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surrogate decision making

Catharine M Sturgeon, Stuart Sprague, Alison Almond, Etienne Cavalier, William D Fraser, Alicia Schimnich-Algeciras, Ravinder Singh, Jean-Claude Souberbielle, Hubert W Vesper
Parathyroid hormone (PTH) measurement in serum or plasma is a necessary tool for the exploration of calcium/phosphorus disorders, and is widely used as a surrogate marker to assess skeletal and mineral disorders associated with chronic kidney disease (CKD), referred to as CKD-bone mineral disorders (CKD-BMD). CKD currently affects >10% of the adult population in the United States and represents a major health issue worldwide. Disturbances in mineral metabolism and fractures in CKD patients are associated with increased morbidity and mortality...
October 13, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
Jérôme Allyn, Cyril Ferdynus, Michel Bohrer, Cécile Dalban, Dorothée Valance, Nicolas Allou
BACKGROUND: End-of-life decision-making in Intensive care Units (ICUs) is difficult. The main problems encountered are the lack of a reliable prediction score for death and the fact that the opinion of patients is rarely taken into consideration. The Decision Curve Analysis (DCA) is a recent method developed to evaluate the prediction models and which takes into account the wishes of patients (or surrogates) to expose themselves to the risk of obtaining a false result. Our objective was to evaluate the clinical usefulness, with DCA, of the Simplified Acute Physiology Score II (SAPS II) to predict ICU mortality...
2016: PloS One
Alexia M Torke, Patrick Monahan, Christopher M Callahan, Paul R Helft, Greg A Sachs, Lucia D Wocial, James E Slaven, Kianna Montz, Lev Inger, Emily Burke
CONTEXT: Although many family members who make surrogate decisions report problems with communication, there is no validated instrument to accurately measure surrogate/clinician communication for older adults in the acute hospital setting. OBJECTIVES: To validate a survey of surrogate-rated communication quality in the hospital that would be useful to clinicians, researchers and health systems. METHODS: After expert review and cognitive interviewing (n=10 surrogates), we enrolled 350 surrogates (250 development sample and 100 validation sample) of hospitalized adults aged 65 and older from three hospitals in one metropolitan area...
October 5, 2016: Journal of Pain and Symptom Management
Danica M Ommen, Christopher P Saunders, Cedric Neumann
In the various forensic science disciplines, recent analytical developments paired with modern statistical computational tools have led to the proliferation of adhoc techniques for quantifying the probative value of forensic evidence. Many legal and scientific scholars agree that the value of evidence should be reported as a likelihood ratio or a Bayes Factor. Quantifying the probative value of forensic evidence is subjected to many sources of variability and uncertainty. There is currently a debate on how to characterize the reliability of the value of evidence...
September 2016: Science & Justice: Journal of the Forensic Science Society
Sue Bookey-Bassett, Maureen Markle-Reid, Colleen A Mckey, Noori Akhtar-Danesh
AIM: To report a concept analysis of interprofessional collaboration in the context of chronic disease management, for older adults living in communities. BACKGROUND: Increasing prevalence of chronic disease among older adults is creating significant burden for patients, families and healthcare systems. Managing chronic disease for older adults living in the community requires interprofessional collaboration across different health and other care providers, organizations and sectors...
September 28, 2016: Journal of Advanced Nursing
Abigail S Joyce, Lisa M Portis, Ashley N Parks, Robert M Burgess
This Critcal Review evaluates passive sampler uptake of hydrophobic organic contaminants (HOCs) in water column and interstitial water exposures as a surrogate for organism bioaccumulation. Fifty-seven studies were found where both passive sampler uptake and organism bioaccumulation were measured and 19 of these investigations provided direct comparisons relating passive sampler uptake and organism bioaccumulation. Polymers compared included low-density polyethylene (LDPE), polyoxymethylene (POM), and polydimethylsiloxane (PDMS), and organisms ranged from polychaetes and oligochaetes to bivalves, aquatic insects, and gastropods...
October 12, 2016: Environmental Science & Technology
Nita Khandelwal, David Benkeser, Norma B Coe, Ruth A Engelberg, J Randall Curtis
RATIONALE: In the intensive care unit (ICU), complex decision-making by clinicians and families requires good communication to ensure care is consistent with patients' values and goals. OBJECTIVES: Assess the economic feasibility of staffing ICUs with a communication facilitator. METHODS: Data from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n=135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker...
September 27, 2016: Annals of the American Thoracic Society
Kristen E Pecanac
The purpose of this study was to explore how clinicians introduce the need to make a decision about the use of life-sustaining treatment and how surrogates respond to these introductions during family conferences in the intensive care unit. This article focuses on the use of the perspective-display sequence as a way to introduce the decision-making conversation. In the family conferences, the perspective-display sequence involved (a) the clinician's perspective-display invitation of the surrogates' assessment of the patient's wishes, (b) the surrogates' reply or assessment, and (c) the clinician's decision proposal, which often incorporates the surrogates' assessment...
September 26, 2016: Health Communication
Adam Feltz
An estimated 1 in 4 elderly Americans need a surrogate to make decisions at least once in their lives. With an aging population, that number is almost certainly going to increase. This paper focuses on financial surrogate decision making. To illustrate some of the empirical and moral implications associated with financial surrogate decision making, two experiments suggest that default choice settings can predictably influence some surrogate financial decision making. Experiment 1 suggested that when making hypothetical financial decisions, surrogates tended to stay with default settings (OR = 4...
2016: Spanish Journal of Psychology
Dafina Petrova, Rocio Garcia-Retamero, Joop van der Pligt
When we make risky decisions for others, we tend to follow social norms about risks. This often results in making different decisions for others than we would make for ourselves in a similar situation (i.e., self-other discrepancies). In an experiment, we investigated self-other discrepancies in young adults' decisions to purchase a vaccine against a sexually-transmitted virus for themselves or for another person (i.e., the target of the decision). When the target's preferences were in line with social norms, surrogates showed large self-other discrepancies in line with these norms...
2016: Spanish Journal of Psychology
Corinna S Bazelet, Aileen C Thompson, Piotr Naskrecki
The use of endemism and vascular plants only for biodiversity hotspot delineation has long been contested. Few studies have focused on the efficacy of global biodiversity hotspots for the conservation of insects, an important, abundant, and often ignored component of biodiversity. We aimed to test five alternative diversity measures for hotspot delineation and examine the efficacy of biodiversity hotspots for conserving a non-typical target organism, South African katydids. Using a 1° fishnet grid, we delineated katydid hotspots in two ways: (1) count-based: grid cells in the top 10% of total, endemic, threatened and/or sensitive species richness; vs...
2016: PloS One
Amber E Barnato, Yael Schenker, Greer Tiver, Mary Amanda Dew, Robert M Arnold, Eduardo R Nunez, Charles F Reynolds
OBJECTIVES: Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU...
September 9, 2016: Critical Care Medicine
Matteo Bauckneht, Roberta Piva, Giulia Ferrarazzo, Valentina Ceriani, Ambra Buschiazzo, Silvia Morbelli, Cecilia Marini, Gianmario Sambuceti
Over the last several decades, radionuclide Myocardial Perfusion Imaging (MPI) has been a mainstay for the evaluation of coronary artery disease (CAD), based on the assumption that a detailed knowledge of stenosis localization and severity is not sufficient for clinical decision making. Furthermore, radionuclide MPI diagnostic accuracy has been implemented by the assessment of Coronary Flow Reserve (CFR) and Myocardial Blood Flow (MBF), as quantitative indexes of stenosis severity and surrogates of total ischaemic burden...
December 2016: Quarterly Journal of Nuclear Medicine and Molecular Imaging
Michael G Tyshenko, Tamer Oraby, Shalu Darshan, Margit Westphal, Maxine C Croteau, Willy Aspinall, Susie Elsaadany, Daniel Krewski, Neil Cashman
A high degree of uncertainty exists for chronic wasting disease (CWD) transmission factors in farmed and wild cervids. Evaluating the factors is important as it helps to inform future risk management strategies. Expert opinion is often used to assist decision making in a number of health, science, and technology domains where data may be sparse or missing. Using the "Classical Model" of elicitation, a group of experts was asked to estimate the most likely values for several risk factors affecting CWD transmission...
2016: Journal of Toxicology and Environmental Health. Part A
(no author information available yet)
This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. Providers ethically may treat women at elevated risk provided that they are carefully assessed; that specialists in their medical condition are consulted as appropriate; and that patients are fully informed about risks, benefits, and alternatives, including oocyte and embryo donation, use of a gestational surrogate, not undergoing fertility care, and adoption. Providers also may conclude that the risks are too high for them to ethically treat particular patients; such determinations must be made in a medically objective and unbiased manner and patients must be fully informed of the decision...
August 13, 2016: Fertility and Sterility
Donald D Anderson, Anthony T Kilburg, Thaddeus P Thomas, J Lawrence Marsh
BACKGROUND: Post-traumatic osteoarthritis (PTOA) is common after intra-articular fractures of the tibial plafond. An objective CT-based measure of fracture severity was previously found to reliably predict whether PTOA developed following surgical treatment of such fractures. However, the extended time required obtaining the fracture energy metric and its reliance upon an intact contralateral limb CT limited its clinical applicability. The objective of this study was to establish an expedited fracture severity metric that provided comparable PTOA predictive ability without the prior limitations...
2016: Iowa Orthopaedic Journal
Allison Tong, Klemens Budde, John Gill, Michelle A Josephson, Lorna Marson, Timothy L Pruett, Peter P Reese, David Rosenbloom, Lionel Rostaing, Anthony N Warrens, Germaine Wong, Jonathan C Craig, Sally Crowe, Tess Harris, Brenda Hemmelgarn, Braden Manns, Peter Tugwell, Wim Van Biesen, David C Wheeler, Wolfgang C Winkelmayer, Nicole Evangelidis, Benedicte Sautenet, Martin Howell, Jeremy R Chapman
BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy...
June 2016: Transplantation Direct
Ami V Patel, Richard J Ackermann
Competence is determined by a court of law, whereas physicians determine medical decision-making capacity (DMC). When patients lack DMC, a surrogate should be identified to make decisions. Ideally, patients will have created a durable power of attorney for health care. If a patient did not do this, state statutes specify which individuals can serve as surrogates; a current spouse typically is the first choice. Ideally, surrogates should use substituted judgment in making decisions. If this is not possible because the patient never shared end-of-life wishes with the surrogate, the surrogate can make decisions that, in the surrogate's opinion, are in the patient's best interests or that a reasonable individual would make...
August 2016: FP Essentials
Chi Eung Danforn Lim, Rachel W C Ng, Nga Chong Lisa Cheng, Maria Cigolini, Cannas Kwok, Frank Brennan
BACKGROUND: End-stage kidney disease (ESKD) is a chronic, debilitative and progressive illness that may need interventions such as dialysis, transplantation, dietary and fluid restrictions. Most patients with ESKD will require renal replacement therapy, such as kidney transplantation or maintenance dialysis. Advance care planning traditionally encompass instructions via living wills, and concern patient preferences about interventions such as cardiopulmonary resuscitation and feeding tubes, or circumstances around assigning surrogate decision makers...
July 26, 2016: Cochrane Database of Systematic Reviews
Aviva L Katz, Sally A Webb
Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in their health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child's and adolescent's opinion in medical decision-making in clinical practice and research. This technical report, which accompanies the policy statement "Informed Consent in Decision-Making in Pediatric Practice" was written to provide a broader background on the nature of informed consent, surrogate decision-making in pediatric practice, information on child and adolescent decision-making, and special issues in adolescent informed consent, assent, and refusal...
August 2016: Pediatrics
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