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surrogate decision making

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https://www.readbyqxmd.com/read/28813240/when-does-therapeutic-misconception-affect-surrogates-or-subjects-decision-making-about-whether-to-participate-in-dementia-research
#1
Laura B Dunn, Barton W Palmer
"Therapeutic misconception" (TM) refers to inappropriate assumptions and beliefs on the part of research participants regarding key distinctions between the purpose, methods, intended benefits, and potential disadvantages of research compared to those of clinical care. Despite an extensive literature describing TM across varied types of research and populations, minimal work has addressed TM in the context of dementia research. This is a serious gap, for several reasons: people with dementia are at significant risk of diminished capacity; surrogate decision makers are typically asked to provide consent on behalf of the person with dementia; and available treatments for dementia are quite limited...
July 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28768291/a-requiem-for-bmi-in-the-clinical-setting
#2
Maria Cristina Gonzalez, Maria Isabel T D Correia, Steven B Heymsfield
PURPOSE OF REVIEW: Quetelet reported in the nineteenth century that body weight varies across adults with the square of height. Quetelet's index, now known as BMI, is accepted by most health organizations as a first-level measure of body fat and as a screening tool for diagnosing excess adiposity. Modern imaging methods now, however, indicate that BMI has limited predictive value for estimating body fat and lean mass at the individual level. The use of BMI as a measure of body composition in the clinical setting should therefore be challenged...
September 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/28766384/-did-i-make-the-right-decision-the-difficult-and-unpredictable-journey-of-being-a-surrogate-decision-maker-for-a-person-living-with-dementia
#3
Deirdre Fetherstonhaugh, Linda McAuliffe, Christopher Shanley, Michael Bauer, Elizabeth Beattie
Many people living with dementia eventually lose the capacity to make their own decisions and will rely on another person - a surrogate decision maker - to make decisions on their behalf. It is important - especially with the increasing prevalence of dementia - that the role of surrogate decision maker is understood and supported. This qualitative study explored the experiences of 34 surrogate decision makers of persons living with dementia in Australia. Face-to-face and telephone interviews were conducted over six months in 2014...
January 1, 2017: Dementia
https://www.readbyqxmd.com/read/28757260/comparison-between-publicly-accessible-publications-registries-and-protocols-of-phase-iii-trials-indicated-persistence-of-selective-outcome-reporting
#4
Sheng Zhang, Fei Liang, Wenfeng Li
OBJECTIVES: The decision to make protocols of phase III randomized clinical trials (RCTs) publicly accessible by leading journals was a landmark event in clinical trial reporting. Here we compared primary outcomes defined in protocols with those in publications describing the trials, and in trial registration. STUDY DESIGN AND SETTING: We identified phase III RCTs published between January 1, 2012 and June 30, 2015 in The New England Journal of Medicine, The Lancet, The Journal of the American Medical Association and The BMJ with available protocols...
July 27, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28755940/behavioral-and-patho-physiological-response-as-possible-signs-of-pain-in-dairy-cows-during-escherichia-coli-mastitis-a-pilot-study
#5
Alice de Boyer des Roches, Marion Faure, Alexandra Lussert, Vincent Herry, Pascal Rainard, Denys Durand, Gilles Foucras
Bovine mastitis is one of the most common diseases in the dairy industry and it is a major welfare problem. Pain during mastitis is generally assessed through behavior but a combination of indicators would increase the chances of detecting pain and assessing its intensity. The aim of this study was to assess behavioral and patho-physiological responses as possible signs of pain experienced by cows after experimental intramammary challenge (mastitis) with Escherichia coli. Six Holstein-Friesian cows received an inoculation of E...
July 26, 2017: Journal of Dairy Science
https://www.readbyqxmd.com/read/28755815/normalized-patellofemoral-joint-reaction-force-is-greater-in-individuals-with-patellofemoral-pain
#6
Lucas T Thomeer, Frances T Sheehan, Jennifer N Jackson
Patellofemoral pain is a disabling, highly prevalent pathology. Altered patellofemoral contact forces are theorized to contribute to this pain. Musculoskeletal modeling has been employed to better understand the etiology of patellofemoral pain. Currently, there are no data on the effective quadriceps moment arm for individuals with patellofemoral pain, forcing researchers to apply normative values when modeling such individuals. In addition, the ratio of patellofemoral reaction force to quadriceps force is often used as a surrogate for patellofemoral joint contact force, ignoring the fact that the quadriceps efficiency can vary with pathology and intervention...
July 26, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28749061/decision-making-for-an-incapacitated-pregnant-patient
#7
Hilary Mabel, Susannah L Rose, Eric Kodish
Decisions about continuing or terminating a pregnancy touch on profound, individualized questions about bodily integrity, reproductive autonomy, deeply held values regarding one's capacity for parenthood, and, in the case of a high-risk pregnancy, the risks one is willing to take to have a baby. So far as possible, reproductive decisions are made between a patient, in some cases her partner, and her medical provider. However, this standard framework cannot be applied if the patient lacks decision-making capacity...
July 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28731837/surrogate-decision-making-when-patients-cannot-decide-within-the-veterans-health-administration-system
#8
Keith M Swetz, Alisha K Stanton, Jill S Lowery
No abstract text is available yet for this article.
July 21, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28718896/nomograms-for-preoperative-prediction-of-axillary-nodal-status-in-breast-cancer
#9
L Dihge, P-O Bendahl, L Rydén
BACKGROUND: Axillary staging in patients with breast cancer and clinically node-negative disease is performed by sentinel node biopsy (SLNB). The aim of this study was to integrate feasible preoperative variables into nomograms to guide clinicians in stratifying treatment options into no axillary staging for patients with non-metastatic disease (N0), SLNB for those with one or two metastases, and axillary lymph node dissection (ALND) for patients with three or more metastases. METHODS: Patients presenting to Skåne University Hospital, Lund, with breast cancer were included in a prospectively maintained registry between January 2009 and December 2012...
July 18, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28716978/how-do-clinicians-prepare-family-members-for-the-role-of-surrogate-decision-maker
#10
Thomas V Cunningham, Leslie P Scheunemann, Robert M Arnold, Douglas White
PURPOSE: Although surrogate decision-making (SDM) is prevalent in intensive care units (ICUs) and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. SUBJECTS AND METHODS: We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death...
July 17, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28716511/an-ensemble-predictive-modeling-framework-for-breast-cancer-classification
#11
Radhakrishnan Nagarajan, Meenakshi Upreti
Molecular changes often precede clinical presentation of diseases and can be useful surrogates with potential to assist in informed clinical decision making. Recent studies have demonstrated the usefulness of modeling approaches such as classification that can predict the clinical outcomes from molecular expression profiles. While useful, a majority of these approaches implicitly use all molecular markers as features in the classification process often resulting in sparse high-dimensional projection of the samples often comparable to that of the sample size...
July 15, 2017: Methods: a Companion to Methods in Enzymology
https://www.readbyqxmd.com/read/28712987/the-tailored-study-a-randomized-controlled-trial-to-improve-surrogate-decision-making
#12
Daniel P Sulmasy, Mark T Hughes, Gayane Yenokyan, Joan Kub, Peter B Terry, Alan B Astrow, Julie A Johnson, Grace Ho, Marie T Nolan
CONTEXT: Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. OBJECTIVES: To test the effectiveness of an intervention to help surrogate decision makers. METHODS: 166 patients (41% with ALS and 59% with gastrointestinal cancers) and their surrogates at 2 university medical centers were randomized to an intensive nurse-directed discussion of the end of life Decision Control Preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention...
July 13, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28673300/volunteer-navigation-partnerships-piloting-a-compassionate-community-approach-to-early-palliative-care
#13
Barbara Pesut, Wendy Duggleby, Grace Warner, Konrad Fassbender, Elisabeth Antifeau, Brenda Hooper, Madeleine Greig, Kelli Sullivan
BACKGROUND: A compassionate community approach to palliative care provides important rationale for building community-based hospice volunteer capacity. In this project, we piloted one such capacity-building model in which volunteers and a nurse partnered to provide navigation support beginning in the early palliative phase for adults living in community. The goal was to improve quality of life by developing independence, engagement, and community connections. METHODS: Volunteers received navigation training through a three-day workshop and then conducted in-home visits with clients living with advanced chronic illness over one year...
July 3, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28672101/impact-of-neoadjuvant-chemotherapy-on-surgical-outcomes-among-patients-with-hormone-receptor-positive-breast-cancer
#14
Andrew N Hage, Christina Capriccioso, Julia Brennan, Brendan Heiden, Alexander Zheutlin, Michael S Sabel
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate for outcome, but not necessarily conversion to BCT eligibility. We sought to examine the impact of NACT on surgical decision making among HR+ patients. METHODS: Our IRB-approved breast cancer database was queried for patients who underwent NACT, including the clinicopathologic data and surgeon's pre- and post-NACT assessment. Surgical conversion rate (SCR) was defined as patients ineligible for BCT prior to NACT, who were given the choice following NACT...
July 3, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28667458/variability-in-measures-of-mineral-metabolism-in-children-on-hemodialysis-impact-on-clinical-decision-making
#15
Aadil Kakajiwala, Thomas O Jemielita, Lawrence Copelovitch, Mary B Leonard, Susan L Furth, Amy York, Maryjane Benton, Andrew N Hoofnagle, Kimberly Windt, Karen Merrigan, April Lederman, Michelle R Denburg
BACKGROUND: Variability in measures of mineral metabolism has not been studied in pediatric end stage kidney disease. We sought to determine the intra-individual variability in measures of mineral metabolism in children on hemodialysis (HD) and its impact on clinical decision-making. METHODS: We conducted a prospective single-center study of children (3.6-17.3 years old) on chronic HD. Serial twice weekly measures of serum calcium, phosphate and intact parathyroid hormone (PTH), as well as weekly measures of fibroblast growth factor 23 (FGF23) and vitamin D metabolites, were obtained over a 12-week period in 10 children...
June 30, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28638969/introduction-childhood-and-disability
#16
EDITORIAL
Erica K Salter
From growth attenuation therapy for severely developmentally disabled children to the post-natal management of infants with trisomy 13 and 18, pediatric treatment decisions regularly involve assessments of the probability and severity of a child's disability. Because these decisions are almost always made by surrogate decision-makers (parents and caregivers) and because these decision-makers must often make decisions based on both prognostic guesses and potentially biased quality of life judgments, they are among the most ethically complex in pediatric care...
June 21, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28636489/evaluation-of-countermeasures-for-red-light-running-by-traffic-simulator-based-surrogate-safety-measures
#17
Changju Lee, Jaehyun Jason So, Jiaqi Ma
OBJECTIVE: The conflicts among motorists entering a signalized intersection with the red light indication have become a national safety issue. Because of its sensitivity, efforts have been made to investigate the possible causes and effectiveness of countermeasures by the comparison sites and/or before-and-after studies. Nevertheless, these approaches are ineffective when comparison sites cannot be found, or crash data sets are not readily available or not reliable for statistical analysis...
June 21, 2017: Traffic Injury Prevention
https://www.readbyqxmd.com/read/28623775/cancer-immunotherapy-opportunities-and-challenges-in-the-rapidly-evolving-clinical-landscape
#18
REVIEW
Leisha A Emens, Paolo A Ascierto, Phillip K Darcy, Sandra Demaria, Alexander M M Eggermont, William L Redmond, Barbara Seliger, Francesco M Marincola
Cancer immunotherapy is now established as a powerful way to treat cancer. The recent clinical success of immune checkpoint blockade (antagonists of CTLA-4, PD-1 and PD-L1) highlights both the universal power of treating the immune system across tumour types and the unique features of cancer immunotherapy. Immune-related adverse events, atypical clinical response patterns, durable responses, and clear overall survival benefit distinguish cancer immunotherapy from cytotoxic cancer therapy. Combination immunotherapies that transform non-responders to responders are under rapid development...
August 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28623051/decision-proposals-in-the-family-conference
#19
Kristen E Pecanac, Roger L Brown
OBJECTIVES: To explore how clinicians make decision proposals about life-sustaining treatments and to determine if certain decision proposals are more likely to lead surrogates to align with or resist the proposal. METHODS: We audio-recorded 36 family conferences between clinicians and surrogates and analyzed the interactions using conversation analysis (a qualitative method) and event sequence analysis (a quantitative method). RESULTS: The transitional probability of a proposal that incorporates the patient's previously described preferences leading to alignment with the proposal was ...
June 9, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28614074/a-patient-not-alone
#20
Lauren Sydney Flicker
This case analysis examines questions that arise when an ethically appropriate recommendation initially appears to be in conflict with the legally appropriate recommendation. The case involves a dying, incapacitated octogenarian who had friends who were willing to share her values, but not to make decisions on her behalf. These circumstances put the patient in the unique position of being legally considered a "patient alone," but who was ethically like a patient with surrogates-distinctions that are crucial when making end-of-life decisions under the New York Family Health Care Decisions Act...
2017: Journal of Clinical Ethics
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