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"Advance directives"

Marisa de-la-Rica-Escuín, Ana García-Barrecheguren, Ana María Monche-Palacín
OBJECTIVES: To describe the advanced chronic patients admitted to an internal medicine department and to identify whether they meet the criteria for the need for palliative care at the time of hospital discharge according to the NECPAL-CCOMS.ICO® instrument. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study performed on patients admitted to the internal medicine department of the Hospital Clínico Universitario Lozano Blesa (Saragossa), with a diagnosis of advanced progressive chronic diseases, from May 1, 2017 to September 1, 2017 Variables: sex, age, advanced chronic disease, reason for admission, primary caregiver, origin (residence, address, etc...
August 14, 2018: Enfermería Clínica
Emily H Eckemoff, S Sudha, Dan Wang
This pilot study examined immigrant Russian seniors and adult children's views on end-of-life care, and hospice staff members' experiences providing care to diverse immigrant clients, in areas of North Carolina with a high proportion of immigrants. Data were collected through individual in-depth interviews with informants, including Russian immigrant seniors, Russian adult children, and hospice staff, and analyzed by qualitative techniques. Findings indicate that there is little awareness of end-of-life care options among the Russian immigrant community in North Carolina...
August 14, 2018: Journal of Cross-cultural Gerontology
Amelia Barwise, Carolina Jaramillo, Paul Novotny, Mark L Wieland, Charat Thongprayoon, Ognjen Gajic, Michael E Wilson
OBJECTIVE: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. PATIENTS AND METHODS: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. RESULTS: Of the 27,523 patients admitted to the ICU, 779 (2...
August 9, 2018: Mayo Clinic Proceedings
Terri R Fried, Colleen A Redding, Steven Martino, Andrea Paiva, Lynne Iannone, Maria Zenoni, Laura A Blakley, Joseph S Rossi, John O'Leary
INTRODUCTION: Advance care planning (ACP) is a key component of high-quality end-of-life care but is underused. Interventions based on models of behaviour change may fill an important gap in available programmes to increase ACP engagement. Such interventions are designed for broad outreach and flexibility in delivery. The purpose of the Sharing and Talking about My Preferences study is to examine the efficacy of three behaviour change approaches to increasing ACP engagement through two related randomised controlled trials being conducted in different settings (Veterans Affairs (VA) medical centre and community)...
August 10, 2018: BMJ Open
Joseph J Fins, James L Bernat
This essay complements the scientific and practice scope of the American Academy of Neurology Guideline on Disorders of Consciousness by providing a discussion of the ethical, palliative, and policy aspects of the management of this group of patients. We endorse the renaming of "permanent" vegetative state to "chronic" vegetative state given the increased frequency of reports of late improvements but suggest that further refinement of this class of patients is necessary to distinguish late recoveries from patients who were misdiagnosed or in cognitive-motor dissociation...
August 7, 2018: Archives of Physical Medicine and Rehabilitation
Juliana M Bernstein, Peter Graven, Kathleen Drago, Konrad Dobbertin, Elizabeth Eckstrom
OBJECTIVES: To design a value-driven, interprofessional inpatient geriatric consultation program coordinated with systems-level changes and studied outcomes and costs. DESIGN: Propensity-matched case-control study of older adults hospitalized at an academic medical center (AMC) who did or did not receive geriatric consultation. SETTING: Single tertiary-care AMC in Portland, Oregon. PARTICIPANTS: Adults aged 70 and older who received an inpatient geriatric consultation (n=464) and propensity-matched controls admitted before development of the consultation program (n=2,381)...
August 10, 2018: Journal of the American Geriatrics Society
Bheemsain Tekkalaki, Veerappa Y Patil, Sandeep Patil, Sameeran S Chate, Ramling Dhabale, Nanasaheb M Patil
Background: Psychiatric advance directives have been incorporated in the Mental Health Care Act 2017 despite strong concerns about their feasibility and utility in the Indian patient population. Data on its utility in India is very scarce. Aims: To determine the possible treatment options our clients make as a part of psychiatric advance directives. Materials and Methods: Fifty consecutive individuals with severe mental illness were interviewed using a self-designed semi-structured tool to find out the possible choices they make as part of advance directives and the factors affecting their choices...
July 2018: Indian Journal of Psychological Medicine
Joseph J Fins, James L Bernat
This essay complements the scientific and practice scope of the American Academy of Neurology Guideline on Disorders of Consciousness by providing a discussion of the ethical, palliative, and policy aspects of the management of this group of patients. We endorse the renaming of "permanent" vegetative state to "chronic" vegetative state given the increased frequency of reports of late improvements but suggest that further refinement of this class of patients is necessary to distinguish late recoveries from patients who were misdiagnosed or in cognitive-motor dissociation...
August 8, 2018: Neurology
Scott Y H Kim, David Gibbes Miller, Rebecca Dresser
No abstract text is available yet for this article.
August 6, 2018: Journal of Medical Ethics
Jane R Schubart, Jean M Reading, Janice Penrod, Renee R Stewart, Ramya Sampath, Lisa S Lehmann, Benjamin H Levi, Michael J Green
BACKGROUND: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. OBJECTIVE: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. PARTICIPANTS: Patients with advanced illness and family caregivers...
September 2018: American Journal of Hospice & Palliative Care
Ariana Barkley, Mike Liquori, Amy Cunningham, John Liantonio, Brooke Worster, Susan Parks
PURPOSE: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. METHODS: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts...
August 2, 2018: American Journal of Hospice & Palliative Care
Sriram Yennurajalingam, Bernard Prado, Zhanni Lu, Syed Naqvi, Janet L Williams, Taekyu Lim, Eduardo Bruera
OBJECTIVE: To determine the timing of palliative care (PC) access, symptoms, and end-of-life (EOL) quality care outcomes of patients with advanced nonsmall cell lung cancer (NSCLC) referred to outpatients embedded palliative care consults (EPC) compared with those of outpatients palliative care consults (OPC). BACKGROUND: There are no studies comparing the outcomes of outpatients EPC consults with those of stand-alone OPC consults among patients with NSCLC. DESIGN: The design consists of a random sample of OPC consults (January 2009 to July 2012) and EPC consults (August 2012 to June 2013) at MD Anderson Cancer Center...
August 1, 2018: Journal of Palliative Medicine
Marianne Turley, Susan Wang, Di Meng, Terhilda Garrido, Michael H Kanter
BACKGROUND: End-of-life care is patient centered when it is concordant with patient preferences. Concordance has been frequently assessed by interview, chart review, or both. These time-consuming methods can constrain sample sizes, precluding population-level quality assessment. Concordance between preferences and care as measured by automated methods is described. METHODS: Automated processes extracted and analyzed electronic health record (EHR) data to assess concordance between 15 advance care planning preference domains and 232 related end-of-life care events for 388 patients aged 65 years or older with an inpatient encounter at Kaiser Permanente Southern California who died during or after the encounter...
July 18, 2018: Joint Commission Journal on Quality and Patient Safety
Rachel A Madrid, William McGee
Management of limited health-care resources has been of growing concern. Stewardship of health-care dollars and avoidance of low-value care is being increasingly recognized as a matter that affects all practitioners. This review aims to examine a particular pathological state with multifactorial origins: chronic critical illness (CCI). This condition exerts a large toll on society as well as individual patients and their families. Here, we offer a brief review as to the incidence/prevalence of CCI and suggestions for prevention...
July 31, 2018: Journal of Intensive Care Medicine
Masako Mayahara, Arlene Michaels Miller, Sean OʼMahony
The purposes of this study were to describe the advance care planning process for nursing home residents and identify common concerns regarding advance care planning. We conducted a content analysis of video-conferenced advance care planning meetings in the nursing home. Fourteen nursing home residents and 10 family members were included in the analysis. Themes based on the participants' statements during the meetings were used to generate the Advance Care Planning Process Framework. The Advance Care Planning Process Framework has 3 primary phases: (1) assess resident's status regarding end-of-life care, which includes establishing common language; identifying resident's unrealistic goals and wishes; and identifying inconsistencies between resident's expressed wishes and the preferences documented in medical record; (2) negotiate realistic plan of care, which includes addressing inconsistencies between resident's and family's goals; rephrasing goals and wishes in hypothetical scenarios; and clarifying goals; and (3) create action plan, which includes complete advance directives and revisit/revise in the future as needed...
February 2018: Journal of Hospice and Palliative Nursing: JHPN
Renea L Beckstrand, Caitlin Mallory, Janelle L B Macintosh, Karlen E Luthy
BACKGROUND: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care...
September 2018: Dimensions of Critical Care Nursing: DCCN
Hao Li, Tianyu Yan, Kristen A Fichthorn, Sirong Yu
In this work, we investigate the dynamic advancing and receding contact angles, and the mechanisms of motion of water droplets moving across nanopillared superhydrophobic surfaces using molecular-dynamics simulation. We obtain equilibrium Cassie states of droplets on nanopillared surfaces with different pillar heights, groove widths, and intrinsic contact angles. We quantitatively evaluate the dynamic advancing and receding contact angles along the advancing direction of an applied body force, and find that they depend on the roughness parameters and the applied body force in a predictable way...
August 16, 2018: Langmuir: the ACS Journal of Surfaces and Colloids
Renato Frey, Stefan M Herzog, Ralph Hertwig
OBJECTIVES: To assess people's procedural preferences for making medical surrogate decisions, from the perspectives of both a potential surrogate and an incapacitated patient. DESIGN: Computer-assisted telephone interviews. Respondents were randomly assigned either the role of an incapacitated patient or that of a potential surrogate for an incapacitated family member. They were asked to rate six approaches to making a surrogate decision: patient-designated surrogate, discussion among family members, majority vote of family members' individual judgements, legally assigned surrogate, population-based treatment indicator and delegating the decision to a physician...
July 25, 2018: BMJ Open
Helen Yue-Lai Chan, Jeffrey Sheung-Ching Ng, Kin-Sang Chan, Po-Shan Ko, Doris Yin-Ping Leung, Carmen Wing-Han Chan, Lai-Ngor Chan, Iris Fung-Kam Lee, Diana Tze-Fan Lee
BACKGROUND: Although evidence increasingly demonstrates the effects of advance care planning, the relevant studies are of questionable quality, and lack consensus regarding when and with whom to initiate the conversation. OBJECTIVE: To examine the effects of a structured, nurse-led post-discharge advance care planning programme on congruence between the end-of-life care preferences of the patient and family members, decisional conflicts and the documentation of care preferences...
July 23, 2018: International Journal of Nursing Studies
Andrea Fry
Not until I had experienced my own mother's illness and death did I appreciate the complexity of end-of-life decision making. As an oncology nurse practitioner, I had been trained in advance directives. I understood the importance and why they were needed. However, my own family's experience taught me that such planning does not always prevail over the spectrum of emotions, family dynamics, and other realities that accompany death.
August 1, 2018: Clinical Journal of Oncology Nursing
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