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2 F O R Q U A L I TY P A L L I ATIV E C A R E

3 F O R Q U A L I TY P A L L I ATIV E C A R E

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50 T, //, *G1 KCH .= 25 %KH ]- 55 ,1-. %JE K*/* .7,.= <3., 1>G 2.+ *.D 7-G<*11,-. 8-5 125,-3 1/: ,// J3D- 52 %[H e52,8, [email protected] AAc AQQ _?bSA?? <5, 1-. 25 1E MA?PE 9$$ &"/ 10 S$ *+)$ &" K+. C G1% > 7+ )< "')+ 45 211 c )2I h-5Z H )h S 0-/3GF,* Y.,;251,+: $F ?1<+/C 01 )<# $F (& ""#&* #4+ !& )+ #$ :-)/# 6)&$/ 25. Mi/ 3= ]E K [email protected]@ E ]E $-1 0* 5+I 5,=>+ ,. *11,1 +2D /,;, .=S 45-G-+,. = =-- D ^3*/, +: 7*52 *+ 2. D -8 /,82 E 67+ g0H ],//25 [H `-/<,. <,72 [email protected] VMQAPE [email protected]@NcON_O ,+) 1$*1 "1F# /* C D ]' H R25 5,., %E 45-G -+ ,. = 2W72 //2.72 ,. 2.D M-8 M/, 82 7*52S [2 11- .1 /2*5.2D 85-G * 7->-5+ -8 .351,.= &2// 28,2/ >-G2 I,+ > *D;*.72 I1-)$&" 10 :+- )1/%# +$ %+ :-)/ #$ FC [email protected] Ac OB_ ObSAV PMAN?E 52 1, D2.+1 D $3. +,. =+ -. D, 12 *12E ,*+2 ]gH KgE J:G<+- G -773 552 .7 2 *.D *11-7 JC H e*6 2I1Z, D 7/, .,7*/ 8*7+-51 ,. .351,.= geH K-++ #>-G<1-. &3.7*. B+/+&) %7 #$ :- )/#$F J ?+& "*7C >-G2 OQB MOPOE 521 ,D2.+1 I,+> 7*.7 25 E [email protected] @NcB?_ObS ],+ 7>2 // J[ E R*G ,/: -; 251,= +>2 ^3* /,+: -8 .351,.= >-G 2 7*5 2 8-5 521, D2. +1 I, +> *D;*. 72D >+ *.D e5 *F -I 1Z, &0H K+.# %&" !&)+C [email protected]@N cOU _Q bSQP VMQUO E .+ ,*E D2G2 *. J' H )2/1 -. 0CH 4255, . )CH ]- 11 C$ H $*GG21 KgH #- //2 JT E C 7- G<* 5, 1-. -8 G2+> -D 1 +- 7-GG3 .,7* +2 $,7ZG <52825 +52 *+ G2.+ 8*7, /,+ ,21S #5*D,+ ,-.*/ <5*7+, 721 ;25131 +> 2 <>:1, 7,* . -5D25 1 8-5 /,82M13 1+*,., .= 2.72 1 ,. .35 1,.= 5*GE *3C [email protected]@ cQV_UbSA ?OA MA?O VE <5-= I1- )$& " 10 *7 + 9< +)#%& $ ,+)#&* )#%/ E1%#+ +52 *+ G2.+ e,;2 .1 g[H J>*882 5 ][ H #2.- g]H ],+7>2// i,2/: 312 *.D -3 +7 -G21 ,. .351,. = >- G2 521, D2 .+1 I,+> &iH J[E $- 1<,72 .+,*E I1- )$& " 10 *7 + 9< +)#%&$ ,+)#&*)#%/ E1%#+*3C [email protected] [email protected] _A?bS? ?V OM??NAE *D; *.72 D D2G2 ][H R- 5+,25 ]E &2;2/--G 35F *. K/*7Z .+1 ,. [email protected]@QE [2 <- 52 ]gH ],// T>, +2 YEJE C [email protected] AcQ A_? bS ?QA M?P @E 67+ ,+)1$ *1"1F#/* CH e-.\*/- R[H ]-5 `E #>2 =5-I+> -8 >-1<,72 ,. YEJE )351, .= $- G21 E I1-)$&" 10 *7+ 9<+)#%&$ ],//25 J0 H [,G* [email protected] [email protected] QV_V VA MAOVV E bSAO ,+) #&*) #%/ E1% #+*3C 0* <5,- #H C> . %H 2+ */ E '.D M-8 M/,82 ^3*/, +: M-8 M7*52 G2*1352 1 8- 5 .351,.= >-G21S 4/* 72 -8 D2*+> *.D ]3Z* G2/ &KH >-1< ,72 E I1-)$&" 10 (&""#& *#4 + K+. #%#$+C [email protected] A? cAQ_ObSOBV MOOPE %,7> J' H T,//,*G1 0JH u,G G25G*. 72 -8 8*G,/: *.D 1+*88 G2 GF 25 52 <-5+1 *F-3 + 2.D -8 /, 82 ,. *11 ,1+2 D JE 0- .7- 5D*. .351,.= >-G ,+) 1$*1 "1 F#/* C [email protected] @c [email protected]_A bSAA [email protected] E /,;, .= *.D 21 E S C 52 ;, 2I -8 +>2 /,+25*+352E . &H K5 *G1 2.1- .35 1,.= >-G 2 12++,.= -. gE $-1< ,72 7*52 I1-)$&" 10 (&# $ &$. J+2; ,. +>2 [email protected]@ NcB V_B bS [email protected] MOQ AE E3<@ *1< K&$& F+ <+$ *C e-\ */- 4H ], +7 >2// J[H K:.3 G g4H &-1* &H ]-5 `E #25G, .*/ >-1<, +*/ ,\ *+, -.1 -8 .351, .= >-G2 521 ,D2. +1S #2 .- g]H = +>2 5*+ 2 -8 D- .-+ 52D37 -5D251 &-21 8*7 ,/,+ : ,.7 52*1,. 2 +>2Gq I1-)$ &" 10 (&#$ J E3<@ *1 < 521317,+*+2 +$*C [email protected] [email protected] [email protected] OU E K&$ &F+< [email protected]_P `4H #>-G<1-. JCH e*62I1Z, KgH K-++ ]gE '.D M-8 M/,82 7*52 ,. .3 51, .= >-G21S +>2 >, => 7-1+ -8 1+*88 +35.-;25E #,/D2. [email protected] A? [email protected] _B bSAP :-)/# $F +%1 $1 <#%V C BMAPP E -8 .3 51, .= >-G D5- < &4H 2.D*// CE 0-G8-5 T*/ 1+3D: i,5Z 2MF*1 2D 2.D M-8M/,82 7*52E I1-)$&" + G2* 135 21S C ^3*/,+*+,;2 10 (&" "#&*# 4+ K+. #% #$+ C [email protected]@ NcA ?_V bSUAN MU? OE T2 /7> [0H ],//2 5 J0H ]*5+, . 'TH )*.D* CE %28255 */ *.D +,G, .= -8 5282 55*/ +- >-1<, 72 7*52 ,. .351,. = >-G21S #> 2 1,= .,8 ,7* .+ 5-/ 2 -8 1+*88 G2 GF2 67+ ,+) 1$* 1"1 F#/ *C [email protected]@VcOV_ObSOUU MOVOE 51E +%* =-*C'*$ ]#H 2+ */E '8827+1 -8 * <*//,*+,;2 7*52 ,.+ 25;2. $2=2/ -3+7-G2 1 ,. <*+, 2.+1 I, +> K*Z ,+ *1 ]H [:- .1 i&H +,- . -. 7/,. ,7*/ S #>2 45- 627 + ')CK[' "" 5*.D -G,\2D 7-. +5-// 2D +5, */E I1- )$ &" 10 *7+ 9<+) #%& $ K+. #% &" *D; *.72 D 7*.725 9/ /1 %#& *# 1$ E [email protected]@[email protected]?_ Ub SU OA MUONE G- D2/ 1 -8 7*.7 K,1>- 0*5-. 4H J+2<> 2.1 [E &2; 2/-< K*Z ,+ *1 ]iH < ]RH 25 <*//,*+ ,;2 7*52 12 5; ,7 21E ,. = 137721183/ E+<# $&) #$ Q$% 1"1 F3 :-) /# $FC [email protected] [email protected] ?P_O bS?P PM?VOE K2Z2 /G* . &KH )-I 2/1 0#H C//2. [CH J> *Z*5 JH i3 +.2 5 gJH ]*+/-7Z &&E (3+<* +,2. + <*//, *+,;2 7*52 8-5 7>5-.,7 >2*5+ 8*,/352 I1- )$& " 10 (&""#& *#4+ K+.#%#$+C [email protected] AcA O_UbSV AQ MV? AE S C 7* 12 12 5,21E &* ;,21 4JH 45,. 72 M4*3/ ]E 4*//, *+,;2 7*5 2 ,. +> 2 -3+ <*+,2.+ 7*.7 25 72.+25 E I1-)$&" 10 ?1/@#%+ &$. (&""# &*#4+ :-)/#$FC [email protected]? cAO [email protected] MQABE e/ *52 4H J2G< /2 &H J+*F/25 JH J*/+1 [E 4*//,*+ 55*/ ,. +>2 -3 +<* +,2.+ 12+ +,. =S ';*/3 *+,-. -8 * <5*7+, 7*/ 12+ -8 5282 ,;2 7*52 [email protected] 75, +25 ,*E I1 -)$&" 10 Q$%1" 1F 3 ()&%* #%+C [email protected] AcU _PbSBPP OU

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54 T, ++ 2.F25= M[:/21 eH (/,;25 &4E %213/ +1 85-G +> 2 .*+,-.*/ >-1<, 72 ;-/3.+2 25 +5*,.,.= 135 ;2:E 'H J7>.2, D25 [email protected] [email protected] B_B bS ?PA M?PQ E I1-) $&" 10 (&""#&*# 4+ K+. #%#$+C @32. +>2 <*+,2.+ 7*..-+ 52<- C112 11,. = 521<,5*+-5 *E : D,1+5211 !"#$# %/ 10 0* G gE 4*+,2. +1 I>- *52 .2*5 D2*+> *52 85 2^32 .+/ : 3.*F/ 2 +- 12/8 M52<-5+ D:1<.2 *E 0* G2 ^3*/,+: -8 D:, .= ,. /-.= M+25G H D:1< I1-)$&" . g0 H 2+ */E 4*,. Cg H $*. 1-. 0* <5,- MPVVE [email protected]@ VcQ P_ObSPVB 10 *7 + 9<+)# %&$ ,+ )#&*) #%/ E1 %# +*3C T*5. $* :2 1 &H g5EH C.1 +2*D D $(E ".>*/ 2D G-5 <>, .2 8-5 <*// ,*+, -. -8 D:1< .2* ,. ]"H 25 %#H i3 >. %gH K*//*5 M1+*= 2 7:1+,7 8, F5- 1,1 E 9<+) #%&$ I1 -)$&" 10 ?+&"*7 GE3 /* +< (7& )< &%3 C [email protected] [email protected] cPU_ NbSUB [email protected] 2.D 52 g]H T>2 2/25 g[H 0355 -I &0H CF 25.2+>: C4 E &:1 <.2* 52; ,2 I 8-5 +>2 <*//,*+,;2 7*52 i*G */ C$H ]*=3, .*/ S C112 11G <5- 8211,- 1E I1 -)$&" 10 (&" "#&*# 4+ K+.# %#$ +C [email protected] Ac AO_ [email protected] UMAAU ?E 2.+H F35 D2. 1H *.D 2+,- /-=,2 KgH 0355- >: C4E "G<5-; ,.= +>2 G* .*= 2G2.+ -8 D:1<.2* ,. +>2 ;1Z: I &0 H CF 25.2+ i*G */ C$H ],5,- 5*<,D /2*5.,.= *<< 5- *7>21E !7)1$ 7-G G3.,+: [email protected]? cN_Ab SQA MPAE 31,.= #% B+/@#) &*1) 3 D# /+&/+C 0> *- 0J H h* .= T4H 0>2. 0$E '88, 7*7: -8 =3 ,D2 D ,G*= 25: I,+> +>2+ * G31,7 8-5 *D ;*.72D 7*.725 [* , TJH D: 1<.2*S * <,/ -+ 1+ 3D:E W#1"1F#%&" B+/+&)%7 01) :-)/ #$ FC [email protected]@ cA?_? bSAV VMANU E <*+ ,2.+1 I,+> Y. D2 51+*. ]*> /25 &CE 1 *. D D-7 3G2.+,.= *.,1G *E #$ [email protected]@1 )*#4 + J (&""#&* #4 + !&)+C [email protected] cQ_?bSUA MUPE D:1 <.2 !-) )+$* [email protected]#$#1$ J2/2 7Z: 4CH $*55- D 0e H 2+ */E CG 25 ,7*. 0- //2=2 -8 0>21 + 4>:1,7, *.1 7-.1 2.131 1+*+2G2.+ -. ]*> /25 &CH D,12*12E G2.+ ,. <* +,2 .+1 I,+> *D;*.72D /3.= -5 >2*5+ -8 D:1 <.2* !7+/* C [email protected] @c ABU _Bb SPUO MPNA E +>2 G*.*=2 !& )+ :-)/#$FC .2* ,. <*+,2.+1 I,+> >2*5 + 8*,/35 2E D#< +$/ #1$ / 10 !)#*#%&" c [email protected] ]*5+ ,. &' E 4*/ /,*+, -. -8 D:1< [email protected]_BbSA OOMAONE ]257* JH `,//* 5, 4H &*;,D RH C=-\\, .- 0E )-. ,.;*1,;2 ;2. +,/ *+,-. 8- 5 +>2 +52 *+G2.+ -8 D:1<.2 * *1 * D*.+2 ,. +2 .1, ;2 +- 2. DM-8 M/,82 7*52 E 10 (&#$ J E3<@ *1< K& $&F +< +$ *C [email protected]@Nc BV_ Bb S2QMUE F5, D=2 85-G I1-)$&" F2// <*// ,*+, -. -8 C1 7> J]H 2+ */E C 52;,2I -8 ^3*/,+: -8 7*52 2;*/3 *+,-. 8-5 +>2 0*G< ]3/ *51 Z, %CH ][H [email protected] [email protected] *E !&)+ K+.# %#$ +C J !)#*#%&" A_Pb SQBO MQBV E D:1 <.2 9<+ )# %&$ I1-) $&" 10 B+/ @#) &*1)3 RH R,2/D 1 JE ';, D2.7 2MF*12D 52;,2I -8 ,. +25;2.+,-.1 +- ,G<5- ;2 <*//,*+,-. -8 <*,.H D:1 <. 2*H D2<5211,- .E )*^; , RH 025;- [email protected] @Nc PO_V bSV [email protected] ,+) #&* )# %/C 1 $CH '/1*:2 G CH 4*/G2 5 g[H K5 325* 'E 0> *5 *7+25, 1+ ,71 *.D 7- 55 2/*+2 1 -8 D:1<.2 * ,. <* +,2 .+1 I,+> %2DD : Ji H 4*51-. E %#$+C [email protected]@NcA?_ AbS? NMBPE *D; *.72 D 7*.725 I1- )$& " 10 (&""#& *#4 + K+.# ,- . -8 D:1< .2*E !7)1$#% B+/@#)&*1)3 D#/+&/ +C [email protected]?cN_ AbSON [email protected] %-7 Z2 5 eE 4*//,*+ .1,-.E )H 4*/*.=2 2. + -8 D:1<.2* ,. *D;*.72D <3/G-.*5: *5+ 25, */ >:<25+2 4E ]*.*=2G J* 6Z -; &H 42+5-;1Z: !-) )+$* [email protected]#$#1 $ #$ E- @@ 1)*# 4+ J (&""#&*#4+ !&)+C [email protected]@cO_?bSUP MVOE :' -/+' K*W +2 5 C[H T*+ 7> * ]RH K*W+25 T`H [2-. = #H T:*++ ]E &2;2/-, /D5 2. E (+.#& *)#%/ C MAQONE [email protected] cA? U_P bS AQO? 21E . 'CE F-I 2/ -F1 +5 37+, -.S C 52 ;, 2I -8 73 552 .+ +52 *+G2.+ 1+5*+2=, .*.+ 9<+)#%&$ I1-)$&" 10 &-/* ]*/,= + J (&""# &*# 4+ K+.#% #$+C [email protected] Ac? V_VbSQ UP MQV?E ?1/@#% $* 5D: g%H (vJ >2* 0H e,/1 >2. *. iH T2 /7> [H &-3=/ *1 0E #>2 288 ,7* 7: -8 >* /-<25,D-/ ,. +>2 CH T>,+2 -8 .* 312* G*.* =2 G2.+ ,.= ,. <*+,2 .+1 I, +> 7*.725 E I1- )$&" 10 (&# $ J E3< @* 1< K&$&F +<+ $*C *.D ;-G,+ [email protected]@ [email protected] _AbSAAA MAAPE g, G2.2\ CH ]* D2 5- %H C/-.1 - CH 2+ */E J:G<+- G 7/31+251 ,. *D;*.7 2D 7*.72 5E I1-)$&" 10 (&#$ J E3<@*1< K&$ &F+< +$*C bS?O MBAE [email protected]?_A K+.# -8 .*312 ;-G,+,.=E ]*. .,W iE 4*//,*+,-. I1-)$& " 10 ?1/@#*&" * *.D %#$+C [email protected]@Nc [email protected]_ObSAN? MANPE W)#*#/7 ],//25 'H g*7 -F 'H $-7 Z2.F 255: ]E )*312*H <*,.H 8*+,=32H *.D G3/+ ,-1<,+*/,\2D 7>,/ D52. I,+> 7*.7 25E :- )/#$ F ;1) - 2 +52*+G2. UAE !1%7 )&$+ D&*&P&/+ 10 E3/*+< &*#% B+4#+ =/C [email protected]@[email protected]@P? QA

55 %*D I*.: J] H ;- . e53 2.,=2. 8- 5 <*+ ,2.+ 1 I, +> -;*5, *. 7*.7 25E !"#$ #%& " `' E 4*//,*+,;2 *.D 2. DM-8 M/,82 7*52 [email protected] ?cQ Q_A bS AUB MAVOE QP/* +* )#%/ J ,3$+% 1" 1F3C ( $% ' 7-.13/ -3+7- + <*,. *.D <*/ /,*+, ;2 7*52 -8 ,. <*+,2. +*+,-.1S &E 4*,. G21 K2// 0[H i35,:* ]H R, 17>F25= .-1,1E I1-)$ &" 10 (&""#&*#4+ K+.# %#$+C &, 88252 [email protected] AO_A @bSAAO ?MAAOV E .72 1 F: 5*72 *.D D,*= (7+ .1>,<1 *G-. = <*,.H .-.<*,. 1:G<+ -G 1H *. D ^3*/ ,+: -8 /,82 52/*+,- K/* 7Z KH $25 5 iH R,. 2 4H 2+ */E #>2 >-1<,72 7*52 E (&#$ K+. #%# $+C [email protected] AcA ?_ Pb SVV @MVVN E G2* 135 21 ,. -/D 25 *D 3/+ 1 I,+> 7*.7 25 527 2,;,.= [0 H ]3. Cg H $*. 1-. H D:1< .2*H *.D +>2 ^3*/,+: -8 D:, .= ,. /-.= M+25G 7*52E 0* <5,- . g0 H 2+ */E 4*,. *) #%/ E1%#+*3 [email protected] @Vc QP_ObSPVB MPV VE $ ,+)#& I1-) $&" 10 *7+ 9<+)#%& C T#H J+ 2;2. iE Y12 -8 7-.+,.3- 31 ,.+ 5*;2. -31 Z2+*G,.2 8-5 0- .I *: ]H T>,+2 )H g2*. 0JH u2G<1Z: I1-)$ M1+*= 2 7*.7 25 <*, . ,. 7>,/D 52 .E [email protected] @Nc? P_? [email protected] @[email protected] E 2.D &" 10 (+. #&* )#% Q$ %1 "1F 3 :- )/ #$FC -1 <, 72 +2*G <5 -72 1121 [email protected]?cV_AbSQ BMUPE I1-) $&" 10 E1% #& " R1)> #$ 8$. G10 GH#0+ J (&"" #&*#4 + !&)+C D- Me3*: &2/=* &H 4*51-. 1 $C H 2+ */E J<,5,+3 */,+:H 52/ ,= ,-1,+:H *.D 1<,5 ,+ 3*/ <*,. ,. *D; *.72D ](H $3, [email protected] VP MNN OE I1 -)$& " 10 (& #$ J E3< @*1< K& $&F +<+ $* C cOA_PbSN 7*. 725 <* +, 2.+ 1E $0H e5*< ]gH [, &H ]2D ,.* gE 4*,. G*.* =2G2.+ <5,. 7, 2 75, +,7* //: '51 +*D K[ H 43.+, //- iH e,/F25+ [email protected]@N ,//E Bb SA @UQ [email protected] !7+/*C cABQ_ <5 *7+,72 iH #,+ /25 ]H 2+ */E #>2 7*. 725 <*,. C G2* 135 2 -8 2;,D2.7 2MF*12 D <5*7 +,7 2 R, .2 4H $255 ,.D2WS 8-5 7*.7 25 <*,. G*.*=2G 2. + ,. -/D25 *D3/+1 ,. >-1< ,7 2 7*52 E I1- )$&" 10 (&#$ J E3 <@* 1< *D> 252 .72 +$*C K&$ &F+< N_ QbSUN [email protected]? E ]*: [email protected] [email protected] H&$%+*C gH (vK5, TH $, // &E '. D,.= ,.2^ G*. +- 28 827+, ;2 <*, . 52/,28q 2. ]H $*// [email protected]@ c [,F25 3,+, 21 ,. *77211 MVQUE BUP_ NUOO bSVQP /2: %E #> 2 5-/2 -8 +>2 <5,.7 , ,71 2D37*+,- . *+ YJ G2 D,7 */ 17 >--/1 *.D ]*7*3 + *+ +>2 I1- )$ &" 10 K+. #%& " 8*7#% /C [email protected] ?c BV_B bSAU OMAU VE 2.D -8 /,82E ,+1 <- +2. +,*/ ,G <* 7+ -. <*,. G*. *=2 G2. 255: ]E )* 312*H <*, .H 8*+, =32H *.D G3/+ ,-1<, +*/, \2D ],//25 'H g*7 -F 'H $-7 Z2.F 7>, /D5 2. I, +> 7* .72 5E Q$%1"1F 3 :-) /#$F ;1)-< C [email protected]_QbS'B V? M'B NB E ]-D21 +- M[-I 2 `H e,5*5D /,. ]E 0*.725 <*,. ,. +> 2 -< ,-,D M*D D,7+ 2D <*+, 2.+ S 7*. I2 +52*+ ,+ 5,=>+q [H 0>*< <+$* C MAUQE I1-) $&" 10 [email protected]# 1#. K&$&F+ [email protected] ?cV_BbSAPU `H 02.+ 2.- #2*7 >,.= D:,.= <*+,2 .+ 7*52 ,. 0H K*/ /F2 gCH #*GF-.2 ]3++ - ']H 0*;*\\-/, 0H `,// *5 ]gE "+*/:E I1-)$&" 10 (&" "#& *#4+ K+. #%# $+C [email protected]@ NcA ?_ UbS [email protected] [email protected] E +>522 3.,; 251 ,+ ,21 ,. C5= 2.+ ,.* H J<* ,.H *.D H D:1< JE ';,D MF*12D 52;,2I -8 ,. +25;2.+,-.1 +- ,G<5- ;2 <*// ,*+, -. -8 <*,. 2.72 .2*H D2<52 11,-.E )*^; , RH 025;- RH R,2/D1 [email protected] @Nc PO_V bSV [email protected] ,+) #&* )# %/C gCH R2 552// KE #>2 ]*. *=2G2 .+ -8 7*.725 4*,72 !9A 9 !&$%+) I1-)$& " 01) !"# $#%#&$/C [email protected]@cP_B bSAQU MAV ?E <*,.E 4*,. #5 2*+ G2 .+ #-<, %,1 Z ]*. *= 2G2.+E [email protected] BE >++ 35 CE 0* 52=,;25 <*5 +,7, <*+,-. ,. >-1<, 72 5 (/ ,;2 5 &H &2 G,5,1 +2*G G22 +,. =1 ;,* ;,D2 -<> -.2 +27>.-/-=:S C <, /-+ 1+3 D: +- ,G< 5-; 2 <* ,. G* .* =2 G2.+ E ,.+ 25 D, 17, ,. =+- . i#H J2> 5*I *+ JE J-7 ,*/ I-5 Z 5-/ 2 ,. >-1<,72 <*,. M[:/2 +S C .*+, -.*/ 2:E I1- )$&" 10 E1%#&" R1)> #$ 8$ .G10 GH# 0+ J (&" "# &*#4+ !& )+C [email protected] @Nc Q_ AM?b SP AMUOE G*.* =2G2. 135; - 0H ]70*8 825: ]E (&#$ 9/ /+/ /<+$* &$. (7&) <& %1"1 F#%& " K& $&F+<+$*C J+E [-3,1 H ](S ]-1F: 4*125 [email protected] AAE 43 F/,1>,.=c 42*+ JE Y1,.= 7* .. *F, .-, D1 ,. <*,. <*//,*+,;2 7*52E S$*+)$ &* #1$& " I1-)$&" *.D :-)/#$FC [email protected]@ [email protected] bSOVA MOVQE 10 (&""#&*#4+ 45- GG25 'E i2+ *G, .2 8-5 <* ,.S C. 3 ]H K:-7Z "E ]2D,7 *+,- . Z,+1 8-5 G*. K,1 >-< J+2 <> 2.1 21 ,. *=, .= 1:G<+-G*+ +>2 >- G2 S C 135 ;2: -8 7-GG-. >- 1< ,72 <5*7 +,7 2E I1 -)$ &" 10 (& "" #& *# 4+ K+. #%# $+ C [email protected]@ NcA ?_ Ab SBU MOO E K--ZF ,.D25 ]H ]7$3 => ]'E J:G <+- G G*.*=2G2 .+ ,. <*//,*+,;2 7*52 *. D 2.D -8 /,82 7*52E :-) /#$ F !"#$ #%/ 10 :1) *7 9<+ )#%&C UA MB?U E [email protected]@ cOQ _BbS? 0/ *5Z iH K:8 ,2 /D+ )H &*I2 ]H 0355- + -8 -+ >25 #52*+,.= 7-.1+,<*+,-. ,. <*//, *+ ,; 2 7*52S #>2 ,G<*7 I &0E [email protected] ?c? N_? bS A? ?MA?Q E 8*7+ -5 1 *1,D 2 85-G -<,- ,D1 E 9<+)#%&$ I1-) $&" 10 ?1/@#%+ J (&" "# &* #4+ K+. #%# $+C Q?

56 &2/=* D- Me3*: JH 4*51-. 1 $H 4*/G 25 g[H K53 25* 'E C11- 7, *+ ,-. F2+I22. 12/8 M52<-5+2D ]H h2..35 *6*/,.=*G 72 *.D 1/22 2.+1 I,+ > *D;* .7 2D 7* .725E I1- )$ &" 10 (&#$ J E3< @*1< -+ >2 5 1:G<+ < D, 1+3 5F*. -G 1 ,. <*+, bSVA [email protected]_Q NMV?UE K&$ &F+< +$*C ]iE K- I2/ -F 1+ 537 +,-. *. D D2 /,5,3GS ]*.*= ,. = D, 88,7 3/+ 1:G<+-G1 [: .7> -8 ]# H &*>/, . 0H K*Z,+*1 *+ 2.D !"# $#%&" I1 -)$&" 10 Q$%1 "1F3 :-) /#$FC [email protected] ?cAP_ObSBNA MBNVE ,8 2E / #[H #:/25 JE 0-. 1+,<*+,-. ,. <251- .1 5272 ,;,.= >- 1<, 72 7*52E I1-)$&" J+5 *112 /1 JCH ]* WI2// 10 (&#$ J [email protected] @cO @ _PbSV E3<@ *1< K&$& F+ <+$ *C [email protected] MV? @E 2+ */E R*+,=3 Y/ /5 ,7> 0iH &3112 *+ +>2 2.D -8 /,82 E I1-)$&" 10 (&#$ J 2 ,. 7>,/D5 / `H $,/ D2 . g]H 2. I,+> 7*.725 OVB MON OE [email protected] @cO @_ObS E3<@ *1< K&$& F+<+ $*C DK : V (/3 &61# 1>$&'# D/C+& */ 10 "')+ I=J D%Z$ +*3 C31+, . 4H T, /2: JH ]7';-: *.D *.W,2+: ,. <*// ,*+, ;2 7*52 ,.<*+,2. +1 7-G<*52 D I,+> 4] H C5 7>25 [E &2<5211,-. 527 2, ;, .= <* // ,*+, ;2 7* 52 *+ >-G2 E (&" "#&*#4+ &$ . E- @@1 )*# 4+ !& )+C [email protected] AA cN_Ob SBNB [email protected] @E +>-12 *.D <5- =521 1,;2 G3 17/2 52/*W *+,-. -. *.W,2 +:H 8*+,=32 H *. D ^3*/,+: -8 /,82 ,. 8*G,/: 0> -, hiE #> 2 288 27+ -8 G31,7 ,72 <* +,2.+ 7*5 2= ,;2 51 -8 >-1< [email protected]@cOU _AbSQB MPN E 1E I1- )$& " 10 K- /#% 67+) [email protected] 3C 7*.7 ]H 4*51-.1 'E J:G<+ -G D,1+521 1 ,. *D; *.72D g[H K5325* 25 <*+, 2. +1 D- Me3*: $CH [, uH 4*/G25 &2/=* ,. +>2 <*//,*+, ;2 7*5 2 12++ ,.=E E- @@ 1)*# 4+ !&) + #$ !&$%+ I,+> *.W, 2+: *.D [email protected]@N cAU_Q bSQU BMQUN E D2<5 211,-. )C JC H "=/2I Z2+ *G,.2 8- 5 +>2 5*<,D +5 2*+G2.+ ,7\ CE (5*/ . *.D *.W,2+: ,. <*+,2.+1 "5 I,. -8 D2<5211,- I1- )$& " 10 (&""#&*#4+ K+. #%#$+C [email protected]@ cAB_UbSN @B [email protected] V 52 72 ,; ,.= >-1 <, 72 7* 52 E E g- >.1 -. iJH #3 /1Z: > D- G*,.1 -8 1<, 5,+3 */,+ : *5 2 *11- 7,*+2 D I,+> *.W,2+ : *.D gC H $*:1 g0H 2+ */E T>,7 I,+> *D; *.7 2D ,/ /. 211q I1-)$&" 10 ,+$+)& " S$*+) $& " K+. #% #$+C [email protected] ?P_U bS UQA MUQV E D2< 52 11,- . ,. <*+,2.+1 3 iH #1 ,/,Z* 'H 4*5 <* 'H 2+ */E "//.2 11M52/*+2 D >-< 2/2 11. 211 ,. *D ;*.72D 7*.72 5S ". 8/32.7 2 -8 ]:1 +*Z,D- 5211 ,- .H *.D <52 <*5 *+- 5: =5 ,2 8E 9)%7#4+/ *.W ,2 +: H D2< [email protected]@N c? B_ ?bS AB VMAOU E 10 (/ 3%7# &*)# % :-)/# $FC I+# $)$ -< K*/ *1 ]H %,72 ]H 0> *< 25-. -+ ]H R37 >1 KE ]*.*=2G2 .+ -8 D2 /,5,3G ,. 75,+,7*// : ,// -/D25 *D3/+1E 0H JG ,+ > $H &,1F [email protected] ?cB ?_Ob S AQM?P !)#*# %&" !&) + :-)/+C ]H ]7$3 => ]'E J:G< +- G G*.*= 2G2 .+ ,. <*//, *+,; 2 7*52 *. D 2.D -8 /,82 7*52E :-) /#$ F !"# $#%/ K--ZF ,.D25 ?UA MB?U E [email protected] @cO Q_BbS 10 :1)*7 9<+ )#% &C - 'H ". -3:2 JH 2+ */E 4251,1+2.+ D2/,5,3G <52D,7+1 =52 *+25 i,2/: I1-)$&" 10 *7+ 9<+)#%&$ &H ]* 57 *. +-., G-5+*/,+:E [email protected] @Nc QU_A bSQQ MPAE ,+) #&*) #%/ E1% #+*3C 'H ';*. 1 [H e32;*5* gE )-. M<>*5 G*7- /-=,7*/ ,.+25; 2.+,-. 8-5 *=, +*+ ,-. ,. D2G2.+ ,*S C 1:1+2G*+,7 i-.= 52; ,2I *.D G2+* 9F#$F J K+$*&" ?+&"*7C [email protected]@NcAB_ObSQA? [email protected] M*.*/:1,1E ]*.*= ]# H &*>/, K- I2/ -F 1+ 537 +,-. *. D D2 /,5,3GS ]iE ,. = D, 88,73/+ 1:G<+-G1 *+ 2. D -8 [: .7> . 0H K*Z,+*1 !"# $#%&" I1 -)$&" 10 Q$%1 "1F3 :-) /#$FC [email protected] ?cAP_ObSBNA /,8 2E MBNVE %*- JH R255 ,1 R&H "5I ,. JCE '*12 8-5 D2< 5211,- . *.D D2/ ,5,3 G ,. <*+,2 .+1 2.5-//2 D ,. ,.<*+,2.+ -8 17522.,.= I1-) $&" 10 (&" "#&*# 4+ K+. #%#$+C [email protected] AO_B bS ?UQ M ?UN E >-1< ,72 7*5 2E J7* 5< , 'H ]*/+-. , ]H ],72/, %H 2+ */E J35 ;,; */ <52D,7+,- . 8- 5 +25G,.*//: ,// 7*.7 25 <*+,2.+1S %2 ;,1,-. -8 +> 2 <*//,*+,; 2 <5- =.- 1+ ,7 17- 52 I,+> ,.7 -5< -5*+ ,-. -8 D2/, 5,3GE [email protected] cAP_A? bSA UNB MAU NNE Q$%1"1F#/*C I+C )+//$ 1% C31+, . 4H T, /2: JH ]7';-: [E &2<5211,-. *.D *.W,2+: ,. <*// ,*+, ;2 7*52 ,.<*+,2. +1 7-G<*52 D 4] H C5 7>25 ,;,.= <* //, *+,; 2 7*5 2 *+ >-G 2E (& ""#&*#4+ &$. [email protected] @1)*# 4+ !& )+C I,+> +>- 12 5272 N_Ob SBNB [email protected]@ E [email protected] K2Z2 /G* . &KH gCH $*; 5*.2 Z '4H 2+ */E J:G<+-G F3 5D2 .H D2<5211, %3G182/D +3*/ I2// MF2,.=S C -.H *. D 1<,5, 7-G <* 5,1 -. -8 >2*5+ 8*,/352 *.D *D; *. 72 D 7*.725 <*+,2 .+1E I1- )$ &" 10 ,+$ +)& " S$* +)$& " K+ .#% #$ +C [email protected]@N c?O _QbSQN? MQNVE D,1+521 D- Me3*: $CH [, uH 4*/G25 g[H K5325* 'E J:G<+ &2/=* ]H 4*51-.1 1 ,. *D; *.72D 7*.7 25 <*+,2 .+1 -G I,+> *.W, 2+: *.D D2<5 211 ,- . ,. +>2 <* //,*+,;2 7*52 12++, .=E E- @@ 1)*# 4+ !&) + #$ !&$%+ )C [email protected]@N cA U_Q bS QU BMQUN E -/-=: $-2 <>2. -G2. &%H K2 // g[H C5G2.+ *.D 17522 .,. = -8 7/ ,. ,7*/ D2 <5211,-. ,. 7*.725 MQAE <*+ ,2. +1E I1-) $& " 10 (/3 %71/1%#& " Q$%1"1F3 C [email protected]@Vc?P_AbSBA QB

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58 g- >.1 -. geH R,51+ ]KH K/-7Z +,; ,+: +- G2.+ */ >2*/+> 125;,721 *G-.= JH 2+ */E J+,= G*+,\*+,- . *. D 5272< E* -.#+/C [email protected]@ NcB B_VbSPNA 52 72 .+ /: F2 52*; 2D *D3 /+1E D+&*7 MUAAE +:<2 KTE $-1< .22 D 8- 5 F252 *;2G2 .+ 7-3.12 /,.=E 9<+)#%&$ g- .21 * =52*+25 1 I>,7 > ,.D,7*+2 ,72 D,12*12 [email protected] [email protected] [email protected]?U_BbSAVU +C I1-) $&" 10 ?1/@#%+ J (&""#& *#4 + K+.#%#$ gH $-+-< 8 ]E %, 1Z 8*7+-51 8-5 7-GG-. G2.+*/ D,1- 5D25 ,. 7*5 2=, ;, .= *.D *< *5 , ]H CD D, .=+-. M$*// i I1-)$&" 10 (&#$ J E3 <@ *1< K&$&F+ <+$*C [email protected] @[email protected]_PbSV OO MVQ PE G2 .+E F25 2*;2 T,/Z,2 &gH 2+ */E &2;2 /- <,. = * F/2.D2D 7- 35 12 -. D:,.=H /- 11H *. D =5, 28 E :-)/+ i*; *.*3 => iH C. D52 -. , `CH [email protected]@NcBO_ Bb SA? PMABA E 8.-%&*1 )C -. )H $*// i22.2 2G2.+ D2F5,28, .= 1211,-. 1S C. ,.+25;2 .+,-. +- 13<<-5+ KH %3 1>+- 'C H $3++ . 0E K252*; *8+25 +>2 D2*+> -8 * <*+, 2.+ E (+.# &*) #% :- )/#$ FC ,. G*.*=,.= >2* /+> 7* 52 <5 -82 11, -.*/1 +> 2,5 =5,28 [email protected]? cBP _ObSAVQ MAVNE i251+ =5,28 ,. <*+,2.+1 I,+> 3.,<-/*5 D2 <5211, -.E I1-)$&" ,.= CH i5- Z2 5 iH $- 51+ G*.. gH 2+ */E 0- G< /,7*+2D [email protected]@N cA AV_A MBbS [email protected] [email protected] 10 900+ %*# 4+ D#/ 1). +)/C >*G M&, 2+ \ CH T*/ 1> ]H h-.Z2 i5*G 25 KgH i*; *. *3=> ,7*+ 2D =5, 28 1:G<+-G1 ,. 7*52=,; 251 -8 ]H #52.+ 5 gCE 0-G2 5-/2 -8 8*G,/: 7-.8/,7+H ,.+5*<1: 7>, 7 1+5*, .1H *.D >-1 <,7 2 3+,/ ,\*+ ,-.E Q<+ F& <25 1- .1 I,+> 10 D+ &*7 J D3#$ FC G I1-)$&" [email protected]@ cP? _BbS? @A [email protected] 1,=., 0355, i22122 )gE J2 .12 *.D %CH 8, 7*. 72S C G,W2D G2+>-D1 TeH [,7 >+2 .+>*/ 25 g] H )2,G 2:25 = *8 +2 5 +>2 /-11 -8 -.2v1 7>,/D E I1- )$ &" 10 !" #$#%& " (/ 3%7 1"1F3 C [email protected] @c PP_ Ub SUN AMVA? E 2W* G, .*+,- . -8 G2*. ,.= G*Z,. ),/ 11-. TeH &TH 2+ */ E Y.D253+,/,\*+,-. -8 G2.+*/ >2 */+> 12 5;,721 *G- .= [,7 >+2 .+>*/ ]H i,1 1*.2 D 7*52=,;2 D =5 ,28 D,1-5D25E (/3%7 #&*) #% E+)4#%+/ C [email protected] AcP?_ [email protected] SA??Q MA?? NE F25 2*;2 51 I, +> <5 -/-.=2 ]H Y+ \ %H &2 `5,2 1 KE 'W<2 5,2 .72 1 *.D 2*5/: 7- <,. = -8 F252 *;2 D 1<-312 1a<*5+.25 1 ,. *. [3 .D &H 0*125+* -. +>2 ,.+ 25 ;2 .+ ,-. F*12D G I1 -) $&" 10 D+& *7 J D3# $F C [email protected]@c PA_ Ob S?N AMBAB E D3*/ <5- 72 11 G-D2/ Q<+F& .+S *. -;25;,2 IE <251< -8 <25 ,.*+*/ 3/+35*/ F252* ;2G2 27 +,;2 (+$$/ 3"4 &$# & :-)/+ ]*5+ ,. ]E #5 *.17 /-11 *.D MPE [email protected]@N cPO _BbSO *.D =5,2 8 ,. <*+,2.+1 I,+ > 17> ,\-<>52.,*S (. /, ;, .= ,. *.-+>2 5 I-5/DE 9)%7#4+/ 10 ]*3 5,+ \ ]H ;* . ]2,6 2/ KE [-11 #% :- )/#$FC QA M?P @E [email protected]@ Nc? B_BbS? (/3 %7#&*) i[H K5,//2 5 J$H J7>,G J]H #>3 51+-. 0H i*F2/ CE 'W*G,.,. = +>2 .2 2D1 -8 F252*;2 D <*52. +1 ,. +>2 ]225+ [email protected] @Nc BB_VbSUA? 7*52 3. ,+S * ^3*/,+*+ ,;2 1+3D:E D+& *7 E*- .#+/ C [email protected] <2D ,*+ 5,7 ,.+ 2.1,;2 ]225+ i[H &-. )2 I+> 0gH 2+ */E 0-G2 <2D ,*+ 5,7 ,.+ 2. 1,;2 7*52 9)%7#4+/ 10 (+. #& *)# %/ J 9. 1"+/ %+$* K+.#% #$+C * 7>, /Dv 1 D2*+> 3.,+E [email protected]@ cAP O_ [email protected] [email protected] E 4*52.+*/ F252*;2G2.+ .22D1 ,. +> 2 <2D, *+5, 7 ,.+2 .1,; J$E 3.,+ S %2 ;,2I ]225+ i[H J7>, G J] H K5 ,//25 2 7*52 1E -8 *;*,/*F/2 K+ .#%#$ +C [email protected] AO _VbSN QA MNPOE G2*1352 I1- )$ &" 10 (&""#&*#4+ i[H J>2 *5 iH )2I+> 0gH 2+ */E R-//- IM3< 1+3 D: -8 7- G+22 . G- .+ >1 *8+ 25 ]225+ ,. +>2 <2D ,* +5,7 ,.+ 2.1,;2 7*5 2 3.,+ E I1-)$ &" 10 (& ""# &*# 4+ K+. #%# $+ C [email protected] AcA O_ [email protected] UM?AOE * 7>, /Dd 1 D2*+> )]H ]2/ >2G eH J>*G12DD2 2. TH T*/Z25 4*:.2 ]H K5 2.+ &CE e5 ,2 8 ,. 7>,/D52. *.D *D -/2172 .+1 4-5+* D F: 13DD2. cPV_N D2 *+ >E 9)%7#4+/ 10 ,+$+)&" (/3%7 #& *)3C [email protected] F25 2*;2 bSNAA MNANE <*5 2.+*/ 3 iH #1 ,/,Z* D >-< 2/2 11. 211 ,. *D ;*.72D 11M52/*+2 ]:1 +*Z,D- 7*.72 5S ". 8/32.7 2 -8 'H 4*5 <* 'H 2+ */E "//.2 *.W ,2 +: H D2<5 21 1,-.H <52<* 5* +-5: =5,28E 9)%7#4+/ 10 (/ 3%7# &*)# % :-)/# $F C [email protected]@N c? B_? bS AB VMAOU E *.D )2I1-. %JH K- 2/2 . 4CH $2Z iH $- 8G*. CH #,2G2,25 $E #>2 <52;* /2.72 *.D 7>*5*7+2 5,1+,71 -8 7-G 1 0]H $H 2D1E W+)+&4+<+$ *A E*-.#+/ 10 ,)#+0 #$ 9.-"* H#0 + 51-. 2DE )2I h-5ZH )hS %-3+ /2D=2 4*5Z2 45,=2 *.D R5*.7,1 e5 -3 2 52/*+ ,- .1>, < F2+ I22. =5,2 TH R,2/D 1+G2.+ *. D . %H 4*7ZG*. 7-.+ ,.3 ,. = F- .D1 8-5 <*52 .+ 1 I>- >*; 2 /-1+ * 7>,/DE Q<+F& G I1- )$ &" 10 D+&*7 J D3#$ FC [email protected]@ NcP @_ Ab SA MBAE %3F ,. JJ H )*D*; (KH ]*/Z,.1-. %H i-52. &H e-8825 MJ>. *57> ]H ],7>*2/ , 'E #>2 +I- M+5*7Z G-D2/ -8 F252*;2 G2.+ ^32 1+,- .. *, 52 _##K9bS &2; 2/ -2 *1 1,G,/ *+,-. -8 45-F /2G *+,7 'W<25 ,2.721 J2^32 .72S C. *<< 5-*7> +- 2; ,D 2.7 2MF*12 D <5* 7+,7 2 ,. F2 52 *;2G2 .+ 7-3. 12/,.=E I1-)$&" 10 E1%#&" R1) > #$ 8$ .G10 GH# 0+ J (&" "#& *#4+ !&)+C MBP?E [email protected] cU_ [email protected] QQ

59 T-5 D2. TE ,)#+0 !1-$/+ 01) *7+ K+ $*&" ?+&"*7 ()& %*#* #1$+)C O+> 2DE "#$F J ,)#+0 67+)[email protected] 9 ?&$.P11> 5 45 211c )2I [email protected]@ NE h- 5ZH )h S J<5,.=2 K: W @1& $'# D/ C+ &* / 10 "') + I=JD 10 E1%#&" 2 *.D 2.D -8 /,82 7*5 2E I1-)$&" <5*7+,72 * eH (+, 1Me5 22. JE J- 7,*/ I-5Z ,. <*//,*+,; C/+ ,/,- #H e*5D, [email protected] @Vc O_O bSA MAN *# 4+ !&) +C R1 )> 8$. 10 H#0+ (&""#& 1-7,*/ ,.+25 *7+,- .1 52/*+2D +- 2.D M-8 M/,8 2 7*52 ,. .3 51,.= ]E C 85* G2I K2 5. Mi/3= -5 Z 8- 5 7*+ 2= -5,\,.= 67+ ,+) 1$* 1"1 F#/ *C [email protected]@N cON _ObSO NQ [email protected] E >- G21 /2W *.D 2G<- I25,.= 0*= /2 geE 'D3 7*+,-. */ I-5Z ,.+2 5; 2.+, -. *+ +>2 2.D -8 /,82E ?+& "*7 J E1%#&" R1)>C S C 7-G< 1-7, M?UE [email protected]@ NcB O_ AbSAU */ I- 5Z *.D *.D ,//.2 11S "G52 JE J2W3*/,+: bS?? BM?BBE ?+& "*7 J E1%# &" R1 )>C [email protected] @Nc BO_B ;2 1-/3+,-. /,2 1 -. +>2 =21 *.D 75 2*+, 85- .+ /,.2 S 0>*//2. 1 ,. 535*/ >-1<,7 2 CuE J25 ;, .= 8*G, $* W+ -. g'H K-2/Z ZE E1%#& " R1) > #$ ?+ &"* 7 !&) +C [email protected]@cO N_PbSQ?P [email protected] E 1-7 ,*/ I-5 0E _? @A?bE $25 G*.H .,+ ,21 8- 5 1-7,*/ I- 5Z2 51 ,. >-1<, 72 *.D <*//, *+, ;2 7*52 E 0>*//2. =21 *. D -<<-5+3 1E II IE1-7 5Z251E-5=a<5*7 +, 72aF252*;2 G2.+ -8 J- 7, */ T- 5Z25 T* 1>, .=+ -.H &0 S )* +, -. */ C1 1- 7,* +,-. ,*/I- 5 ?AH [email protected] A?E C772 112 D &2 72GF2 2 K'E ". +25 ;2.+,- . 8-//-I,.= * 13DD2. D2* +>S #>2 1-7 ,*/ I-5Z MG2D, 7*/ 2W*G,.25 G- D2/ E \/ 2 JH K5,D i,.+ bS?? AM??OE [email protected] [email protected] BQ_B ?+& "*7 J E1%# &" R1 )>C 25 K#H i*;*. *3=> ]H #52. +>*G M&,2+ \ CH T* /1> ]H h-.Z 25 gCE 452D, 7+-51 -8 8*G,/: 7-.8/,7+ *+ +>2 2. D i5*G 721 -8 1<-3 -8 /, 82 S #> 2 2W<25,2. 5E 67 + ,+)1$*1" 1F# /*C [email protected] [email protected] 121 *.D *D3 /+ 1 7>, /D5 2. -8 <2 51-. 1 I,+ > /3. = 7*.72 [email protected] _? bS?A QM??QE */ I- 5Z ,. ,. +2.1, 0'H %E "G<5- ;,.= 1-7, ]70-5 ;2 7*52 3.,+ <*//, *+ ,;2 G, 7Z CgH 035 +,1 g%H J+-I2// MT2 ,11 4H #-G1 +1 -8 * ^3*/,+ : ,G<5 -;2 G2. + ,.+ 25 ;2.+ ,- .E I1-)$&" 10 (&" "#&*# 4+ K+.#%#$+C [email protected] [email protected] _BbS?NU [email protected] 7*5 2S %213/ 7,*+ ,-. -8 J-7 ,*/ T- 5Z25 1E 025+,8,2D $-1 <,72 *.D 4*/ /, *+ ,;2 J-7 ,*/ T-5Z _0$ 4MJTb [email protected] @NE )*+ ,- .*/ C11- 2D2.+ ID7E- 5=a75 ,*/ 1a7 ><12E*1 ,* /1 a75 2D2.+ >+ + [email protected]+&>/5 :9E R (1"# %3 E*&* +<+$*/5 \]O\ G\]Ob C N+> 1E +-. H &,1+5, 7+ -8 0-/3G 452 11c [email protected] ?E 2D E T* 1>,.= F, *S )C JT 1E J-7,*/ 1 ,. $-1 <,7 2 *.D 4*/ /, *+,;2 0*52 S (773<*+,-.*/ 7,*+ ,-. -8 J-7 ,*/ T- 5Z25 T-5Z25 )*+ ,- .*/ C11- Z251E 45 -8 ,/2 E [email protected]@ E >+ + ]H 0y 5D2 .* 1 hH '< <25> *5+ %H 2+ */E 43 F/,7 >-1< ,+*/ <*//,*+,; 2 1-7, */ I- 5ZS CDD5211, .= <* +,2. + 4*55 .2 2D1E R1) > #$ 8$. G10G H# 0+ J (&" "# &* #4+ !&)+C 10 E1%#&" 73 /+ 35* / D,;2 51 ,+: *.D <1: 7> -1-7,*/ [email protected] A?c I1-)$&" S?A OM??VE V_Bb E1%# &" R1) > #$ 8$. 10 H#0+ &$. (& ""# &*#4+ !&)+C 0>,7 ]E "[S [:723 G K--Z 1c [email protected] @NE %2 ,+> ]H 4*:.2 *=-H iH K5 -311*5D 0E 'W- 1<,72 */ I-5Z25 1 *.D -+>25 G2 GF251 -8 +>2 +2*G 1-7, 10 E1%# &" R1)> #$ 8$. G10 GH#0+ J (&" "# &*# 4+ !&)+ E C I1-)$&" cYOZ A [email protected] A?cASA @M?VE J, G- .1 iH 4*5 ZM[2 2 'E J-7,* / I-5 Z 1+ 3D 2.+ 1d 7-G8 -5+ I,+> 2. DM-8M/,82 7*52E I1- )$&" 10 E1%#&" R1)> #$ 8$ .G10 GH#0+ J (&"" #&*#4+ !&) +C _A M?b SBO MOV E [email protected]@NcQ 2H *.D */ T-5 2 1-7 ,*/ I- 5ZS [,.Z,. = <-/,7 :H <5*7+,7 $-1<,7 5212 *57 >E C 52 <-5+ 85-G J-7, Z 4-/ ,7 : ".1 +, +3+2E ]*57 > ?QH [email protected]@ 1:G<-1 +>2 [email protected] [email protected] E III E1 -7, */I -5Z<- /, 7:E- 5=aI<7 -.+2 .+a3 -D 8- 5 F3,/D,.= 2G<* +> :E I1-)$&" 10 E1%#&" R1)> #$ 8$. G10 GH#0+ J (&"" #&*#4+ !&) +C _AbSB NMQQE [email protected] I1- )$ &" 10 ,+)1$*1"1 <1:7> +52*+G2.+ T*/ D5- < &4 E '; ,D2 .72 MF*12D -8 /,82E -1-7,*/ F#%&" E1%#&" R1) >C *+ 2.D [email protected]@ VcQ @_ JA bS ?PU M?N?E T,// ,*G1 JTH T,//,*G 1 0JH u,G G25 G*. JH ]3. . gH &-F F1 &H J/-*.2 4E 'G-+, -.*/ *.D <>:1, 7*/ >2*/ +> -8 ,.8-5G*/ 7*5 2=, ;25 1 -8 521, D2.+ 1 *+ +>2 2.D -8 /,82S #>2 5-/2 -8 1-7 ,* / 13<<- 5+ E I1-)$&"/ 10 ,+) 1$*1 "1F3 E+)#+/ WG MAVBE (/ 3%71 /1%#&" E%#+$%+/ J E1%#& " E%#+$%+/C [email protected] @Vc PB_B bSJAUA QP

60 I=J DK : X @C$)$* -'# D/C+&* / 10 "' )+ $eH 2+ */E l"8 e-D C/7- 5. J%H K* /F -., ]gH D*:H " I-3/D.v+ F2 >252 +-D*:S n I*.+2D 45,=251-. G2 :21+25 2W<25 1 -8 *D ;*.72D 7*.725E I1- )$ &" 10 (&""# &*#4 + K+. #% #$+ C .+1d ,2.72 %2/ ,=, -31 *.D 1<,5 ,+3 */ +> 2G 21 ,. <*+,2 [email protected]@ cAB _QbSQVA MQVVE ]H i,5* $H J>,G* C.D - ]H ]-5 -8 F2 52 *;2 G2.+ /,82 52;,2I -. 1<,5,+3*/ ,+* #H ], :*1>,+* ]H J*.6- hE '88 27+1 *1< K&$ &F+<+$ *C [email protected]@[email protected]_ Bb SOQ BMOQN E I1 -)$ &" 10 (&#$ J E3<@ I2//MF2,. = *. D D2 <52 11 ,-.E ., ]H 4*3/Z ]' H 2+ */E J3 <<-5 + -8 7*.725 <*+,2.+1 d 1<,5,+ 3*/ .22D1 K*/ F-., *11-7 ,*+ ,-.1 I,+> #H K*/F- *.D 7-1+1 *+ +>2 2.D !&$%+)C [email protected]_?BbE G2D ,7* / 7*52 -8 /,8 2E *D;*.7 4*3 /Z ]'H -8 1< ,5,+3*/ 7*52 +- <*+, 2.+ 1 I,+> -. , ]gH 2+ */E 45 -;,1,-. 2D 7*.725 S #CH K*/F K*/ F-., ,7*/ 7*5 2 *. D ^3*/,+: -8 /,82 .2*5 C1 1- 7, *+ ,-.1 I1- )$ &" 10 !" #$#% &" Q$%1" 1F3C [email protected]@ Nc ?V_ Bb SOO QMOQ? E I,+> G2D D2*+>E %3G182/D 5*.2 Z '4H 2+ */E J:G<+-G F35D2.H gCH $*; 1<, 5,+3*/ I2 //MF2,.=S C K2Z2 /G* . &KH D2 <52 11, -.H *.D 8*,/352 *.D *D; *. 72 D 7*.725 <*+,2 .+1E I1- )$&" 10 ,+$ +)& " S$* +)$& " K+ .#% #$+C [email protected]@Nc ?O_Q bSQN?M 7-G <* 5,1 -. -8 >2*5+ QNVE K25=G* [H ]*/,1Z, JH [,+I, . ]JE J<,5,+ 3*/,+ : *.D 2.D M-8 M/,82 7*52 ,. D,1*D; *.+*=2D G2 . D:,. = . gH R,.Z CH iI*. C MONE R1) ". I1- )$ &" 10 [)1"1F3 -8 <5- 1+ *+2 7*. 725 E [email protected]?N_AbSOB 43 7>*/1Z, 0]E ';*/3*+,-. -8 +> 2 R"0C +--/ 8-5 1<, 5,+3 */ *11 211G2.+E I1 -)$&" 10 (&#$ K-5.2 G*. #H R25 52// K%H [email protected] A?c [email protected] _? bSAP 1< K& $&F+<+$*C J E3<@* BMAUBE */ I-5Z E M12.1 ,+ ,;2 7*5 2 ,. >-1< ,72 1-7, 0* //*>* . C] E J< ,5 ,+3*//: I1- )$&" 10 E1%# &" R1)> #$ 8$ .G10GH#0 + J (&""#&*#4+ !&) +C [email protected]@ Nc Q_B MObSAPN MAVQ E D- Me3*: ](H $3, &H 4*51-. 1 $C H 2+ */E J<,5,+3 */,+:H 52/ ,= ,-1,+:H *.D 1<,5 ,+ 3*/ <*,. ,. *D; *.72D 7*.72 5 <*+ ,2. +1E &2/=* *C I1-) $&" 10 (&#$ J E3<@ *1< K&$ &F +<+$ [email protected]_PbSNVP MNNOE I1-)$& *. D 1<,5,+3*/ .+ *.D igE %2/ ,=,-. +,-.E ,+:S C11 211G2 " 10 E1%#&" R1)> #$ 8$. G10 GH#0+ J (&"" #&*# 4+ &-Z* ,.+ 25;2. [email protected] Ac U_AbSNN [email protected] !&) +C 5- /2 -8 <5-8211,-.*/ 0*D=2 5 )H R/ *.*=*. 'H ],1*1, gE #>2 TH K25/,.=2 7>* 2++ eH [:. D2 1 iCH E +2*G1S 4251<2 7+ ,;21 85-G <> :1,7,*.1 *. D 7>*, /D52 . 5272 ,; ,.= <2D, *+5,7 <*//, *+,;2 7*52 $2 W2G R23D+.25 :H -5 /,82 <>, /- 1-<> +, G21E I1 -)$ &" 10 (& ""# &* #4+ K+.#% #$+C [email protected] AcA O_ Ab SBN MOOE H 1<,5 ,+3*/,+ : ,. +-3=> 312 52/,=,-. JH 4*5 1- .1 $CH &2/= *D- Me3*: ]H K5 325* 'E #>2 852^32 .7: *. D 7-552/ *+21 -8 1<,5,+ $3, &H D2 /* 05 3\ ]H #>-5.2: 3*/ <*+,2.+ *DG ,++2D +- *. *73+2 <*/ /,*+ ,;2 7* 52 3. ,+ E 9<+)#%& $ 1 I,+ > *D; *.7 2D 7*.725 D,1+5 211 *G-.= +C [email protected] AA c?V_ObS?P [email protected] J (&""#& *#4 + K+.#%#$ I1-) $&" 10 ?1/@#%+ g- >.1 -. iJH #3 /1Z: g0H 2+ */E T>,7 > D- G*,.1 -8 1<, 5,+3 */,+ : *5 2 *11- 7,*+2 D I,+> *.W,2+ : *.D D2<5211,-. gC H $*:1 ,. <*+ ,2 .+1 I, +> *D;*. I1-)$&" 10 ,+$+) &" S$ *+)$ &" K+. #%# $+C [email protected] c?P_ UbSUQ AMUQV E 72 D ,// .2 11 q %H `* . 0/ 2; 2 [H J*;2D5* I,+> *D; *.72D 7*.7 25S %21<-.1 21 +- * 1<, 5,+3*/ ^3*/, +: -8 /,82 i*G <25 ]E 0>,/D 52. I1 -)$&" 01) [email protected] +%#&"# /*/ #$ (+. #& *)#% :-)/#$FC ,.+ 25 ;,2 IE [email protected] [email protected] [email protected]@cA i.*<< 0H ]* DD2 . `H T*. = $H 03 5+,1 0H J/-:25 4H J> 2.ZG*. 'E J<, 5,+3*/ ,+: -8 <*52.+ 1 ,. <*//,*+ ,;2 7*52E I1 -)$&" 10 (&" "#&*# 4+ K+. #% #$+ [email protected] AcA O_ObS OBU MOOBE [,+ +/2 )iE 0/, .,7* / <* 1+-5*/ ,-. *1 <5-8211,-.* / +5*,., .= S J-G2 2.+ 5*.7 2H 7355,73 /3G *.D *11 211G2.+ 2D37*+ ,7* +, -.1 E J !1- $/+"#$FC [email protected]@ cPO_B bSQEA MVE ,G,. =+- .H &,1 +5, 7+ -8 0-/ 3G F,*S CG2 C11-7,*+ ,-. -8 0- //2= 21 -8 )35 1,.= c [email protected] [email protected] E 5,7*. /<>,*H ]H K-:/2 6)&$/ %-"* -)&" !1$ %+ @*/ 10 :-)/#$F C.D 52I1 P+> 2DE 4>, /*D2 gH 2D 1E 4C S [,< <,.7 -+ + T,/ /,*G1 o T,/Z,.1c !&)+C [email protected] E C.. =2/* M0-/2 [H i*v (<3* [H K317 > ]E "11321 7-.85 -.+,.= 1-7,*/ I- 5Z251 ,. +>2 <5-;,1,-. -8 <*// ,*+, ;2 7*52 ,*+2D 12 5; ,721 4* 7, 8,7 K* 1,. _$* I* ,v, *.D +>2 YEJE C88,/ ,. +>2 4*7, 8,7 "1/ *.D )*+,-. 1 *.D #2 55,+ -5 ,21 bE MAPBE I1-) $&" 10 E1%#&" R1) > #$ 8$. G10 GH#0+ J (&" "#&*#4+ !&)+C [email protected]@cP_B [email protected] QU

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67 12 TI CE PRAC ED ERR PREF DOMA IN 2. P TS L ASP ICA EC HYS e and document pai n, dys pn ea , cons ti pati on, an d othe r sym pto ms using avail able " Measur O F CARE es. standardi zed scal P PRAC 13 ED TI CE REF ERR " sy mp to ms an d sid e effec ts in a ti me Assess safe , an d effe ctive manner to a le vel and manage ly, a le to th e pati en t and fa mi ly. cc ep tab 14 TI CE PRAC ED ERR PREF D OMA IN 3. HOLOGICA L AND PSYC " ora ces, an l disturb havi be sio n, oth er Measur e and document anxi ety, de pres and del iri um, P CH IA TRI C SY le st and d scal ize common psychologica l sym ptoms usi ng ava il ab es. ard A OF SP ECTS CARE ERR PRAC TI CE 15 PREF ED Manage anx ie ty , dep re ssio n, del iri um , be havi ora l di sturba nc es , and other co mm on " ho psyc in a tim ely , safe, and ef fec tiv e manner to a level acc ept abl e to the lo gi ca l sy mp toms fam t and il y pat ien PREF ERR ED PRAC TI CE 16 and manage ps ych olo gica " ion s of pati en ts an d fami lies to add re ss emo tion al an d Assess l re act al im pai rm ent and lo ss , (i ncluding str ess , ant ici pat ory gr ief and cop ing), in a regul ar func ti on oi ng . fas hi on ong PREF ERR ED PRAC TI CE 17 Dev elop and of fer a grief and bereavemen t care plan to pr ovi de servic es to pa tien ts and fa mili es " ath r to and st 13 month s after th e de at lea of th e patie nt. prio for 18 TI CE PRAC ED ERR PREF DOMA IN 4. OF PECTS AS SOCIAL ri ate rop " Conduc t re gular patie nt and fami ly care con fe ren ce s wi th physi cians an d ot he r app E CAR the membe ipl inar y team to provide inf ormat ion, di sc uss goal s of care, dis ease inter rs of disc ad van pla nni ng , and offe r su ppor t. ce d care pro gn os is , and PRAC TI CE 19 ED ERR PREF and implem ent a comprehensi ve soci al ca re pl an which addresse s the soci al, prac tic al " Dev elop le ga ds of the pati ent and careg ive l nee ng but not limited to: relation ships, and rs , inc ludi ati on, exist ing socia l and cu ltu ra l netw orks, de cisi onma ki ng, wo rk and sch oo l se ttings, communic nc es, se xu al it y/int , caregi ver avai labi li ty/ st res s, and access to medi ci nes and fina imacy ip men t. equ ERR PREF 20 TI CE PRAC ED DOMA IN 5. AL , SPI RITU as ses sment and tia l sten exi l, and ua s, spirit " Deve lop of re li gi ou doc ument a pl an bas ed on AN S, OU IGI REL D ins trum conc erns usi ng a stru ct ured d integra ent an te the infor mati on ob tained fro m the TI AL EXI STEN ass es sm en t int o the pall iati ve care pla n. ASP ECTS OF CARE PREF ERR PRAC TI CE 21 ED itu al ca re Prov ide rmat ion ab " the ava ila bilit y of spir info ser vice s and ma ke spiritu al car e out ava ila bl e eit he r thr ou gh organ iz ati on al spi ri tual coun se li ng or throu gh the patient’s own cler gy rel at ion sh ips . PREF ERR ED PRAC TI CE 22 " Specialized pallia tiv e and ho spice ca re tea ms sho uld inclu de sp iri tual care profes sionals app ro pr ia te ly tra in ed and ce rtif ie d in palliative car e. 23 PREF ERR ED PRAC TI CE PO

68 " Specialized ho spice sp ir itu al ca re pr ofe ssio nals sho uld bui ld pa rtne rship s wit h pallia tiv e and c y clergy catio n and co unse ling re late d to end-of-life car e. , and ommunit provi de edu PREF 24 TI CE PRAC ERR ED IN 6. DOMA C URA S L ASPECT ULT " Inco rpo ra te cultural ass essme nt as a comp one nt of co mpre hen si ve palliative and ho spice ca re O F CARE ass es sm in g, but no t limi ted to: loc us of dec ision ma king, pre feren ces re gard in g t, inc lud en d su re in form ation, tru th tel ling and dec isi on is clo ing, di etary prefere nces, la ngua ge, famil y of mak c ati on, for su pport me asu res such as pal li ative desire rap ie s and complemen ta ry ommunic the a al tern at ive med ic ine , pers pec ti ves on de ath , sufferi ng and grie vin g, and fu nera l/bu rial ritu als. nd P REF ICE 25 ERR ED PRACT " pa cult ur ally se nsit iv e materi als in the s and tien t’s and re te r se rv ice l int erp pr ofessiona Prov ide fami ly’ s pre fe rr ed la ngu age. 26 PREF ERR ED PRAC TI CE D IN 7. OMA TI EN T AT CAR E OF PA the ac tiv e dyi e and document the tr ans it ion to Rec ogniz " ng phase and comm unicate to the LI FE END OF t, fam ily, an d staff the expe ctati on of immi nent death. pat ien P REF PRAC TI CE 27 ERR ED ptoms e fami ly is edu a ti me ly basi s rega rdi Th signs and sym ca te d on of imm ine nt dea th in a " ng pme nt all y, age -, and cultu rally appr opr iat e manner . dev elo ERR PRAC TI CE 28 ED PREF As pa rt of the ongoing ca re pla nn ing pro cess, rou tin ely asce rta in and do cum en t patie nt an d " ou s ab fu lfi ll patie nt t th e ca re setti ng for site of dea th, and fami ly wishe and fa mil y prefere nces when po ss ible. ERR ED TI CE 29 PREF PRAC as appro ad dosa ge of anal ges ics and sed ati ves ate pri ate to achie ve pa tie nt co mfo rt Prov ide equ " dyi ng phas e an d ad dur in g the s and fears abo ut usi ng nar co tics and of ac ti ve dres s co nc ern lg es ic s ha death. ana st eni ng ERR PRAC TI CE 30 PREF ED Tr ea t the bo dy po st -death wi th re sp ec t accord in g to " cul tura l and re li gio us pra ctice s of th e the fami ly and in acco ce with lo ca l law. rd an ERR ED TICE 31 PREF PRAC a bere ci lit at e effe cti ve gri evi ng by Fa nti ng in a ti mel y ma nner impl ave ment ca re pla n after " eme t’s death wh the pat ien the focus of car e. en th e family remains PREF 32 TI CE PRAC ED ERR IN 8. DOMA GAL LE AND AL ETHIC for law te ak er " Docu ment the de si gn ated surro gate/d ec is ionm every in acc orda nce wi th sta CARE OF ASP ECTS hos t in prim an d lo ng -ter m care and in palliati ve and te, pi ce care. pat ien ar y, acu ERR ED PRAC TI CE 33 PREF Docu ment the patie nt/s " e pref erences for goals of car e, tr eatment optio ns, and sett ing of urrogat car e at asses sment and at first qu en t int erv als as co nditi on s ch ange . fre PREF ERR ED PRAC TI CE 34 orders " pa tient trea tm ent goal s int o med ical er t the and ensure that the infor ma tion is Conv tra nsf er ab le an d appl ica ble acro ss care sett ings , includ in g long -term care, emergency med ical (PO ser vic es , and su ch as the Physi ci an Orde rs fo r Life -Su stain ing Treatments hospitals, LST ) Progr am. PREF ERR ED PRAC TI CE 35 whi le " Make advan ce di rec tive s and surro gac y de si gn atio ns avai labl e across care settings, PQ

69 pro te ct ing pa vac y an d adh ere nce to He al th Ins uran ce Por tability an d Accoun tabili ty Act ti en t pri ( lth HI PAA In te rn et-bas ed re gi stri es or el ectron ic perso nal hea s, e.g., records. ) re gul ati on by ERR ED PRAC TI CE 36 PREF " hea lthc ar e and com mu nity co llab ora tions to pro mo te ad vance care planni ng an d Dev elop mmunity ion ance dire cti ves for al l ind ivi du al s, e.g., Resp ectin g Choi ce s, Co adv of complet er sat ions on Com pas sionat e Ca re. Conv ERR ED PRAC TI CE 37 PREF " cons or hav e acces s to eth ic s co mm it tee s or ethi cs lish ultati on across car Estab ti ng s to e set a dd re ss ethi ca l co nfl ic ts at the en d of life . PREF ERR PRAC TI CE 38 ED Fo s and prefe dec is ion maki ng capa city , do cume nt the child’s vi ew " re nce s for r min or s with opr cal car ass ent for tr ea tment, and giv e appr e, inclu di ng iat e weight in deci sionmaki ng. medi M ak e appropr iat e pr of ess ional staf f mem bers avai labl e to both the chil d and the adu lt d ec is io nm for co nsu lta ti on and inte rven ti on wh en the child’ s wi shes ak er from th ose of the differ adu lt deci si on ma ke r. tio nal pted fro m The Nationa l Con se ns us Pro ject for Pall iat iv e Care 2013 Cl ini cal Practice Guid eli nes for Pal li ati ve Care and the Na Ada Report. Qual it y Fo rum 20 06 A National Framework and Preferred Pra ctice s fo r Palliative and Hospice Care Quality: A Con sensus PP

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74 For more copi of th is pub licati on , pl ea se co ntact: es Consensus National Project Penn Center West, Suite One 229 Pittsburgh, P A 15276-0100 Phone: 412.787.9301 Fax: 412.787.9305 [email protected] © 2009, National Consensus Project for Quality Palliative Care Copyright ISBN 978-1-934654-35-4 9 781934 654354 R Q U A L I TY P A L L I ATIV E C A R E F O

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