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https://www.readbyqxmd.com/read/28504894/preventing-burdensome-transitions-of-nursing-home-residents-with-advanced-dementia-it-s-more-than-advance-directives
#1
Ruth Palan Lopez, Susan L Mitchell, Jane L Givens
BACKGROUND: Although a palliative approach to care is recommended for people with advanced dementia, many nursing home (NH) residents with dementia experience burdensome interventions such as hospital transfers at the end of life. OBJECTIVE: The goal of this study was to examine how decisions to transfer NH residents with advanced dementia are made, from the perspective of NH nurses and physicians. METHODS: A qualitative, descriptive method was used...
May 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28502810/outcome-selection-and-measurement-in-pragmatic-trials
#2
Paco Welsing, Katrien Oude Rengerink, Sue Collier, Laurent Eckert, Maarten van Smeden, Antonio Ciaglia, Gaelle Nachbaur, Sven Trelle, Aliki Taylor, Matthias Egger, Iris Goetz
Results from pragmatic trials should reflect the comparative treatment effects encountered in patients in real-life clinical practice to guide treatment decisions. Therefore pragmatic trials should focus on outcomes that are relevant to patients, clinical practice, and treatment choices. This 6(th) paper in the series (see box) discusses different types of outcomes and their suitability for pragmatic trials, design choices for measuring these outcomes and their implications and challenges. Measuring outcomes in pragmatic trials should not interfere with real-world clinical practice to ensure generalizability of trial results and routinely collected outcomes should be prioritized...
May 11, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28499120/characterising-bias-in-regulatory-risk-and-decision-analysis-an-analysis-of-heuristics-applied-in-health-technology-appraisal-chemicals-regulation-and-climate-change-governance
#3
Brian H MacGillivray
In many environmental and public health domains, heuristic methods of risk and decision analysis must be relied upon, either because problem structures are ambiguous, reliable data is lacking, or decisions are urgent. This introduces an additional source of uncertainty beyond model and measurement error - uncertainty stemming from relying on inexact inference rules. Here we identify and analyse heuristics used to prioritise risk objects, to discriminate between signal and noise, to weight evidence, to construct models, to extrapolate beyond datasets, and to make policy...
May 9, 2017: Environment International
https://www.readbyqxmd.com/read/28497934/cerebral-autoregulation-monitoring-in-acute-traumatic-brain-injury-what-s-the-evidence
#4
Leanne A Calviello, Joseph Donnelly, Frederick A Zeiler, Eric P Thelin, Peter Smielewski, Marek Czosnyka
Cerebral autoregulation is conceptualized as a vascular self-regulatory mechanism within the brain. Controlled by elusive relationships between various biophysical processes, it functions to protect the brain against potential damages caused by sudden changes in cerebral perfusion pressures and flow. Following events such as traumatic brain injuries (TBI), autoregulation may be compromised, potentially leading to an unfavorable outcome. In spite of its complexity, autoregulation has been able to be quantified non-invasively within the neuro-critical care setting with the aid of transcranial Doppler...
May 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28486509/combining-participatory-and-socioeconomic-approaches-to-map-fishing-effort-in-small-scale-fisheries
#5
Lauric Thiault, Antoine Collin, Frédérique Chlous, Stefan Gelcich, Joachim Claudet
Mapping the spatial allocation of fishing effort while including key stakeholders in the decision making process is essential for effective fisheries management but is difficult to implement in complex small-scale fisheries that are diffuse, informal and multifaceted. Here we present a standardized but flexible approach that combines participatory mapping approaches (fishers' spatial preference for fishing grounds, or fishing suitability) with socioeconomic approaches (spatial extrapolation of social surrogates, or fishing capacity) to generate a comprehensive map of predicted fishing effort...
2017: PloS One
https://www.readbyqxmd.com/read/28484927/ethical-and-legal-considerations-in-the-management-of-an-unbefriended-patient-in-a-vegetative-state
#6
Alexandra Lloyd-Smith Sequeira, Ariane Lewis
BACKGROUND: Patients without surrogates are referred to as "unbefriended." Because these patients do not have representatives to assist with medical decision-making, patient autonomy and self-determination, fundamental concepts of American healthcare, are jeopardized. METHODS: We present a case of an unbefriended patient in a vegetative state and discuss the ethical and legal complications associated with management of unbefriended patients. RESULTS: An unbefriended patient was admitted to our hospital with a cardiac arrest in the setting of an intracerebral hemorrhage...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28473036/ethical-analysis-of-withdrawing-total-artificial-heart-support
#7
Erin S DeMartino, Sara E Wordingham, John M Stulak, Barry A Boilson, Kayla R Fuechtmann, Nausheen Singh, Daniel P Sulmasy, Octavio E Pajaro, Paul S Mueller
OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed...
May 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28473002/surrogate-prediction-of-quality-of-life-and-desire-for-treatment-a-guess-of-a-guess
#8
Scott Snyder, Halima Amjad
In conditions, such as dementia, stroke, or critical illness, clinicians often rely on substituted judgment through a surrogate to assist in medical decision making. Surrogates may face tough decisions regarding whether to pursue or forego surgery, tube feeding, and cardiopulmonary resuscitation. Surrogates often have little confidence in their decision (Majesko et al., 2012), though substituted judgment relies on the surrogate to determine the decision that the patient would have made. Prior studies suggest that surrogates predict patient preferences with only 68% accuracy (Shalowitz et al...
May 5, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28472247/pharmacodynamics-of-isavuconazole-for-invasive-mold-disease-role-of-galactomannan-for-real-time-monitoring-of-therapeutic-response
#9
Laura L Kovanda, Ruwanthi Kolamunnage-Dona, Michael Neely, Johan Maertens, Misun Lee, William W Hope
Background.: The ability to make early therapeutic decisions when treating invasive aspergillosis using changes in biomarkers as a surrogate for therapeutic response could significantly improve patient outcome. Methods.: Cox proportional hazards model and logistic regression were used to correlate early changes in galactomannan index (GMI) to mortality and overall response, respectively, from patients with positive baseline GMI (≥0.5) and serial GMI during treatment from a phase 3 clinical trial for the treatment of invasive mold disease...
June 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28449820/range-and-heterogeneity-of-outcomes-in-randomized-trials-of-pediatric-chronic-kidney-disease
#10
Lauren S H Chong, Benedicte Sautenet, Allison Tong, Camilla S Hanson, Susan Samuel, Michael Zappitelli, Allison Dart, Susan Furth, Allison A Eddy, Jaap Groothoff, Nicholas J A Webb, Hui-Kim Yap, Detlef Bockenhauer, Aditi Sinha, Stephen I Alexander, Stuart L Goldstein, Debbie S Gipson, Gayathri Raman, Jonathan C Craig
OBJECTIVE: To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN: The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated...
April 24, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28444879/prioritising-treatment-outcomes-how-people-with-acne-vulgaris-decide-if-their-treatment-is-working
#11
Alison M Layton, Heather Whitehouse, E Anne Eady, Fiona Cowdell, Katherine L Warburton, Mark Fenton
AIM: To collect information about how people with acne make day-to-day decisions concerning the effectiveness of their treatment. METHODS: Between May and August 2013, an optional question was embedded in the James Lind Alliance Acne Priority Setting Partnership's online survey to collect treatment uncertainties. The question asked people with acne to 'Tell us in your own words how you decide if your treatment has been effective'. RESULTS: A total of 742 respondents specified at least one outcome or means of assessing change (outcome measure)...
April 26, 2017: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/28443357/informed-consent-and-the-aftermath-of-cardiopulmonary-resuscitation-ethical-considerations
#12
Pamela Bjorklund, Denise M Lund
BACKGROUND: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. OBJECTIVE: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28441102/the-importance-of-intergenerational-communication-in-advance-care-planning-generational-relationships-among-perceptions-and-beliefs
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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