48 Our results suggest that less use of palliative chemotherapy among patients recognized to have a life expectancy of six months or less or more frequent end of life discussions in this group may reduce intensive end of life care and promote earlier access to hospice services, thus improving the quality of advanced cancer patients' end of life care.
Instead, this finding should serve as a reminder that palliative chemotherapy does not necessarily extend life, but is associated with more intensive end of life care and increased risk of dying in an intensive care unit, so continuing treatment should not come at the cost of engaging in advance care planning.
When required, children's community nursing services tended to provide intensive end-of-life care in children's homes in substitution to providing routine scheduled children's community nursing services.
The proportion of dialysis patients who reside in rural areas may also affect discontinuation rates, as rural populations have been found to use less intensive end-of-life care than urban counterparts [ 7, 20].
Several of the demographic characteristics associated with greater intensity of care at the end of life, such as non-white race and lower age at the time of death, are also more prevalent in the regions of the country known to have more intensive end-of-life care patterns.
40 Qualitative studies and surveys suggest that most patients on HD do not perceive that they have been given a choice of treatment 41, 42 and many regret having started HD. 32, 42 Receipt of intensive end-of-life care in HD patients also seems to be driven more by practice related factors than patient characteristics.
Additionally, using quality improvement techniques in single centres or collaboratives, the intervention could be implemented in non-academic settings such as rural areas or resource-poor countries, with the same CIMT design but less resource-intensive end points, such as questionnaires.
Structural materials in many technology intensive high end applications such as petrochemical, industrial manufacturing, aerospace, automotive, and bio-resources have to operate under extreme conditions of temperature, pressure and slurry erosion/abrasion.
The large hot utility requirements of current pre-processing technologies and ethanol distillation stages prevent decoupling of front-end processing from the highly capital intensive, tail-end lignin treatment and utility generation.
The intensive standoff ended in late December, when top provincial leaders agreed to some of their demands.
Populations of whales like the 100-foot blue, the largest animal ever to inhabit the planet, remain profoundly depleted decades after intensive hunts ended.
