model which provides high employee productivity and also provides an effective way to deal with future uncertainties or pandemic-like crises.Mindfulness, proper designated office space at home, and Organisation based supportive policies were some of the main recommendations given for employees' better productivity and work-life balance. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and s to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%];P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020). © 2022, College of Intensive Care Medicine. All rights reserved.
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The use of social media has grown significantly in the last few years. Social media refers to "the websites and online tools that facilitate interactions between users by providing them opportunities to share information, opinions, and interest " (Swar and Hameed, 2017, p. 141). Adolescents have been found to be more vulnerable to addiction and crimes related to social media. Hence, the study has tried to understand the association of social media with the well being of adolescents. The first part of the paper deals with the role and relevance of social media.Further, the literature review depicts a strong connection between social media and individuals' well-being. For the quantitative analysis, various statistical techniques are used. In order to evaluate the association between variables, the composite index has been prepared. Further, the ranking has been given to reflect social media's impact on adolescents' well-being. Lastly, a few recommendations have been made for the state government regarding the well being of the adolescents.
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Background: Clinician emotion regulation (ER), self and the patient's, likely moderates successful prognostic discussions with patients, yet challenges around its evaluation limit its investigation. We performed a pilot study to develop and assess an experimental framework that uses multimodal assessment (self-report, observer, and biometric data) to measure clinician ER during a simulated, serious illness conversation (SIC). Method(s): We developed our experimental framework in four steps: 1) drafted a patient case and assessment framework;2) refined the data collection strategy using a multidisciplinary research team;3) trained our actor;and 4) iteratively piloted the case to optimize data collection. For the assessment, we conducted a cross-sectional, case series pilot study with physicians trained in SIC to assess its feasibility and acceptability, defined a priori as an enrollment rate >60% of approached clinicians, > 90% completion rate of survey items, < 20% missing data from wearable heart rate variability (HRV) sensors. To characterize clinician ER strategies, we analyzed the visit dialogue, physician interviews performed while watching the visit back, and physician SIC documentation generated post visit. We used a hybrid approach of inductive and deductive coding and theme development based on preexisting ER theory. Result(s): The development phase yielded two major modifications: 1) abandoned use of AppleWatch since it did not provide continuous HRV measurement;and 2) used telehealth with video given context of COVID-19 pandemic. We approached 12 physicians and 11 enrolled, of which 5 were female and 10 white, 5 were medical oncologists, and 6 specialty palliative care physicians. All participants completed all study survey items. The results of our three HRV sensors were as follows: Empatica E4 and Polar H10 met our pre-specified HRV collection in all 11 resting tasks and SIC encounters, and the Scoche R24 the benchmark in 7/11 resting tasks and 4/11 of simulated encounters. Preliminary qualitative analysis suggests investigators can characterize clinician use of intrapersonal and interpersonal ER strategies. Conclusion(s): The use of multimodal assessment of clinician ER in a simulated, telehealth SIC visit was acceptable and feasible.
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: COVID-19 associated morbidity and mortality are largely related to hypercoagulability events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), with right ventricular (RV) dysfunction playing a likely role in the severity of outcomes. The purpose of this study is to correlate right ventricular parameters on echocardiography in patients who developed DVT and PE while admitted with COVID-19 infection, and to determine if PE and DVT were related to a higher incidence of adverse outcomes. METHODS: Single-center retrospective study from March 2020 to August 2021 including patients older than 18 years old hospitalized with confirmed COVID-19 by RT-PCR, who had an echocardiogram performed while inpatient. Right ventricular parameters were obtained mostly by linear measurements, with a limited COVID-19 protocol determined by the institution. The presence of PE and DVT were confirmed by chest CT angiography and venous ultrasound, respectively. RESULTS: A total of 223 patients were included in the study (mean age 64.3 +/- 16, 59.6% male, 67.4% Hispanic). Baseline characteristics did not differ when stratified for the outcomes of interest. DVT occurred in 9.4% (n=21) and PE in 19.6% (n=44) patients. PE and DVT were related to a higher rate of ARDS, ICU admission, non-fatal stroke and prolonged length of stay (38.9 vs 16.9 days, p<0.05). Although there was a higher rate of intubation in patients admitted with DVT (p<0.05), it was non-significant for patients with PE. Mortality was similar to patients without thromboembolic events. For PE and DVT, RV dilation was present on 25% (p<0.05) and 14%, and RV dysfunction on 21% and 11%, respectively. CONCLUSIONS: PE and DVT in patients with COVID-19 were related to higher morbidity, but not mortality in this patient population. Interestingly, these events were related to a higher rate of non-fatal stroke, suggesting that hypercoagulability plays a major role in the development of some adverse outcomes. Despite only finding RV dilation as a statistically significant marker present in patients who developed PE, the study was potentially underpowered to find significant differences between groups. CLINICAL IMPLICATIONS: Development of PE and DVT in patients admitted with COVID-19 infection are markers of increased morbidity and higher length of stay. RV dilation might be used as a marker of potential thromboembolic events in this patient population, but more studies with controlled variables are needed to determine it's utility. DISCLOSURES: No relevant relationships by Sharon Andrade-Bucknor No relevant relationships by Mikayla Bowen No relevant relationships by Alexis Jones No relevant relationships by Sukhpreet Kaur No relevant relationships by Neal Olarte No relevant relationships by Beatriz Rivera Rodriguez No relevant relationships by Crystal Yan
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SESSION TITLE: Drug-Induced Lung Injury and Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Lomustine, a nitrosurea, inhibits DNA, RNA, and protein synthesis by carbamylation and alkylation, leading to cytotoxic effects 1, 3. Its concentration is high in the central nervous system (CNS) and therefore is commonly used for the management of CNS tumors including recurrent glioblastoma. While known side effects include pancytopenia, few pulmonary toxicities have been reported. This case is a rare example of lomustine induced pneumonitis. CASE PRESENTATION: A 54-year-old female with a history of glioblastoma, treated with a combination of surgical resection, radiation therapy, and temozolomide followed by stereotactic surgery and bevacizumab after disease recurrence, developed progressive dyspnea after initiating lomustine. She had received one dose of lomustine 90 mg/m2 two months prior to developing dyspnea upon exertion. At baseline, she was an active individual who played sports. A chest computed tomography (CT) scan preformed ten months prior was without any parenchymal abnormalities, and pulmonary function tests (PFTs) two months prior were normal with an adjusted DLCO of 15.4 mL/mmHg/min (88%). Repeat chest CT revealed diffuse ground glass opacities, and repeat PFTs showed a moderately impaired adjusted DLCO of 10.4 mL/mmHg/min (60%). Other lab evaluation, CBC, BNP, troponin, and COVID PCR, were negative. After receiving six weeks of steroids, there was resolution of CT findings, improvement of DLCO, and relief from symptoms. DISCUSSION: More common adverse effects of lomustine are GI discomfort and pancytopenia. It is less widely documented to cause pulmonary toxicity compared to its chemical relative carmustine 1, 3. This is perhaps due to decreased alkylation ability and penetration into the lung tissue by lomustine7. There have been few case reports revealing pneumonitis and pulmonary fibrosis. Lomustine induced pneumonitis induces acute parenchymal changes of the lung demonstrated by characteristic symptoms and imaging/biopsies abnormalities after initiation of a drug. 2 Findings include breathlessness, dyspnea upon exertion, cough, hypoxia, crackles upon lung auscultation. PFT's may show a restrictive pattern with decreased FEV1/FVC ratio and DLCO. Imaging may reveal diffuse groundglass opacities, traction bronchiectasis, interlobular septal thickening, and honeycombing. Bronchoscopy with lavage would rule out infection. Management involves discontinuation of culprit medication, immunosuppression, and supportive therapies to alleviate respiratory discomfort. Lack of treatment may produce complications of acute respiratory distress syndrome and fibrosis. CONCLUSIONS: Lomustine is an essential treatment drug for recurrent CNS tumors. Toxicities such as pneumonitis have been rarely demonstrated. Timely recognition of pneumonitis features is key to treat this complication, improve quality of life, and prevent permanent lung compromise. Reference #1: Dent RG. Fatal pulmonary toxic effects of lomustine. British medical journal. 1982;DOI:10.1136/thx.37.8.627 Reference #2: Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton, C, et al. Drug-Induced Interstitial Lung Disease: A Systemic Review. Journal of Clinical Medicine. 2018;doi 10.3390/jcm7100356 Reference #3: Weiss RB, Issell BF. The nitrosureas: carmustine and lomustine. Cancer treatment reviews. 1982;https://doi.org/10.1016/S0305-7372(82)80043-1 DISCLOSURES: No relevant relationships by Sukhdeep Kaur No relevant relationships by Chelsea Kennedy-Snodgrass No relevant relationships by Sarun Thomas
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Steganographic technique is a way of hiding confidential data that needs to be protected from unauthorized users and also no suspicion should be there that the cover image is carrying the secret information. Therefore, in steganography technique it is critical to have an algorithm that can hide information securely and uses best combination of techniques. In this research the 2 main factors are considered i.e., payload capacity and stego-image quality. In this model different techniques have been hybridised and those are DWT, Huffman Encoding and Ebola optimisation technique. These combinational techniques work on both capacity and image quality. In this database of Covid-19 patients is used as the confidential data and the results that this model has performed better than the existing ones. © 2022 IEEE.
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Background: Coronavirus-19 (COVID-19) was identified as a cause of a disease outbreak in 2019 that originated in China. An infection without a cure makes the people, especially health care workers more vulnerable to get affected because of insufficient knowledge and unhealthy practices. Aim and Objective: This study aims to assess the knowledge and perceptions among medical students. Materials and Methods: A questionnaire-based cross-sectional study was conducted from December 2020 to February 2021 among the undergraduates and interns. The study was adapted from the current interim guidelines and information provided by Ministry Health and Family Welfare, Government of India (MOHFW, GOI) and Indian Council of Medical Research. Results: There were a total 355 participants. The majority (90.4%) of students had adequate knowledge. Only 9.5% had partial or no knowledge, the majority >90% of them showed a positive perception of COVID-19 prevention and control. In fact, majority 98.30% of students also got vaccinated against COVID-19. Conclusion: As there is no specific cure against COVID-19, it is essential to improve knowledge and belief among general public to prevent the spread. Medical students can, therefore, play a significant role by making community people aware about the seriousness of this pandemic.
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INTRODUCTION: Health insurance is one of the main non-life insurance sectors, which contributes nearly 29% of general insurance premium income. Almost every industry in the world has been affected by the COVID-19 outbreak and its associated lockdowns, including the Indian insurance industry, which makes a significant contribution to a nation's Gross Domestic Product (GDP) and economic development. OBJECTIVES: This review of literature aims to critically evaluate the performance of Indian health insurance companies along with examining various opportunities and challenges during the time of COVID-19 pandemic. METHOD: The present study is a combination of both exploratory and descriptive literature review types and was entirely based on published secondary data. Literature searches were performed using Google Scholar, Research Gate, ProQuest, and Scopus databases for articles published between 2020 and 2022. The study also used various annual reports of the Insurance Regulatory and Development Authority of India (IRDAI), the internet, newspaper articles, and company websites for the study. RESULTS: Even though there was a lack of literature on this topic, 19 articles were identified for review based on the keyword search that most closely matched the topic of the study. The study assesses the effectiveness of various Indian health insurance companies using four key metrics: gross health premium income, incurred claim ratio, number of policies issued or covered and amount of claim paid. Results of the study have shown that as more people get health insurance during the COVID-19 pandemic, there is a notable growth seen in the overall performance of the health insurance business. CONCLUSION: Health insurers faced both opportunities and challenges as a result of the COVID-19 pandemic, including the imperative need to develop more customer-centric new products and services that enable them to provide a significant health insurance benefit to the large untapped population of the Indian market.
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The COVID-19 pandemic has caused major disruptions to several industries including higher education. Malaysia has attempted to be a hub of educational excellence by transforming its higher education, thereby attracting international students as key drivers to its economy and internationalization. This study aims to identify the current challenges international students have faced due to the pandemic and proposes solutions to tackle those challenges. The data for this study was collected qualitatively through focus group interviews using a purposive sample of students, administrative, and academic staff of two universities in Malaysia. Data was collected between October 2020 and January 2021, covering the COVID situation for the whole of year 2020 to reflect the experiences of the international students. The results indicate that the students have some major concerns as a result of numerous academic, administrative, social, financial, and emotional challenges they have been facing. Addressing the challenges and concerns is of great importance in ensuring the sustainability of keeping universities in Malaysia appealing destinations to international students. The research proposes some solutions for improving the current situation in light of the findings of the study. © 2022 selection and editorial matter, Sheena Kaur, Prasana Rosaline Fernandez, and Ali Jalalian Daghigh.
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Part of a mini series of Focus books on COVID-19 in Malaysia, the chapters in this book address the pandemic’s impacts on education and literacy. Covering a range of teaching and learning challenges impacting learners and teachers, the contributors highlight the pervasiveness of the pandemic on Malaysian society and how Malaysians have found ways to cope. They focus mainly on students’ COVID-19 narratives, digital and health literacy issues, language, and new vocabulary. This is an opportunity to witness how researchers from multiple disciplines can join forces during challenging times. There are a great many lessons to be learned from the successes and failures in responding to the pandemic and the measures that have been necessary to contain it. A fascinating read for scholars and educators with an interest in crisis management in non-Western contexts, especially those with a particular interest in Malaysia, or Southeast Asia more generally. © 2022 selection and editorial matter, Ambigapathy Pandian, Surinderpal Kaur, and Huey Fen Cheong.
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Background/aims: Hospitals are the most frequent place of death in Germany (47%) but also the least preferred one - for both patients and relatives. The project 'StiK-OV' aims to optimize care for dying patients in hospitals using a bottom-up approach. Therefore specific measures on non-palliative wards at two university hospitals will be implemented and evaluated. In the first project phase, the current state of non-specialist inpatient care in the dying phase was assessed. Methods: Online survey with national health care professionals in the field of care in the dying phase. The survey consisted of seven open-ended questions on important issues, facilitators, barriers and needs for improvement regarding the care for patients dying in hospitals as well as COVID-19 pandemic specifics. Qualitative data was analyzed thematically. Results: Of 67 participants, 66% worked in clinical practice, 34% in managerial positions. We identified five relevant topics of care in the dying phase: involvement of relatives;symptom control;patient-centeredness;professional competencies;as well as time, space and human resources. Participants aimed to uphold patient-centeredness as a priority in the dying phase despite reporting needs for improvement in all topics: 'Everything that is good for the patient is allowed.' This contrasts with the experience during the pandemic, when involvement of relatives and patient-centerednesswere hard to maintain due to visiting restrictions and high workload - leading to patient isolation and dying in loneliness. Conclusions: The survey revealed common topics on care in the dying phase from the perspective of health professionals to be targeted by ward-specific measures. Difficulties due to the pandemic have to be considered for optimal care in the dying phase under exceptional circumstances. The results can help to develop and implement context-specific measures to improve quality of hospital care during the dying phase.