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"Advance Directive"

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https://www.readbyqxmd.com/read/28644706/advance-care-planning-and-palliative-care-integration-for-patients-undergoing-hematopoietic-stem-cell-transplantation
#1
Winnie S Wang, Joseph D Ma, Sandahl H Nelson, Carolyn Revta, Gary T Buckholz, Carolyn M Mulroney, Eric J Roeland
PURPOSE: Advance care planning (ACP) in hematopoietic stem-cell transplantation (HSCT) is challenging, given the potential for cure despite increased morbidity and mortality risk.The aim of this study was to evaluate ACP and palliative care (PC) integration for patients who underwent HSCT. METHODS: A retrospective analysis was conducted and data were extracted from electronic medical records of patients who underwent HSCT between January 2011 and December 2015. Patients who received more than one transplant and who were younger than 18 years of age were excluded...
June 23, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28635066/consensus-development-of-quality-indicators-for-end-of-life-care-for-elders-in-japan
#2
Harue Masaki, Nobuko Kawai, Keiko Matsumoto, Miyoko Kuwata, Sachiko Yoshioka, Midori Nishiyama, Ryoko Uchino, Hiroko Nagae, Megumi Teshima, Sayuri Sakai, Kazuko Endo
AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics...
June 2017: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/28625275/advance-directives-and-powers-of-attorney-in-intensive-care-patients
#3
Geraldine de Heer, Bernd Saugel, Barbara Sensen, Charlotte Rübsteck, Hans O Pinnschmidt, Stefan Kluge
BACKGROUND: Advance directives and powers of attorney are increasingly common, yet data on their use in clinical situations remain sparse. METHODS: In this single center cross-sectional study, we collected data by questionnaire from 1004 intensive care patients in a university hospital. The frequencies of advance directives and powers of attorney were determined, and the factors affecting them were studied with multivariate logistic regression analysis. RESULTS: Usable data were obtained from 998 patients...
June 5, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28623155/care-toward-the-end-of-life-in-older-populations-and-its-implementation-facilitators-and-barriers-a-scoping-review
#4
REVIEW
Diane Erin Threapleton, Roger Y Chung, Samuel Y S Wong, Eliza L Y Wong, Nicole Kiang, Patsy Y K Chau, Jean Woo, Vincent C H Chung, Eng Kiong Yeoh
PURPOSE: To inform health system improvements for care of elderly populations approaching the end of life (EOL) by identifying important elements of care and implementation barriers and facilitators. DESIGN: A scoping review was carried out to identify key themes in EOL care. Articles were identified from MEDLINE, the Cochrane Library, organizational websites, and internet searches. Eligible publications included reviews, reports, and policy documents published between 2005 and 2016...
June 13, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28615706/channel-branching-and-zigzagging-in-negative-cloud-to-ground-lightning
#5
Rubin Jiang, Xiushu Qie, Hongbo Zhang, Mingyuan Liu, Zhuling Sun, Gaopeng Lu, Zhichao Wang, Yu Wang
A fundamental question in lightning flash concerns why the discharge channel propagates in a zig-zag manner and produces extensive branches. Here we report the optical observation of two negative cloud-to-ground lightning discharges with very high temporal resolution of 180,000 frames per second, which shows in detail the dependence of channel branching and tortuous behavior on the stepping process of the leader development. It is found that the clustered space leaders formed in parallel ahead of the channel tip during an individual step process...
June 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28614079/do-not-resuscitate-with-no-surrogate-and-no-advance-directive-an-ethics-case-study
#6
Jamie Diamond, Umesh Gidwani, Rosamond Rhodes
Do-not-resuscitate (DNR) orders are typically signed by physicians in conjunction with patients or their surrogate decision makers in order to instruct healthcare providers not to perform cardiopulmonary resuscitation (CPR). Both the medical literature and CPR guidelines fail to address when it is appropriate for physicians to sign DNR orders without any knowledge of a patient's wishes. We explore the ethical issues surrounding instituting a two-physician DNR for a dying patient with multiple comorbidities and no medical record on file, no advance directives, and no surrogate decision maker...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28609408/feasibility-of-the-korean-advance-directives-among-community-dwelling-elderly-persons
#7
Shinmi Kim, Sun Woo Hong, JinShil Kim
A newly developed Korean-Advance Directive (K-AD) consists of a value statement, treatment directives, and proxy appointment. It remains undetermined whether K-AD is applicable to community-dwelling persons (≥ aged 60 years). Using a descriptive study design, 275 elderly persons completed the K-AD (mean age = 77.28 ± 8.24 years). The most frequent value at the end of life was comfort dying, followed by no burden to family (23.6%). Among 4 K-AD treatment options, more than half had a preference for hospice care and had reluctance with aggressive treatment choices of cardiopulmonary resuscitation (76...
July 2017: Holistic Nursing Practice
https://www.readbyqxmd.com/read/28608972/new-frontiers-in-end-of-life-ethics-and-policy-scope-advance-directives-and-conscientious-objection
#8
EDITORIAL
Udo Schuklenk
No abstract text is available yet for this article.
July 2017: Bioethics
https://www.readbyqxmd.com/read/28583382/advance-directives-and-individuals-with-disabilities
#9
Keydron K Guinn, Charlotte R Winston
No abstract text is available yet for this article.
June 1, 2017: Disability and Health Journal
https://www.readbyqxmd.com/read/28583175/are-advance-directives-helpful-for-good-end-of-life-decision-making-a-cross-sectional-survey-of-health-professionals
#10
Eimantas Peicius, Aurelija Blazeviciene, Raimondas Kaminskas
BACKGROUND: This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives...
June 5, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28574529/prospective-cohort-study-of-hospitalized-adults-with-advanced-cancer-associations-between-complications-comorbidity-and-utilization
#11
Peter May, Melissa M Garrido, Melissa D Aldridge, J Brian Cassel, Amy S Kelley, Diane E Meier, Charles Normand, Joan D Penrod, Thomas J Smith, R Sean Morrison
BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers...
June 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28572521/the-feeding-paradox-in-advanced-dementia-a-local-perspective
#12
J Kh Luk, F Hw Chan, E Hui, C Y Tse
Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding...
June 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28564570/delegalizing-advance-directives-facilitating-advance-care-planning
#13
Joshua A Rolnick, David A Asch, Scott D Halpern
When Luis Kutner, a human rights lawyer, first proposed the idea of the "living will" in 1969, he conceptualized it as a document establishing a trust, with the patient as the beneficiary and physicians as trustees. Kutner expected that such a document would be signed by two witnesses, notarized,..
June 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28561696/using-the-new-asco-clinical-practice-guideline-for-palliative-care-concurrent-with-oncology-care-using-the-team-approach
#14
Cardinale B Smith, Tanyanika Phillips, Thomas J Smith
Palliative care alongside usual oncology care is now recommended by ASCO as the standard of care for any patient with advanced cancer on the basis of multiple randomized trials that show better results with concurrent care than with usual oncology care. Some benefits include better quality of life, better symptom management, reduced anxiety and depression, less caregiver distress, more accordance of care with the wishes of the patient, and less aggressive end-of-life care. Several studies show a survival advantage of several months, and many show considerable cost savings: better care at an affordable cost...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28559690/terminal-patients-and-the-right-to-refuse-medical-treatment-in-argentina
#15
Martín Hevia, Daniela Schnidrig
The right to health has many dimensions. On the one hand, it entails positive duties for states to protect the health of individuals. On the other, it encompasses patient decision making regarding personal health, an idea which is closely linked to the right to autonomy and the right to free development of the individual-that is, to dignity.(1) This is why the informed consent of the patient and her right to make a choice according to her own values should be honored, even when her decision may seem irrational or imprudent...
December 2016: Health and Human Rights
https://www.readbyqxmd.com/read/28555717/beyond-the-individual-the-interdependence-of-advance-directive-completion-by-older-married-adults
#16
Catheryn S Koss
OBJECTIVES: To determine how individual and spousal demographic and health factors are associated with advance directive (AD) completion by married older adults. DESIGN: Dyadic structural equation modeling using the Actor-Partner Interdependence Model. SETTING: The 2004 to 2012 waves of the Health and Retirement Study. PARTICIPANTS: Community-dwelling heterosexual married couples aged 65 and older (N = 2,243). MEASUREMENTS: Structural equation modeling with a probit link function was used to estimate associations between men's and women's age, education, health status, prior hospitalization or outpatient surgery in the past 10 years, regular health care provider, and household net assets and their own and their spouses' probabilities of having an AD...
May 29, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28528421/end-of-life-care-for-glioblastoma-patients-at-a-large-academic-cancer-center
#17
Kamini E Kuchinad, Roy Strowd, Anne Evans, W Anthony Riley, Thomas J Smith
Glioblastoma (GBM) is a universally fatal disease, complicated by significant cognitive and physical disabilities, inherent to the disease course. The purpose of this study was to retrospectively analyze end-of-life care for GBM patients at an academic center and compare utilization of these services to national quality of care guidelines, with the goal of identifying opportunities to improve end-of-life care. Single center retrospective cohort study of GBM patients at Johns Hopkins Hospital (JHH) between 2009 and 2014, using electronic medical records and hospice records...
May 20, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28523117/evaluation-of-pediatric-residents-attitudes-toward-ethical-conflict-a-cross-sectional-study-in-tehran-iran
#18
Maliheh Kadivar, Marjan Mardani-Hamooleh, Shiva Shayestefar
Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014...
2017: Journal of Medical Ethics and History of Medicine
https://www.readbyqxmd.com/read/28520863/persistent-gaps-in-use-of-advance-directives-among-nursing-home-residents-receiving-maintenance-dialysis
#19
Manjula Kurella Tamura, Sai Liu, Maria E Montez-Rath, Ann M O'Hare, Yoshio N Hall, Karl A Lorenz
No abstract text is available yet for this article.
May 18, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28520838/effect-of-the-prepare-website-vs-an-easy-to-read-advance-directive-on-advance-care-planning-documentation-and-engagement-among-veterans-a-randomized-clinical-trial
#20
Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D McMahan, Mary T Katen, Deborah E Barnes
Importance: Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective: To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read advance directive (AD) to increase planning documentation. Design, Setting, and Participants: This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center...
May 18, 2017: JAMA Internal Medicine
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