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Advanced care plans

Viacheslav Soyfer, Benjamin W Corn, Yaron Meir, Diana Matceyevsky, Nir Honig, Natan Shtraus
BACKGROUND: Family physicians and internal medicine specialists play an essential role in treating cancer patients. Modern technological advances in radiotherapy are not widely appreciated by primary care physicians. Bone metastases are a frequent complication of cancer. Palliative radiation therapy, as a component of modern advances in radiation treatments, should not subject normal bodily structures to excessive doses of irradiation. The sacrum is a common destination site for bone metastases, yet its concave shape along with its proximity to the rectum, intestines, and femoral heads creates treatment-planning challenges...
July 2018: Israel Medical Association Journal: IMAJ
Anja Siegle, Matthias Villalobos, Jasmin Bossert, Katja Krug, Laura Hagelskamp, Johannes Krisam, Violet Handtke, Nicole Deis, Jana Jünger, Michel Wensing, Michael Thomas
BACKGROUND: The care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory...
August 14, 2018: Trials
Bettina Korn, Maria Bailey-Scanlan, Leo Honse Ribeiro, Julie Broderick
PURPOSE: This study aimed to investigate the practice of advance care planning (ACP) education within pulmonary rehabilitation programs (PRPs) in Ireland. METHODS: All 27 PRPs in the Republic of Ireland were surveyed between May and September 2015, eliciting detailed quantitative and qualitative information about ACP education delivery. Data were analyzed using SPSS statistical software and content analysis. RESULTS: Twenty-two PRPs (82%) took part in the survey, with 86% (n = 19) of these being delivered in a hospital setting...
August 13, 2018: Journal of Cardiopulmonary Rehabilitation and Prevention
Paul Russell Roberts, Ashesh B Jani, Satyaseelan Packianathan, Ashley Albert, Rahul Bhandari, Srinivasan Vijayakumar
For 2018, the American Cancer Society estimated that there would be approximately 1.7 million new diagnoses of cancer and about 609,640 cancer-related deaths in the United States. By 2030 these numbers are anticipated to exceed a staggering 21 million annual diagnoses and 13 million cancer-related deaths. The three primary therapeutic modalities for cancer treatments are surgery, chemotherapy, and radiation therapy. Individually or in combination, these treatment modalities have provided and continue to provide curative and palliative care to the myriad victims of cancer...
August 13, 2018: Radiation Oncology
Trygve Johannes Lereim Sævareid, Lillian Lillemoen, Lisbeth Thoresen, Reidun Førde, Elisabeth Gjerberg, Reidar Pedersen
BACKGROUND: Close to half of all deaths in Norway occur in nursing homes, which signals a need for good communication on end-of-life care. Advance care planning (ACP) is one means to that end, but in Norwegian nursing homes, ACP is not common. This paper describes the protocol of a project evaluating an ACP-intervention in Norwegian nursing homes. The aims of this research project were to promote the possibility for conversations about the end of life with patients and relatives; promote patient autonomy; create a better foundation for important decisions in the case of medical emergencies and at the end of life; and gain experiences in order to find out what characterizes good ACP and good implementation strategies...
August 13, 2018: BMC Geriatrics
Kelly K Shum K, Tripti Gupta T, Mary Canobbio, Jennifer Durst, Sangeeta B Shah
With advances in congenital heart disease management, there are an increasing number of women reaching reproductive age. Pregnancy results in a surge of hormones and increased demands on both the cardiovascular (CV) and respiratory systems. Depending on the heart defect and the treatments the mother has undergone, these hemodynamic changes can result in an increased risk of maternal CV events and an increased risk of fetal morbidity and mortality. Thus, it is important to have a comprehensive approach to adult congenital heart disease patients involving pre-pregnancy planning in addition to diligent peri- and post-partum care...
August 10, 2018: Progress in Cardiovascular Diseases
Luca Cozzi, Tiziana Comito, Antonella Fogliata, Ciro Franzese, Stefano Tomatis, Marta Scorsetti
PURPOSE: To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT). METHODS: An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3%) and isocenter positioning (2,4,6mm) uncertainties...
2018: PloS One
Barbara Jester, Timothy Uyeki, Daniel Jernigan
The 1918 H1N1 pandemic caused unprecedented mortality worldwide. The tools to deal with the global emergency were limited with insufficient surveillance systems and a dearth of diagnostic, treatment, and prevention options. With continuing focus on pandemic planning, technologic advances in surveillance, vaccine capabilities, and 21st century medical care and countermeasures, we are more prepared for a severe pandemic than 100 years ago; however, notable gaps remain.
August 9, 2018: American Journal of Epidemiology
Glenn Isaacson, Elizabeth T Drum
Objective: To review current evidence and experience with anesthesia and airway management issues in children and young adults with arthrogryposis. Data sources: Review of existing world literature and description of personal experience at a center for children's orthopedic surgery and rehabilitation over 2 decades. Methods: Description of common problems and their solutions in this unusual and diverse group of patients. Results: Arthrogryposis multiplex congenital includes more than 400 conditions that lead to congenital joint contractures affecting more than one body area...
June 2018: World Journal of Otorhinolaryngology—Head and Neck Surgery
Rajiv Agarwal, Andrew S Epstein
OBJECTIVE: To highlight the importance, challenges, and evolution of advance care planning for patients with cancer. DATA SOURCES: Peer-reviewed journal articles and clinical guidelines. CONCLUSION: Advance care planning is fundamental to support the personhood of patients with advanced cancer. Patients must be encouraged by physicians and nurses to articulate what matters and provides meaning to them as they live, cope, and receive treatment for their cancer...
August 9, 2018: Seminars in Oncology Nursing
Manuel Lillo-Crespo, Jorge Riquelme, Rhoda Macrae, Wilson De Abreu, Elizabeth Hanson, Iva Holmerova, Mª José Cabañero, Rosario Ferrer, Debbie Tolson
BACKGROUND: There is a paucity of robust research concerning the care experiences of peoplewith advanced dementia within Europe. It is essential to understand these experiences if weare to address care inequalities and create impactful dementia policies to improve servicesthat support individuals and enable family caring. OBJECTIVES: To identify the strengths and weaknesses in daily life perceived by people with dementia and family caring across Europe by exemplifying experiences and the range of typical care settings for advanced dementia care in seven partner countries...
2018: Global Health Action
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
Woan Shin Tan, Ram Bajpai, Chan Kee Low, Andy Hau Yan Ho, Josip Car
BACKGROUND: One of the key outcomes of Advance Care Planning (ACP) is whether patients had received care that was consistent with their expressed goals and preferences. AIM: To illustrate the feasibility of using routinely collected healthcare data that includes hospital procedural codes, diagnosis-related codes, health services utilisation and death registry data, to ascertain the level of concordance between care received and the stated goals. DESIGN: In this retrospective cohort study, medical treatments were ascertained using a combination of hospital procedural codes, and diagnosis-related codes...
August 7, 2018: Journal of Pain and Symptom Management
Elizabeth A Luth, Holly G Prigerson
CONTEXT: Research has revealed racial disparities in advance care planning and intensity of end-of-life care. Studies of the relationship between advance care planning and sadness and anxiety at the end-of-life are inconclusive. OBJECTIVE: To determine the extent to which the relationship between advance care planning and sadness and anxiety at the end-of-life differs by race. METHODS: Study analyzes data from 315 Medicare beneficiaries from the 2011-2016 National Health and Aging Trends Study...
August 7, 2018: Journal of Pain and Symptom Management
Claire E O'Hanlon, Anne M Walling, Edward Okeke, Sharon Stevenson, Neil S Wenger
BACKGROUND: Advance care planning (ACP) is fundamental to guiding medical care at the end of life. Understanding the economic impact of ACP is critical to implementation, but most economic evaluations of ACP focus on only a few actors, such as hospitals. OBJECTIVE: To develop a framework for understanding and quantifying the economic effects of ACP, particularly its distributional consequences, for use in economic evaluations. DESIGN: Literature review of economic analyses of ACP and related costs to estimate magnitude and direction of costs and benefits for each actor and how data on these costs and benefits could be obtained or estimated...
August 10, 2018: Journal of Palliative Medicine
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
Raphaël Jumeau, Phuc Félix Nguyen-Tan, Houda Bahig, Xavier Liem, Louise Lambert, Matthieu Schmittbuhl, Dany Simard, Edith Filion
Aim: To develop a tool in order to guide pre-irradiation dental care (PIDC) for patients with oropharyngeal cancers. Background: Osteoradionecrosis of the jaws is a potential complication of radiotherapy (RT) for head and neck cancers. To prevent this complication, PIDC can involve multiple dental extractions as a preventative measure to avoid post-RT complications. However, there is no standardized tool to guide PIDC. Materials and methods: From January 2005 to October 2015, 120 head and neck cancer patients were prospectively included in a study investigating dysgeusia after RT...
July 2018: Reports of Practical Oncology and Radiotherapy
Juliane Dias Aldrighi, Marilene Loewen Wall, Silvana Regina Rossi Kissula Souza
OBJECTIVE: To describe the experience of pregnant women at an advanced age. METHOD: This is a qualitative and descriptive study, which was conducted with 21 pregnant women aged 35 years older or over undergoing high-risk prenatal care, from December 2015 to April 2016. The data were collected by means of semi-structured interviews. The thematic analysis of the data followed the six steps proposed by Creswell. RESULTS: Six thematic categories have appeared: Ambivalence: from fear to happiness; The (un)planning and the divine; Family (re)organization: from support to non-acceptance; Maturity as a facilitator for motherhood; Advanced age and risk perception; The biological age of the body hindering pregnancy...
August 2, 2018: Revista Gaúcha de Enfermagem
B van Oorschot, K Mücke, A Cirak, T Henking, S Neuderth
BACKGROUND AND PURPOSE: There is little information about the desired place of death of nursing home residents because they are usually not interviewed in population-based representative surveys. In preparation of support services for advance care planning the kind of care and support that nursing home residents desire needs to be systematically determined. METHOD: From October 2016 to January 2017 the residents of 5 nursing homes, municipally owned by Würzburg, were interviewed face-to-face...
August 6, 2018: Zeitschrift Für Gerontologie und Geriatrie
Jun Wan, Can Zhang, Yu-Peng Liu, Hong-Bo He
BACKGROUND: The optimal strategy for shepherd's crook deformity correction remains technically challenging. In particular, it is difficult to perform an accurate osteotomy based on the pre-operative correction plan. Moreover, the choice of ideal hardware remains unclear. In addition, when combined with the deformity of knee joint, the sequence of deformity correction is another overlooked factor when making a correction strategy. METHODS: From February 2012 to March 2014, we retrospectively examined a cases series in our department involving the creation of three-dimensional (3D) printing osteotomy templates and inner fixation for shepherd's crook deformity in fibrous dysplasia...
August 6, 2018: International Orthopaedics
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