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https://www.readbyqxmd.com/read/28441102/the-importance-of-intergenerational-communication-in-advance-care-planning-generational-relationships-among-perceptions-and-beliefs
#1
Jennifer Freytag, Emily A Rauscher
This study explores triadic intergenerational perceptions of family members' beliefs and behaviors that often impact an individual's willingness to engage in advance care planning. Using data from 189 triads of young adults, their parents, and their grandparents, we examined generational relationships among individuals' openness about death, death anxiety, knowledge of surrogate decision-making, and advance care planning self-efficacy. Results of this study found significant relationships between grandparents and parents, as well as between parents and children for all variables except self-efficacy...
April 25, 2017: Journal of Health Communication
https://www.readbyqxmd.com/read/28439491/translating-new-data-to-the-daily-practice-in-second-line-treatment-of-renal-cell-carcinoma-the-role-of-tumor-growth-rate
#2
EDITORIAL
Enrique Grande, Olga Martínez-Sáez, Pablo Gajate-Borau, Teresa Alonso-Gordoa
The therapeutic options for patients with metastatic renal cell carcinoma (mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased in daily practice and now it is not uncommon to see patients surviving kidney cancer for more than four to five years. Once treatment fails with the first line targeted therapy, head to head comparisons have shown that cabozantinib, nivolumab and the combination of lenvatinib plus everolimus are more effective than everolimus alone and that axitinib is more active than sorafenib...
April 10, 2017: World Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28436932/complexities-in-caregiving-comforts-cultures-countries-conversations-and-contracts
#3
Shenbagam Dewar, Rajan Dewar
As depicted in the case of Mrs. Indira, decision making by patients and surrogates may be complicated by multiple factors, including care, comfort, country, and culture.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436931/family-loyalty-as-a-cultural-obstacle-to-good-care-the-case-of-mrs-indira
#4
Shahla Siddiqui
What is the responsibility of the physician when a capacitated patient assigns decision-making authority to a surrogate who does not act in the patient's best interest?
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28428191/the-role-of-minimal-residual-disease-testing-in-myeloma-treatment-selection-and-drug-development-current-value-and-future-applications
#5
Kenneth C Anderson, Daniel Auclair, Gary J Kelloff, Caroline C Sigman, Herve Avet-Loiseau, Ann T Farrell, Nicole J Gormley, Shaji K Kumar, Ola Landgren, Nikhil C Munshi, Michele Cavo, Faith E Davies, Alessandra Di Bacco, Jennifer S Dickey, Steven I Gutman, Howard R Higley, Mohamad A Hussein, J Milburn Jessup, Ilan R Kirsch, Richard F Little, Robert D Loberg, Jens G Lohr, Lata Mukundan, James L Omel, Trevor J Pugh, Gregory H Reaman, Michael D Robbins, A Kate Sasser, Nancy Valente, Elena Zamagni
Treatment of myeloma has benefited from the introduction of more effective and better tolerated agents, improvements in supportive care, better understanding of disease biology, revision of diagnostic criteria, and new sensitive and specific tools for disease prognostication and management. Assessment of minimal residual disease (MRD) in response to therapy is one of these tools, as longer progression-free survival (PFS) is seen consistently among patients who have achieved MRD negativity. Current therapies lead to unprecedented frequency and depth of response, and next generation flow and sequencing methods to measure MRD in bone marrow are in use and being developed with sensitivities in the range of 10(-5)‒10(-6) cells...
April 20, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28387538/the-voice-of-surrogate-decision-makers-family-responses-to-prognostic-information-in-chronic-critical-illness
#6
Judith E Nelson, Laura C Hanson, Kristine L Keller, Shannon S Carson, Christopher E Cox, James A Tulsky, Douglas B White, Emily J Chai, Stefanie P Weiss, Marion Danis
RATIONALE: Information from clinicians about the expected course of the patient's illness is relevant and important for decision-making by surrogates for chronically critically ill patients on mechanical ventilation. OBJECTIVE: Observe how surrogates of chronically critically ill patients respond to information about prognosis from palliative care clinicians. METHODS: Qualitative analysis of a consecutive sample of audio-recorded meetings from a larger, multisite, randomized trial of structured informational and supportive meetings led by a palliative care physician and nurse practitioner for surrogates of patients in Medical Intensive Care Units with chronic critical illness (i...
April 7, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28386685/a-machine-learning-approach-to-investigate-the-relationship-between-shape-features-and-numerically-predicted-risk-of-ascending-aortic-aneurysm
#7
Liang Liang, Minliang Liu, Caitlin Martin, John A Elefteriades, Wei Sun
Geometric features of the aorta are linked to patient risk of rupture in the clinical decision to electively repair an ascending aortic aneurysm (AsAA). Previous approaches have focused on relationship between intuitive geometric features (e.g., diameter and curvature) and wall stress. This work investigates the feasibility of a machine learning approach to establish the linkages between shape features and FEA-predicted AsAA rupture risk, and it may serve as a faster surrogate for FEA associated with long simulation time and numerical convergence issues...
April 6, 2017: Biomechanics and Modeling in Mechanobiology
https://www.readbyqxmd.com/read/28384070/the-palliative-care-quality-network-improving-the-quality-of-caring
#8
Steven Z Pantilat, Angela K Marks, Kara E Bischoff, Ashley R Bragg, David L O'Riordan
OBJECTIVE: Describe the establishment of the palliative care quality network (PCQN) with guidance on how teams can develop similar collaborations. BACKGROUND: In the current healthcare environment, palliative care (PC) teams must be able to demonstrate value and provide efficient care while supporting the clinicians who provide that care. DESCRIPTION: The PCQN is a national quality improvement (QI) collaborative comprised of specialty PC teams from a diverse range of hospitals across the United States Results: PCQN members identified five core activities to support PC teams...
April 6, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28366114/facilitation-of-psychiatric-advance-directives-by-peers-and-clinicians-on-assertive-community-treatment-teams
#9
Michele M Easter, Jeffrey W Swanson, Allison G Robertson, Lorna L Moser, Marvin S Swartz
OBJECTIVE: Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams...
April 3, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28363342/chance-constrained-multi-objective-optimization-of-groundwater-remediation-design-at-dnapls-contaminated-sites-using-a-multi-algorithm-genetically-adaptive-method
#10
Qi Ouyang, Wenxi Lu, Zeyu Hou, Yu Zhang, Shuai Li, Jiannan Luo
In this paper, a multi-algorithm genetically adaptive multi-objective (AMALGAM) method is proposed as a multi-objective optimization solver. It was implemented in the multi-objective optimization of a groundwater remediation design at sites contaminated by dense non-aqueous phase liquids. In this study, there were two objectives: minimization of the total remediation cost, and minimization of the remediation time. A non-dominated sorting genetic algorithm II (NSGA-II) was adopted to compare with the proposed method...
March 14, 2017: Journal of Contaminant Hydrology
https://www.readbyqxmd.com/read/28355608/new-wavelet-neurovascular-bundle-for-bedside-evaluation-of-cerebral-autoregulation-and-neurovascular-coupling-in-newborns-with-hypoxic-ischemic-encephalopathy
#11
Lina F Chalak, Rong Zhang
Neonatal encephalopathy (NE) resulting from birth asphyxia constitutes a major global public health burden for millions of infants every year, and despite therapeutic hypothermia, half of these neonates have poor neurological outcomes. As new neuroprotective interventions are being studied in clinical trials, there is a critical need to establish physiological surrogate markers of therapeutic efficacy, to guide patient selection and/or to modify the therapeutic intervention. The challenge in the field of neonatal brain injury has been the difficulty of clinically discerning NE severity within the short therapeutic window after birth or of analyzing the dynamic aspects of the cerebral circulation in sick NE newborns...
March 30, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28335889/human-papillomavirus-as-prognostic-marker-with-rising-prevalence-in-neck-squamous-cell-carcinoma-of-unknown-primary-a-retrospective-multicentre-study
#12
Lea Schroeder, Paolo Boscolo-Rizzo, Elisa Dal Cin, Salvatore Romeo, Lorena Baboci, Gerhard Dyckhoff, Jochen Hess, Carlota Lucena-Porcel, Anne Byl, Nikolaus Becker, Laia Alemany, Xavier Castellsagué, Miquel Quer, Xavier León, Manuel Wiesenfarth, Michael Pawlita, Dana Holzinger
Patients with neck squamous cell carcinomas of unknown primary tumour (NSCCUP) present with lymph node metastasis without evidence for a primary tumour. Most patients undergo an aggressive multimodal treatment, which induces severe, potentially unnecessary toxicity. Primary tumours of NSCCUP can be hidden in the oropharynx. Human papillomavirus (HPV) is causally involved in a subgroup of oropharyngeal squamous cell carcinomas (OPSCC) associated with early lymph node metastasis and good prognosis. Detection of markers for HPV transformation in NSCCUP could allow focussing on the oropharynx in primary tumour search and could be of value for choice and extent of treatment...
March 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28333517/considering-a-family-systems-approach-to-surrogate-decision-making
#13
Elizabeth K Vig, Janelle S Taylor, Ann M O'Hare
Comments on the original article by Rolland, Emanuel, and Torke (see record 2017-05300-001) regarding a family systems approach to medical decision-making by proxy. The authors expanded the focus of clinicians beyond the patient to a more comprehensive understanding of the patient's family. They assert that a better understanding of family dynamics may help clinicians to engage with families more effectively when decision-making is needed for seriously ill loved ones, and may lessen the emotional challenges families and clinicians face when decisions are needed...
March 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28322634/end-of-life-decision-support-in-the-icu
#14
Grant Pignatiello, Ronald L Hickman, Breanna Hetland
Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies...
November 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28317097/engagement-in-advance-care-planning-and-surrogates-knowledge-of-patients-treatment-goals
#15
Terri R Fried, Maria Zenoni, Lynne Iannone, John O'Leary, Brenda T Fenton
OBJECTIVES: A key objective of advance care planning (ACP) is improving surrogates' knowledge of patients' treatment goals. Little is known about whether ACP outside of a trial accomplishes this. The objective was to examine patient and surrogate reports of ACP engagement and associations with surrogate knowledge of goals. DESIGN: Cohort study SETTING: Primary care in a Veterans Affairs Medical Center. PARTICIPANTS: 350 community-dwelling veterans age ≥55 years and the individual they would choose to make medical decisions on their behalf, interviewed separately...
March 20, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28284519/breast-conserving-surgery-and-locoregional-control-after-neoadjuvant-chemotherapy
#16
REVIEW
M Teshome, H M Kuerer
The management of breast malignancy and the role of neoadjuvant systemic therapy has continued to evolve over the past 50 years. Survival equivalence with adjuvant systemic therapy is well accepted and demonstrated in several clinical trials. However, strong association with survival outcome and pathologic complete response emerged. Assessment of tumor response, as a surrogate for outcome, continues to be a driver for neoadjuvant therapy with increased applicability in the setting of sophisticated understanding and implications of breast tumor biology and molecular subtype...
May 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28283409/topics-in-practice-management-integrating-advance-care-planning-into-practice
#17
REVIEW
Laura E Dingfield, Joshua B Kayser
Advanced respiratory diseases progress over time and often lead to death. As their condition worsens, patients may lose medical decision making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences, or appointment of a health care power of attorney (HCPOA)...
March 7, 2017: Chest
https://www.readbyqxmd.com/read/28278611/specific-words-and-experience-matter-to-surrogates-when-making-end-of-life-decisions
#18
Dawn E Fairlie
This grant funded preliminary study investigated the relationship between end-of-life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults aged 50 and older. Participants were randomized into two groups; each received a survey packet that varied only in the use of the words "Do Not Resuscitate (DNR)" and "Allow Natural Death (AND)." The Decisional Conflict Scale (DCS) was administered and demographic data were collected. No difference was found in the total DCS scores based on the AND and DNR versions...
February 17, 2017: Health Communication
https://www.readbyqxmd.com/read/28265798/the-role-of-a-hospital-ethics-consultation-service-in-decision-making-for-unrepresented-patients
#19
Andrew M Courtwright, Joshua Abrams, Ellen M Robinson
Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment (LST) for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013...
March 6, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28261960/neurofilament-light-chain-in-cerebrospinal-fluid-and-prediction-of-disease-activity-in-clinically-isolated-syndrome-and-relapsing-remitting-multiple-sclerosis
#20
I Håkansson, A Tisell, P Cassel, K Blennow, H Zetterberg, P Lundberg, C Dahle, M Vrethem, J Ernerudh
BACKGROUND AND PURPOSE: Improved biomarkers are needed to facilitate clinical decision-making and as surrogate endpoints in clinical trials in multiple sclerosis (MS). We assessed whether neurodegenerative and neuroinflammatory markers in cerebrospinal fluid (CSF) at initial sampling could predict disease activity during 2 years of follow-up in patients with clinically isolated syndrome (CIS) and relapsing-remitting MS. METHODS: Using multiplex bead array and enzyme-linked immunosorbent assay, CXCL1, CXCL8, CXCL10, CXCL13, CCL20, CCL22, neurofilament light chain (NFL), neurofilament heavy chain, glial fibrillary acidic protein, chitinase-3-like-1, matrix metalloproteinase-9 and osteopontin were analysed in CSF from 41 patients with CIS or relapsing-remitting MS and 22 healthy controls...
March 6, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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