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surrogate decision making

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https://www.readbyqxmd.com/read/29218626/treatment-related-changes-in-glioblastoma-a-review-on-the-controversies-in-response-assessment-criteria-and-the-concepts-of-true-progression-pseudoprogression-pseudoresponse-and-radionecrosis
#1
REVIEW
P D Delgado-López, E Riñones-Mena, E M Corrales-García
The assessment of response to therapy in glioblastoma remains a challenge, because the surrogate measures of survival are subject to radiographic misinterpretation. A solid and reliable definition of progression is needed for both clinical decision-making and for evaluating response within the clinical trials. Historically, assessment criteria have used radiologic and clinical features aimed to correctly classify patients into progressive or non-progressive disease. The widely used RANO criteria are a valuable tool in disease evaluation, both in the clinical setting and in the clinical trials...
December 7, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/29217285/outcomes-and-palliative-care-utilization-in-patients-with-dementia-and-acute-abdominal-emergency-opportunities-for-surgical-quality-improvement
#2
Ana Berlin, Franchesca Hwang, Ranbir Singh, Sri Ram Pentakota, Roshansa Singh, Brad Chernock, Anne C Mosenthal
BACKGROUND: When patients with dementia develop acute surgical abdomen, patients, surrogates, and surgeons need accurate prognostic information to facilitate goal-concordant decision making. Palliative care can assist with communication, symptom management, and family and caregiver support in this population. We aimed to characterize outcomes and patterns of palliative care utilization among patients with dementia, presenting with abdominal surgical emergency. METHOD: We retrospectively queried the National Inpatient Sample for patients aged >50 years with dementia and acute abdominal emergency who were admitted nonelectively 2009-2013, utilizing ICD-9-CM codes for dementia and surgical indication...
December 4, 2017: Surgery
https://www.readbyqxmd.com/read/29215368/numeracy-and-interpretation-of-prognostic-estimates-in-intracerebral-hemorrhage-among-surrogate-decision-makers-in-the-neurologic-icu
#3
Nikita Leiter, Melissa Motta, Robert M Reed, Temitope Adeyeye, Debra L Wiegand, Nirav G Shah, Avelino C Verceles, Giora Netzer
OBJECTIVE: Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers...
December 5, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29186982/a-randomized-controlled-trial-of-strategies-to-improve-family-members-preparedness-for-surrogate-decision-making
#4
Michael J Green, Lauren J Van Scoy, Andrew J Foy, Renee R Stewart, Ramya Sampath, Jane R Schubart, Erik B Lehman, Anne E F Dimmock, Ashley M Bucher, Lisa S Lehmann, Alyssa F Harlow, Chengwu Yang, Benjamin H Levi
OBJECTIVE: To evaluate 2 strategies for preparing family members for surrogate decision-making. DESIGN: A 2 × 2 factorial, randomized controlled trial testing whether: (1) comprehensive online advance care planning (ACP) is superior to basic ACP, and (2) having patients engage in ACP together with family members is superior to ACP done by patients alone. SETTING: Tertiary care centers in Hershey, Pennsylvania, and Boston, Massachusetts. PARTICIPANTS: Dyads of patients with advanced, severe illness (mean age 64; 46% female; 72% white) and family members who would be their surrogate decision-makers (mean age 56; 75% female; 75% white)...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29185176/communication-quality-predicts-psychological-well-being-and-satisfaction-in-family-surrogates-of-hospitalized-older-adults-an-observational-study
#5
Alexia M Torke, Christopher M Callahan, Greg A Sachs, Lucia D Wocial, Paul R Helft, Patrick O Monahan, James E Slaven, Kianna Montz, Emily S Burke, Lev Inger
BACKGROUND: Many hospitalized older adults require family surrogates to make decisions, but surrogates may perceive that the quality of medical decisions is low and may have poor psychological outcomes after the patient's hospitalization. OBJECTIVE: To determine the relationship between communication quality and high-quality medical decisions, psychological well-being, and satisfaction for surrogates of hospitalized older adults. DESIGN: Observational study at three hospitals in a Midwest metropolitan area...
November 28, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29174253/the-association-of-the-syntax-score-ii-with-carotid-intima-media-thickness-and-epicardial-fat-tissue
#6
Uğur Aksu, Oktay Gulcu, Zeynep Bilgi, Selim Topcu, Serdar Sevimli, Ednan Bayram, Ibrahim Halil Tanboğa
AIM: Syntax score II (SSII) is a highly predictive scoring system, which is used to improve individualized assessment of patients with complex coronary artery disease and facilitates clinical decision making. Surrogate markers [carotid intima-media thickness (CIMT), epicardial fat tissue (EFT)] are also used for risk assessment, but their relation with SSII is not well established. METHOD: We enrolled 543 consecutive patients, who underwent coronary angiography for stable angina pectoris and acute coronary syndrome, in the study...
November 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/29148907/impact-of-patients-expressed-wishes-on-their-surrogate-decision-makers-preferred-decision-making-roles-in-japan
#7
Shuji Tsuda, Mieko Nakamura, Shigeru Aoki, Hiroshi Ono, Mitsuru Takagi, Hiroki Ohashi, Junichiro Miyachi, Yoshinori Matsui, Toshiyuki Ojima
BACKGROUND: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. OBJECTIVE: We investigated the decision readiness of HMC patients and their family surrogates. DESIGN: Cross-sectional survey. SETTING/SUBJECTS: We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016...
November 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#8
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29121600/use-of-surrogate-indicators-for-the-evaluation-of-potential-health-risks-due-to-poor-urban-water-quality-a-bayesian-network-approach
#9
Buddhi Wijesiri, Kaveh Deilami, James McGree, Ashantha Goonetilleke
Urban water pollution poses risks of waterborne infectious diseases. Therefore, in order to improve urban liveability, effective pollution mitigation strategies are required underpinned by predictions generated using water quality models. However, the lack of reliability in current modelling practices detrimentally impacts planning and management decision making. This research study adopted a novel approach in the form of Bayesian Networks to model urban water quality to better investigate the factors that influence risks to human health...
November 6, 2017: Environmental Pollution
https://www.readbyqxmd.com/read/29120347/cuff-less-blood-pressure-measurement-from-dual-channel-photoplethysmographic-signals-via-peripheral-pulse-transit-time-with-singular-spectrum-analysis
#10
Yang Wang, Zhiwen Liu, Shaodong Ma
This paper proposes an unobtrusive blood pressure (BP) measurement system design with motion artifact (MA) compensation strategy as a potential surrogate to the traditional cuff-based sphygmomanometer for self-monitoring in less restricted environment. Approach: A dual-channel photoplethysmographic signal acquisition system is designed and implemented for the cuff-less BP measurement based on peripheral pulse transit time (PPTT) acquired from the forearm and wrist. Comprised of motion decision, singular spectrum analysis, PPTT calculation and BP measurement, a novel approach is proposed to realize BP measurement with suppressing MA interference...
November 9, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/29117010/assessing-the-methodological-quality-of-glaucoma-clinical-practice-guidelines-and-their-recommendations-on-microinvasive-glaucoma-surgery-a-systematic-review
#11
Evan Michaelov, James J Armstrong, Mary Nguyen, Bridget Instrum, Tracey Lam, James Denstedt, Cindy M L Hutnik
INTRODUCTION: Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical procedures (MIGS) were introduced. Since then, a number of these novel intraocular pressure (IOP) controlling surgical options have been approved worldwide. Governing bodies and healthcare administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate and up-to-date CPGs in the rapidly evolving field of MIGS...
November 7, 2017: Journal of Glaucoma
https://www.readbyqxmd.com/read/29099239/physician-approaches-to-conflict-with-families-surrounding-end-of-life-decision-making-in-the-icu-a-qualitative-study
#12
Hashim M Mehter, Jessica B McCannon, Jack A Clark, Renda Soylemez Wiener
RATIONALE: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. OBJECTIVES: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making...
November 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29082773/size-distribution-and-clinico-radiological-signs-of-aggressiveness-in-odontogenic-myxoma-three-dimensional-analysis-and-systematic-review
#13
Martin Kauke, Ali-Farid Safi, Matthias Kreppel, Andrea Grandoch, Hans-Joachim Nickenig, Joachim E Zöller, Timo Dreiseidler
OBJECTIVES: Therapeutic assessment of odontogenic myxoma (OM) is poorly standardized. Unidimensional size criteria have shown to be unreliable in therapeutic decision-making. We evaluate the size distribution of OM and scan for associated clinico-radiological signs of aggressiveness. Additionally, we evaluate three-dimensional size delineation of OM, aiming to improve future therapeutic assessment of this destructive neoplasm. METHODS: Primarily, we reviewed the database "PubMed" for data concerning the size of OMs as radiologically determined...
October 30, 2017: Dento Maxillo Facial Radiology
https://www.readbyqxmd.com/read/29068438/clinical-decision-making-observing-the-smartphone-user-an-observational-study-in-predicting-acute-surgical-patients-suitability-for-discharge
#14
Richard Hoffman, Simon Harley, Samuel Ellison, Peter G Devitt
INTRODUCTION: An accurate and rapid assessment of an acutely unwell patient's clinical status is paramount for the physician. There is an increasing trend to rely on investigations and results to inform a clinician of a patient's clinical status, with the subtleties of clinical observation often ignored. The aim of this study was to determine if a patient's use of a smartphone during the initial clinical assessment by a surgical consultant could be used as a surrogate marker for patient well-being, represented as their suitability for sameday discharge...
August 23, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29058014/quantitative-rapid-assessment-of-leukoaraiosis-in-ct-comparison-to-gold-standard-mri
#15
Uta Hanning, Peter Bernhard Sporns, Rene Schmidt, Thomas Niederstadt, Jens Minnerup, Georg Bier, Stefan Knecht, André Kemmling
PURPOSE: The severity of white matter lesions (WML) is a risk factor of hemorrhage and predictor of clinical outcome after ischemic stroke; however, in contrast to magnetic resonance imaging (MRI) reliable quantification for this surrogate marker is limited for computed tomography (CT), the leading stroke imaging technique. We aimed to present and evaluate a CT-based automated rater-independent method for quantification of microangiopathic white matter changes. METHODS: Patients with suspected minor stroke (National Institutes of Health Stroke scale, NIHSS < 4) were screened for the analysis of non-contrast computerized tomography (NCCT) at admission and compared to follow-up MRI...
October 20, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29054389/optimizing-surgical-quality-datasets-to-care-for-older-adults-lessons-from-the-american-college-of-surgeons-nsqip-geriatric-surgery-pilot
#16
Julia R Berian, Lynn Zhou, Melissa A Hornor, Marcia M Russell, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Thomas N Robinson, Ronnie A Rosenthal
BACKGROUND: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers)...
September 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29032876/clinical-value-of-triage-lactate-in-risk-stratifying-trauma-patients-using-interval-likelihood-ratios
#17
Bonny J Baron, Andrew Nguyen, Dimitre Stefanov, Amit Shetty, Shahriar Zehtabchi
Emergency physicians face the challenge of rapidly identifying high-risk trauma patients. Lactate (LAC) is widely used as a surrogate of tissue hypoperfusion. However, clinically important values for LAC as a predictor of mortality are not well defined. OBJECTIVES: 1. To assess the value of triage LAC in predicting mortality after trauma. 2. To compute interval likelihood ratios (LR) for LAC. METHODS: Retrospective chart review of trauma patients with a significant injury mechanism that warranted labs at an urban trauma center...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29019452/minimal-residual-disease-analysis-in-myeloma-when-why-and-where
#18
Uday Yanamandra, Shaji K Kumar
The primary hurdle in the path to curing multiple myeloma (MM) is defining a validated minimal residual disease (MRD) and its utility in the therapeutic decision making. A better definition of MRD will aid in tailoring MM therapy further to address the clonal heterogeneity and genomic instability and overcome patient's ineffective immune surveillance. MRD analysis can define the logical endpoint for maintenance therapy, in addition also aids in providing a better clinical end point for studies comparing novel agents in myeloma...
October 11, 2017: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/29017596/providers-and-patients-face-to-face-what-is-the-time
#19
Andrew D Racine
BACKGROUND: The frequency of visiting primary care providers and the duration of those visits varies substantially by patient demographics and across different developed countries. The significance of a cumulative measure of this time spent with providers in face-to-face visits is not well understood. COMMENTARY: In a recent IJHPR issue Nathan and co-authors have suggested a new metric for capturing the cumulative time spent annually in face-to-face encounters between providers and patients...
October 10, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28993286/spirit-trial-a-phase-iii-pragmatic-trial-of-an-advance-care-planning-intervention-in-esrd
#20
Mi-Kyung Song, Mark L Unruh, Amita Manatunga, Laura C Plantinga, Janice Lea, Manisha Jhamb, Abhijit V Kshirsagar, Sandra E Ward
Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates...
October 6, 2017: Contemporary Clinical Trials
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