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care of patients at the end of life

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https://www.readbyqxmd.com/read/28335744/a-systematic-review-of-prognostic-factors-at-the-end-of-life-for-people-with-a-hematological-malignancy
#1
Elise Button, Raymond Javan Chan, Shirley Chambers, Jason Butler, Patsy Yates
BACKGROUND: Accurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding 'bedside' prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality...
March 23, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28329829/-end-of-life-care-i-m-not-going-to-worry-about-that-yet-health-literacy-gaps-and-end-of-life-planning-among-elderly-dialysis-patients
#2
Keren Ladin, Katie Buttafarro, Emily Hahn, Susan Koch-Weser, Daniel E Weiner
Purpose: Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Design and Methods: Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston...
March 10, 2017: Gerontologist
https://www.readbyqxmd.com/read/28329822/it-s-all-about-the-relationship-cognitively-intact-mother-daughter-care-dyads-in-hospice-at-home
#3
Diane N Solomon, Lissi Hansen, Judith G Baggs
Purpose of the Study: Adult daughters providing care to aging, ill mothers comprise the most prevalent caregiving dyad. Little is known, however, regarding relationship quality and its impact on care in these dyads, particularly in the context of cognitively intact patients at end of life in hospice. This interpretive descriptive work privileges voices of terminally ill mothers and care-partnering daughters in the home hospice context. Specific aims were to describe and interpret how mothers and daughters: (a) perceive relationship quality and (b) perceive how relationships have developed over time through health, chronic illness, and hospice...
March 10, 2017: Gerontologist
https://www.readbyqxmd.com/read/28329430/maintaining-family-life-balance-while-facing-a-child-s-imminent-death-a-mixed-methods-study
#4
Katri Eskola, Eva Bergstraesser, Karin Zimmermann, Eva Cignacco
AIM: To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision. BACKGROUND: A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home. DESIGN: Concurrent embedded mixed methods design. METHODS: This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012...
March 22, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28326200/the-anaesthesiologist-and-palliative-care-in-a-newborn-with-the-adam-sequence
#5
Alberto Vieira Pantoja, Maria Emília Gonçalves Estevez, Bruno Lima Pessoa, Fernando de Paiva Araújo, Bruno Mendonça Barcellos, Ciro Augusto Floriani, Marco Antonio Cardoso de Resende
Reports focusing on biomedical principlism and the role of anaesthesiologists in palliative care are rare. We present the case of a newborn with multiple craniofacial anomalies and a diagnosis of ADAM "sequence," in which surgical removal of placental adhesions to the dura mater and the correction of meningocele was not indicated due to the very short life expectancy. After 48 hours, the odor from the placenta indicted a necrotic process, which prevented the parents from being close to the child and increased his isolation...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28325567/microvascular-surgery-in-the-congenital-cardiac-patient-a-case-series-exploring-feasibility-and-practical-applications
#6
John A LoGiudice, Karri Adamson, Nancy Ghanayem, Ronald K Woods, Michael E Mitchell
BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015...
February 17, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28324205/levels-of-intervention-how-are-they-used-in-quebec-hospitals
#7
Marjolaine Frenette, Jocelyne Saint-Arnaud, Karim Serri
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered...
March 21, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28320024/-therapeutic-decisions-concerning-severe-neurological-diseases-and-at-the-end-of-life
#8
Christoph Burkhard Lücking
Modern medicine increasingly enables survival of life-threatening diseases. On the other side, however, especially in Neurology, the questions have to be addressed how intensive the initial treatment should be and how to deal with residual states when severe functional or cognitive deficits are expected. In these cases, it is not only important to decide which medical measures are appropriate for the patient, but also whether, given the prognosis, the patient would agree with the suggested measures. This article first describes the basis for each medical action, i...
March 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28318209/end-of-life-care-managing-common-symptoms
#9
REVIEW
Ross H Albert
Physicians should be proficient at managing symptoms as patients progress through the dying process. When possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than to treat an acute symptom. As swallowing function diminishes, medications are typically administered sublingually, transdermally, or via rectal suppository. Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. Delirium and agitation may be caused by reversible etiologies, which should be identified and treated when feasible...
March 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28317138/impact-of-providing-psychiatry-specialty-pharmacist-intervention-on-reducing-drug-related-problems-among-children-with-autism-spectrum-disorder-related-to-disruptive-behavioural-symptoms-a-prospective-randomized-open-label-study
#10
R Wongpakaran, T Suansanae, T Tan-Khum, C Kraivichian, R Ongarjsakulman, C Suthisisang
WHAT IS KNOWN AND OBJECTIVES: Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours...
March 20, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28316557/achieving-prudent-dementia-care-palliare-an-international-policy-and-practice-imperative
#11
Debbie Tolson, Anne Fleming, Elizabeth Hanson, Wilson de Abreu, Manuel Lillo Crespo, Rhoda Macrae, Graham Jackson, Simona Hvalič-Touzery, Iva Holmerová, Pirkko Routasalo
This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources...
December 31, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28306661/referring-patients-to-hospice-or-palliative-care
#12
Kathleen Broglio, Anne Walsh
NPs care for patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, cancer, and dementia. As the disease progresses or patients age, disease-related symptoms may become increasingly burdensome, and these patients may benefit from hospice or palliative care. NPs can guide individuals in this process to optimize care and support at the end of life.
April 16, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28304263/battling-a-tangled-web-the-lived-experience-of-nurses-providing-end-of-life-care-on-an-acute-medical-unit
#13
Irene Oliveira, Frances Fothergill-Bourbonnais, Christine McPherson, Brandi Vanderspank-Wright
Meeting the heath care needs of patients at the end of life is becoming more complex. In Canada, most patients with life-limiting illness will die in hospitals, many on medical units. Yet, few studies have qualitatively investigated end-of-life care (EOLC) in this context, or from the perspectives of nurses providing EOLC. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology guided the method and analysis...
November 1, 2016: Research and Theory for Nursing Practice
https://www.readbyqxmd.com/read/28302739/changing-landscape-of-congenital-heart-disease
#14
Berto J Bouma, Barbara J M Mulder
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28296280/prevention-of-renal-failure-in-chinese-patients-with-newly-diagnosed-type-2-diabetes-a-cost-effectiveness-analysis
#15
REVIEW
Bin Wu, Suhua Zhang, Houwen Lin, Shan Mou
AIMS: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease (ESRD) in China. The current study is to assess the cost effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes (T2DM) from the Chinese health care perspective. METHODS: A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed T2DM might receive treatment according to one of the following three strategies: "do nothing" strategy (control strategy), treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) (universal strategy), or screening for microalbuminuria followed by ACEI/ARB treatment (screening strategy)...
March 10, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28295138/frequency-and-risk-factors-for-live-discharge-from-hospice
#16
David Russell, Eli L Diamond, Bonnie Lauder, Ritchell R Dignam, Dawn W Dowding, Timothy R Peng, Holly G Prigerson, Kathryn H Bowles
OBJECTIVES: To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice. DESIGN: Retrospective cohort study using electronic medical records of hospice patients who received care from a large urban not-for-profit hospice agency in New York City during a 3-year period between 2013 and 2015 (n = 9,190). RESULTS: Roughly one in five hospice patients were discharged alive (21%; n = 1911). Acute hospitalization was the most frequent reason for live discharge (42% of all live discharges; n = 802)...
March 13, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28294576/end-of-life-care-where-do-cancer-patients-want-to-die-a-systematic-review
#17
REVIEW
Jonas Nilsson, Carl Blomberg, Georg Holgersson, Tobias Carlsson, Michael Bergqvist, Stefan Bergström
The importance to die at preferred death place is substantial among terminally ill cancer patients. Previously, several studies have investigated this issue, but no systematic review has been made for many years. This systematic review was made in order to investigate preferred death place among cancer patients. A systematic search was made in PubMed library and a total of 399 articles were found, of which 23 were eligible and included in the review. Preference of home death averaged by 59.9% (39.7-100%) across all studies...
March 13, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28294479/understanding-advance-care-planning-within-the-south-asian-community
#18
Patricia D Biondo, Rashika Kalia, Rooh-Afza Khan, Nadia Asghar, Cyrene Banerjee, Debbie Boulton, Nancy Marlett, Svetlana Shklarov, Jessica E Simon
BACKGROUND: Advance care planning (ACP) is a process of reflection on and communication of a person's future health-care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community. OBJECTIVE: To explore perspectives of South Asian community members towards ACP...
March 10, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28287827/intensive-care-unit-educators-a-multicenter-evaluation-of-behaviors-residents-value-in-attendings
#19
Lekshmi Santhosh, Snigdha Jain, Anna Brady, Michelle Sharp, W Graham Carlos
RATIONALE: It is important for attendings to know which behaviors influence learner perceptions. To date, two studies focusing on general medicine attendings have been published addressing internal medicine residents' perceptions of attendings; there are no data on intensive care unit (ICU) attendings. OBJECTIVES: We sought to expand the evidence regarding this topic through a multicenter study at four geographically diverse academic medical centers. Our study focused on identifying the teaching behaviors of ICU physicians that learners observe in attendings they value as effective educators...
March 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28287357/a-review-of-agents-for-palliative-sedation-continuous-deep-sedation-pharmacology-and-practical-applications
#20
John Bodnar
Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care...
March 2017: Journal of Pain & Palliative Care Pharmacotherapy
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