surrogate decision making

CONTEXT: Despite making do-not-resuscitate or comfort care decisions during advance care planning, terminally ill patients sometimes receive life-sustaining treatments as they approach end of life. OBJECTIVES: To examine factors contributing to non-concordance between end-of-life care and advance care planning. METHODS: In this longitudinal retrospective cohort study, terminally ill patients with a life expectancy shorter than six months, who had previously expressed a preference for do-not-resuscitate or comfort care, were followed up after palliative shared care intervention...

CONTEXT: Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress. OBJECTIVES: The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates. METHODS: Surrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals...

OBJECTIVE: For nursing home residents with severe dementia, high-intensity medical treatment offers little possibility of benefit but has the potential to cause significant distress. Nevertheless, mechanical ventilation and intensive care unit (ICU) transfers have increased in this population. We sought to understand how and why such care is occurring. DESIGN: Mixed methods study, with retrospective collection of qualitative and quantitative data. SETTING: Department of Veterans Affairs (VA) hospitals...

Merging areas serve as the potential bottlenecks for continuous traffic flow on freeways. Traffic incidents in freeway merging areas are closely related to decision-making errors of human drivers, for which the autonomous vehicles (AVs) technologies are expected to help enhance the safety performance. However, evaluating the safety impact of AVs is challenging in practice due to the lack of real-world driving and incident data. Despite the increasing number of simulation-based AV studies, most relied on single traffic/vehicle driving simulators, which exhibit limitations such as inaccurate description of AV behavior using pre-defined driving models, limited testing modules, and a lack of high-fidelity traffic scenarios...

The law 219/2017 is the first Italian law about advanced care planning (ACP). ACP is an important part of the therapeutic relationship between patients and doctors: thanks to ACP patients can think and discuss about end of life decisions, considering clinical aspects, but also psychological, cultural, social and ethical issues. Patients prepare themselves in advance because of the possibility of future cognitive impairment, can identify a surrogate decision maker and make end-life decisions according to their goals and values...

INTRODUCTION: Brain metastases commonly occur in patients with non-small cell lung cancer (NSCLC). Standard first-line treatment for NSCLC, without an EGFR, ALK or ROS1 mutation, is either chemoimmunotherapy or anti-PD-1 monotherapy. Traditionally, patients with symptomatic or untreated brain metastases were excluded from the pivotal clinical trials that established first-line treatment recommendations. The intracranial effectiveness of these treatment protocols has only recently been elucidated in small-scale prospective trials...

Shared decision-making (SDM) is the standard of care for patient or surrogates and their clinicians to arrive at a medical decision. Evidence suggests that SDM increases patients' understanding of their illness and satisfaction with their decision-making process. Dialysis patients often report the perception that they were passive participants in the decision to start dialysis, suggesting further opportunities for enhancing the application of SDM in decision-making with patients with kidney disease. The hallmark feature of SDM is sensitive, culturally- and equity-informed communication and effective partnership between patient or surrogate and clinician...

Horses undergoing abdominal exploratory surgery are at risk of hypotension and hypoperfusion. Normal mean arterial pressure is used as a surrogate for adequate tissue perfusion. However, measures of systemic circulation may not be reflective of microcirculation. This study measured the mean arterial pressure, cardiac index, lactate, and four microcirculatory indices in six healthy, anesthetized adult horses undergoing elective laparotomies. The microcirculatory parameters were measured at three different sites along the gastrointestinal tract (oral mucosa, colonic serosa, and rectal mucosa) with dark-field microscopy...

BACKGROUND: Enrollment into critical care clinical trials is often hampered by the need to rely on surrogate decision-makers. To identify potential interventions facilitating enrollment into critical care clinical trials, a better understanding of surrogate decision-making for critical care clinical trial enrollment is needed. RESEARCH QUESTION: What are the barriers and facilitators of critical care trial enrollment? What are surrogate decision-makers' perspectives on proposed interventions to facilitate trial enrollment? STUDY DESIGN AND METHODS: We conducted semistructured interviews with 20 surrogate decision-makers of critically ill patients receiving mechanical ventilation...

Clinical conversations surrounding the continuation or limitation of life-sustaining treatments (LLST) are both challenging and tragically necessary for patients with Disorders of Consciousness (DoC) following severe brain injury. Divergent cultural, philosophical, and religious perspectives contribute to vast heterogeneity in clinical approaches to LLST - as reflected in regional differences and inter-clinician variability. Here we provide an ethical analysis of factors that inform LLST decisions among patients with DoC...

When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better-informed decisions has led to the development of dementia-specific advance directives, in which people are given tools to help them communicate what their preferences are while they are still able...

Canalicular-like pleomorphic adenomas are a relatively recently described entity, that possess features of both canalicular adenomas and pleomorphic adenomas. The presence of unusual HMGA2 -fusion partners (most commonly HMGA2::WIF1 gene fusions) has established canalicular-like pleomorphic adenoma as a distinct entity. The use of intraoperative frozen section analysis and surrogate HMGA2 IHC are 2 tools that can provide the surgical team with valuable insight into intraoperative decision making and final classification of rare tumors of the parotid gland, respectively...

HER2/ERBB2 evaluation is necessary for treatment decision-making in breast cancer (BC), however current methods have limitations and considerable variability exists. DNA copy number (CN) evaluation by droplet digital PCR (ddPCR) has complementary advantages for HER2/ERBB2 diagnostics. In this study, we developed a single-reaction multiplex ddPCR assay for determination of ERBB2 CN in reference to two control regions, CEP17 and a copy-number-stable region of chr. 2p13.1, validated CN estimations to clinical in situ hybridization (ISH) HER2 status, and investigated the association of ERBB2 CN with clinical outcomes...

Stroke is a major cause of death and lifelong disability. Although stroke treatments have improved, many patients are left with life-changing deficits. Shared decision making and consent are fundamental to good medical practice. This is challenging because stroke often causes mental incapacity, prior views might not be known and prognosis early after stroke is often uncertain. There are no large trials of shared decision making after severe stroke, so we need to rely on observational data to inform practice...

Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making. We conducted a nationally representative experimental survey that cross-randomized cognitive impairment, gender, and characteristics of advance care planning among hospitalized older adults through a series of vignettes. Our study yielded three main findings: first, respondents were much less likely to recommend life-sustaining treatments for patients with dementia, especially after personal exposure...

CONTEXT: Reliable and valid measures are critical in accurately assessing outcomes of advance care planning interventions (ACP) for end-of-life (EOL) decision-making. OBJECTIVES: To develop measures of preparedness for EOL decision-making for patients with end-stage renal disease and their surrogates (an exemplar population) METHODS: In this 3-phase study, Phases 1 and 2 included a cross-discipline concept analysis of the preparedness construct, item generation for patient and surrogate scales (82 items), evaluation of content validity and readability, cognitive interviewing, and item reduction...

BACKGROUND: In the intensive care unit (ICU) relatives play a crucial role as surrogate decision-makers, since most patients cannot communicate due to their illness and treatment. Their level of involvement in decision-making can affect their psychological well-being. During the COVID-19 pandemic, relatives' involvement probably changed. We aim to investigate relatives' involvement in decision-making in the ICU before and during the pandemic and their experiences and preferences in this regard...

Nutrient runoff into rivers caused by human activity has led to global eutrophication issues. The Nakdong River in South Korea is currently facing significant challenges related to eutrophication and harmful algal blooms, underscoring the critical importance of managing total nitrogen (T-N) levels. However, traditional indoor analysis methods that rely on sampling are labor-intensive and present high-frequency data collection limitations. Despite sensor advancements that have enabled the measurement of various parameters, sensors still cannot directly measure T-N, which necessitates surrogate regression methods...

BACKGROUND: Transmission Assessment Survey (TAS) is the WHO recommended method used for decision-making to stop or continue the MDA in lymphatic filariasis (LF) elimination programme. The WHO has also recommended Molecular Xenomonitoring (MX) of LF infection in vectors as an adjunct tool in settings under post-MDA or validation period. Screening of non-vectors by MX in post-MDA / validation settings could be useful to prevent a resurgence of LF infection, as there might be low abundance of vectors, especially in some seasons...

When we recognize images with the help of Artificial Neural Networks (ANNs), we often wonder how they make decisions. A widely accepted solution is to point out local features as decisive evidence. A question then arises: Can local features in the latent space of an ANN explain the model output to some extent? In this work, we propose a modularized framework named MemeNet that can construct a reliable surrogate from a Convolutional Neural Network (CNN) without changing its perception. Inspired by the idea of time series classification, this framework recognizes images in two steps...