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surrogate decision making

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https://www.readbyqxmd.com/read/29649031/low-level-of-vegetative-state-after-traumatic-brain-injury-in-a-swiss-academic-hospital
#1
Federica Stretti, Stephanie Klinzing, Ulrike Ehlers, Peter Steiger, Reto Schuepbach, Tanja Krones, Giovanna Brandi
BACKGROUND: No standards exist regarding decision making for comatose patients, especially concerning life-saving treatments. The aim of this retrospective, single-center study was to analyze outcomes and the decision-making process at the end of life (EOL) in patients with traumatic brain injury (TBI) in a Swiss academic tertiary care hospital. METHODS: Consecutive admissions to the surgical intensive care unit (ICU) with stays of at least 48 hours between January 1, 2012 and June 30, 2015 in patients with moderate to severe TBI and with fatality within 6 months after trauma were included...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29623450/the-role-of-non-invasive-testing-in-evaluation-and-diagnosis-of-pediatric-lower-urinary-tract-dysfunction
#2
REVIEW
Jason P Van Batavia, Andrew J Combs
PURPOSE OF REVIEW: The symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children...
April 6, 2018: Current Urology Reports
https://www.readbyqxmd.com/read/29617766/narrative-interest-standard-a-novel-approach-to-surrogate-decision-making-for-people-with-dementia
#3
James M Wilkins
Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions...
June 17, 2017: Gerontologist
https://www.readbyqxmd.com/read/29608338/exploring-provider-surrogate-communication-during-polst-discussions-for-individuals-with-advanced-dementia
#4
Hyejin Kim, Christine Bradway, Susan E Hickman, Mary Ersek
OBJECTIVES: This qualitative descriptive study explored provider-surrogate communication during Physician Orders for Life-Sustaining Treatment (POLST) discussions for patients with advanced dementia. METHODS: Data from participant observations and audio-recordings of ten POLST discussions were analyzed using directed content analysis within the context of an existing conceptual model of Communication and Surrogate Decision Making. RESULTS: Surrogates primarily focused on making sense of the clinical information about life-sustaining treatments during POLST conversations...
April 2, 2018: Aging & Mental Health
https://www.readbyqxmd.com/read/29605154/prognostication-of-diffuse-large-b-cell-lymphoma-in-the-molecular-era-moving-beyond-the-ipi
#5
REVIEW
Joel C Wight, Geoffrey Chong, Andrew P Grigg, Eliza A Hawkes
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with variable outcomes. Despite the majority of patients being cured with combination chemoimmunotherapy, up to 30% eventually succumb to the disease. Until recently, baseline prognostic assessment has centred on the International Prognostic Index (IPI), although this index is yet to impact strongly on treatment choice. Molecular features such as cell of origin, MYC and BCL-2 genetic alterations and protein overexpression were identified over a decade ago, yet their prognostic value is still not fully elucidated...
March 26, 2018: Blood Reviews
https://www.readbyqxmd.com/read/29595129/assessing-the-validity-of-surrogate-endpoints-in-the-context-of-a-controversy-about-the-measurement-of-effectiveness-of-hepatitis-c-virus-treatment
#6
Claudia C Dobler, Rebecca L Morgan, Yngve Falck-Ytter, Victor M Montori, M Hassan Murad
Surrogate endpoints are often used in clinical trials, as they allow for indirect measures of outcomes (eg, shorter trials with less participants). Improvements in surrogate endpoints (eg, reduction in low density lipoprotein cholesterol, normalisation of glycated haemoglobin) achieved with an intervention are, however, not always associated with improvements in patient-important outcomes. The common tendency in evidence-based medicine is to view results based on surrogate endpoints as less certain than results based on long term, final patient-important outcomes and rate them as 'lower quality evidence'...
April 2018: BMJ evidence-based medicine
https://www.readbyqxmd.com/read/29590519/nudge-or-grudge-choice-architecture-and-parental-decision-making
#7
Jennifer Blumenthal-Barby, Douglas J Opel
Richard Thaler and Cass Sunstein define a nudge as "any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives." Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates' decision-making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision-making in the context of pediatrics, despite fundamental differences that exist between the pediatric and adult contexts...
March 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29587711/a-review-of-paper-based-advance-care-planning-aids
#8
John F P Bridges, Thomas Lynch, Anne L R Schuster, Norah L Crossnohere, Katherine Clegg Smith, Rebecca A Aslakson
BACKGROUND: Advance care planning (ACP) aids can help prepare patients, family members, and physicians for in-the-moment medical decision-making. We wished to describe the content and approach of paper-based ACP aids in order to characterize existing aids and inform the development of a new ACP aid. METHODS: Paper-based ACP aids were identified through an environmental scan and screened for eligibility. ACP conceptual frameworks and data were gathered via stakeholder engagement and used to inform the coding framework that two investigators used to independently code each aid...
March 27, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29580950/the-value-of-early-depth-of-response-in-predicting-long-term-outcome-in-egfr-mutant-lung-cancer
#9
Chee Khoon Lee, Sally Lord, Ian Marschner, Yi Long Wu, Lecia Sequist, Rafael Rosell, Masahiro Fukuoka, Tetsuya Mitsudomi, Rebecca Asher, Lucy Davies, Val Gebski, Richard Gralla, Tony Mok, James Chih-Hsin Yang
INTRODUCTION: Traditionally, marked tumor shrinkage has been assumed to portend better outcome. We investigated whether depth of tumor response was associated with improved survival outcomes in advanced EGFR-mutant non-small cell lung cancer (NSCLC). METHODS: Individual patient data from randomized trials (EURTAC, IPASS, ENSURE, LUX-Lung 3, and LUX-Lung 6) were used. The association of depth of response with progression-free survival (PFS) and overall survival (OS) was examined using landmark analyses...
March 23, 2018: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/29567375/on-the-use-of-total-aerobic-spore-bacteria-to-make-treatment-decisions-due-to-cryptosporidium-risk-at-public-water-system-wells
#10
Philip Berger, Michael J Messner, Jake Crosby, Deborah Vacs Renwick, Austin Heinrich
Spore reduction can be used as a surrogate measure of Cryptosporidium natural filtration efficiency. Estimates of log10 (log) reduction were derived from spore measurements in paired surface and well water samples in Casper Wyoming and Kearney Nebraska. We found that these data were suitable for testing the hypothesis (H0 ) that the average reduction at each site was 2 log or less, using a one-sided Student's t-test. After establishing data quality objectives for the test (expressed as tolerable Type I and Type II error rates), we evaluated the test's performance as a function of the (a) true log reduction, (b) number of paired samples assayed and (c) variance of observed log reductions...
March 8, 2018: International Journal of Hygiene and Environmental Health
https://www.readbyqxmd.com/read/29566541/advance-care-planning-for-people-with-dementia-ordinary-everyday-conversations
#11
Kay de Vries, Jenny Drury-Ruddlesden
Advance care planning for people with dementia has become a focus of dementia care policies in developed countries. In New Zealand, the framework for dementia care relies on the person with dementia having a level of competence to enable them to participate in the planning process. For people with dementia, it may be too late to initiate these discussions in terms of decision-making capacity. Consequently, decisions about end-of-life care for people with dementia are typically made by a family member who acts as a surrogate decision maker on behalf of the person with dementia...
January 1, 2018: Dementia
https://www.readbyqxmd.com/read/29564855/-the-intentions-affecting-the-medical-decision-making-behavior-of-surrogate-decision-makers-of-critically-ill-patients-and-related-factors
#12
Szu-Huei Su, Li-Min Wu
BACKGROUND: The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE: To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS: A cross-sectional, correlation study design was used...
April 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29556497/application-of-raman-spectroscopy-and-univariate-modelling-as-a-process-analytical-technology-for-cell-therapy-bioprocessing
#13
Marc-Olivier Baradez, Daniela Biziato, Enas Hassan, Damian Marshall
Cell therapies offer unquestionable promises for the treatment, and in some cases even the cure, of complex diseases. As we start to see more of these therapies gaining market authorization, attention is turning to the bioprocesses used for their manufacture, in particular the challenge of gaining higher levels of process control to help regulate cell behavior, manage process variability, and deliver product of a consistent quality. Many processes already incorporate the measurement of key markers such as nutrient consumption, metabolite production, and cell concentration, but these are often performed off-line and only at set time points in the process...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29554176/characteristics-associated-with-preferences-for-parent-centered-decision-making-in-neonatal-intensive-care
#14
Elliott Mark Weiss, Dawei Xie, Noah Cook, Katherine Coughlin, Steven Joffe
Importance: Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. Objective: To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU)...
March 19, 2018: JAMA Pediatrics
https://www.readbyqxmd.com/read/29550975/the-voice-is-as-mighty-as-the-pen-integrating-conversations-into-advance-care-planning
#15
Kunal Bailoor, Leslie H Kamil, Ed Goldman, Laura M Napiewocki, Denise Winiarski, Christian J Vercler, Andrew G Shuman
Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical options, and cultural disparities...
March 17, 2018: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/29543586/considerations-and-pitfalls-in-selecting-the-drug-vehicles-for-evaluation-of-new-drug-candidates-focus-on-in-vivo-pharmaco-toxicological-assays-based-on-the-rotarod-performance-test
#16
Mariana Matias, Samuel Silvestre, Amílcar Falcão, Gilberto Alves
Purpose - During the discovery and development of new drugs, compounds with low aqueous solubility pose special challenges in their pharmacological evaluation and, therefore, the selection of appropriate vehicles to administer the compounds of interest is determinant for the quality of the results generated during the in vivo non-clinical studies. This work aimed to evaluate the motor deficit (as a surrogate of neurotoxicity) of several administration/delivery vehicles through the rotarod performance test. Methods - Trained male CD-1 mice were intraperitoneally administered with the following vehicles: dimethyl sulfoxide (DMSO), aqueous sodium chloride (NaCl) 0...
2018: Journal of Pharmacy & Pharmaceutical Sciences: a Publication of the Canadian Society for Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29542117/prognosis-after-emergency-department-intubation-to-inform-shared-decision-making
#17
Kei Ouchi, Guruprasad D Jambaulikar, Samuel Hohmann, Naomi R George, Emily L Aaronson, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Jeremiah D Schuur, Daniel J Pallin
OBJECTIVES: To inform the shared decision-making process between clinicians and older adults and their surrogates regarding emergency intubation. DESIGN: Retrospective cohort study. SETTING: Multicenter, emergency department (ED)-based cohort. PARTICIPANTS: Adults aged 65 and older intubated in the ED from 2008 to 2015 from 262 hospitals across the United States (>95% of U.S. nonprofit academic medical centers). MEASUREMENTS: Our primary outcome was age-specific in-hospital mortality...
March 15, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29541613/recent-updates-on-echocardiography-and-ultrasound-for-kawasaki-disease-beyond-the-coronary-artery
#18
REVIEW
Nobutaka Noto, Akiko Komori, Mamoru Ayusawa, Shori Takahashi
Kawasaki disease (KD) is a systemic vasculitis with a predilection for damage to the coronary arteries. In the acute phase, clinical decision making for KD relies on the measurements of the coronary z-score obtained by 2-dimensional echocardiography (2DE). In the convalescent phase, KD patients with coronary artery abnormalities (CAAs) eventually show arteriosclerotic vascular remodeling characterized by marked intimal proliferation and neoangiogenesis after KD vasculitis, which often induces myocardial ischemia...
February 2018: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/29513227/surrogate-decision-making
#19
Toni M Roucka
No abstract text is available yet for this article.
March 2018: General Dentistry
https://www.readbyqxmd.com/read/29502720/shared-decision-making-in-neurocritical-care
#20
REVIEW
Muhammad Waqas Khan, Susanne Muehlschlegel
Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit...
April 2018: Neurosurgery Clinics of North America
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