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surrogate decision making

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https://www.readbyqxmd.com/read/29032876/clinical-value-of-triage-lactate-in-risk-stratifying-trauma-patients-using-interval-likelihood-ratios
#1
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
#2
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
#3
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
#4
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
https://www.readbyqxmd.com/read/28974996/monitoring-pressure-augmentation-in-patients-with-ischemic-penumbra-using-continuous-electroencephalogram-three-cases-and-a-review-of-the-literature
#5
Christopher R Newey, Vikas Gupta, Agnieszka A Ardelt
BACKGROUND: Continuous electroencephalography (CEEG) is a sensitive, noninvasive surrogate monitor of cerebral blood flow (CBF). Changes in CBF can be seen as changes in the frequencies on the CEEG. This case series suggests that increase in CEEG frequencies may be used to detect improved CBF following pressure augmentation such as with treatment of vasospasm from subarachnoid hemorrhage (SAH) or acute thrombosis from ischemic stroke. The application of this observation to clinical decision-making has not been clearly defined and requires further study...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28972523/shared-decision-making-interventions-theoretical-and-empirical-evidence-with-implications-for-health-literacy
#6
Dawn Stacey, Sophie Hill, Kirsten McCaffery, Laura Boland, Krystina B Lewis, Lidia Horvat
Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28968619/balancing-patient-autonomy-surrogate-decision-making-and-physician-non-maleficence-when-considering-do-not-resuscitate-orders-an-ethics-case-analysis
#7
Nabil Mehta, Samantha Roche, Elisabeth Wong, Abass Noor, Kathryn DeCarli
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
October 2, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#8
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28966471/invited-commentary-changing-the-conversation-at-the-end-of-life-how-the-language-we-use-impacts-surrogates-decision-making-burden
#9
EDITORIAL
Laurel B Kilpatrick
No abstract text is available yet for this article.
October 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28962816/shared-decision-making-in-neurocritical-care
#10
REVIEW
Muhammad Waqas Khan, Susanne Muehlschlegel
Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28949899/physician-understanding-and-application-of-surrogate-decision-making-laws-in-clinical-practice
#11
Amber Rose Comer, Margaret Gaffney, Cynthia L Stone, Alexia Torke
BACKGROUND: Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice. METHODS: A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice...
July 2017: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/28940348/empty-spaces
#12
Adira Hulkower
"I'm Jewish, you know, and my mother said, 'Always trust the rabbis.'" I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility-white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces-the absence of his voice, the too-large bed for his shrinking frame, the always-empty chair by his bedside, and most of all, the myriad gaps in his life story...
September 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28930710/at-the-intersection-of-faith-culture-and-family-dynamics-a-complex-case-of-refusal-of-treatment-for-childhood-cancer
#13
Amy E Caruso Brown
Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28922998/risk-preferences-in-surrogate-decision-making
#14
Eleonore Batteux, Eamonn Ferguson, Richard J Tunney
There is growing evidence that decisions made on behalf of other people differ from the decisions we make for ourselves because we are less affected by the subjective experience of their outcome. As a result, the decisions we make for other people can be more optimal. This experiment investigated surrogate decision making using a probability discounting task where participants made choices between risky and sure options. Psychological distance between the decision maker and the recipient was manipulated by having participants make decisions for themselves, their friend, and another unknown participant...
July 2017: Experimental Psychology
https://www.readbyqxmd.com/read/28904482/mathematics-of-ventilator-induced-lung-injury
#15
REVIEW
Ubaidur Rahaman
Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28892669/development-of-a-prediction-model-for-long-term-quality-of-life-in-critically-ill-patients
#16
Sandra Oeyen, Karel Vermeulen, Dominique Benoit, Lieven Annemans, Johan Decruyenaere
PURPOSE: We developed a prediction model for quality of life (QOL) 1 year after intensive care unit (ICU) discharge based upon data available at the first ICU day to improve decision-making. METHODS: The database of a 1-year prospective study concerning long-term outcome and QOL (assessed by EuroQol-5D) in critically ill adult patients consecutively admitted to the ICU of a university hospital was used. Cases with missing data were excluded. Utility indices at baseline (UIb) and at 1 year (UI1y) were surrogates for QOL...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28865869/homing-in-on-the-social-systems-level-influences-on-overly-aggressive-treatments-at-the-end-of-life
#17
Elizabeth Dzeng, Daniel Dohan, J Randall Curtis, Thomas J Smith, Alessandra Colaianni, Christine Ritchie
CONTEXT: The American medical system is programmed to a default setting of aggressive care for the terminally ill. Institutional norms of decision-making have been shown to promote high intensity care, regardless of consistency with patient preferences. There are myriad factors at a system, clinician, surrogate, and patient level that drive the culture of overly aggressive treatments in American hospitals. OBJECTIVE: To understand physician perspective of the ways systems-level factors influence patient, physician, and surrogate perceptions and consequent behavior...
August 30, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28857480/principles-for-ethical-treatment-decision-making-in-veterinary-oncology
#18
REVIEW
C Rohrer Bley
Many owners of companion animals with cancer are overwhelmed by having to choose the "right course of action." With the aim of reducing the burden on owners who are forced to act as surrogates for their animals, this work discusses principles that apply to ethical treatment decision-making for animal patients with cancer. Four principles frequently used for ethical decision-making in human medicine will be considered for their potential applicability in veterinary medicine. As a result of these considerations, preliminary guidelines are presented, along which a decision-making discussion can be held...
August 31, 2017: Veterinary and Comparative Oncology
https://www.readbyqxmd.com/read/28840485/how-surrogates-decide-a-secondary-data-analysis-of-decision-making-principles-used-by-the-surrogates-of-hospitalized-older-adults
#19
Rohit Devnani, James E Slaven, Gabriel T Bosslet, Kianna Montz, Lev Inger, Emily S Burke, Alexia M Torke
BACKGROUND: Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions should focus on a patient's preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients. OBJECTIVES: We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so...
August 24, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28813240/when-does-therapeutic-misconception-affect-surrogates-or-subjects-decision-making-about-whether-to-participate-in-dementia-research
#20
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
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