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https://www.readbyqxmd.com/read/28979824/when-the-opioid-medications-go-missing-confidentiality-and-safety-in-adolescents
#1
Muhammad Hassan Majeed
Patients receiving end-of-life or palliative care usually possess an ample supply of opioid pain medications to help alleviate their pain. The risk of these drugs being diverted is high because such patients often have an excess of these medications, and because they are typically unable to manage medications themselves. For example, adolescents might steal these medications for recreational use. The author presents a case in which a minor admitted stealing and using opioid pain medication belonging to her mother, who was in hospice home care...
May 2017: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/28975473/why-are-there-so-few-ethics-consults-in-children-s-hospitals
#2
Brian Carter, Manuel Brockman, Jeremy Garrett, Angie Knackstedt, John Lantos
In most children's hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians about clinical dilemmas...
October 3, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28975242/ethics-and-the-legalization-of-physician-assisted-suicide-an-american-college-of-physicians-position-paper
#3
Lois Snyder Sulmasy, Paul S Mueller
Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end...
September 19, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28957338/-i-think-my-body-has-become-addicted-to-those-tablets-chronic-heart-failure-patients-understanding-of-and-beliefs-about-their-illness-and-its-treatment-a-qualitative-longitudinal-study-from-uganda
#4
Elizabeth Namukwaya, Scott A Murray, Julia Downing, Mhoira Leng, Liz Grant
BACKGROUND: Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services...
2017: PloS One
https://www.readbyqxmd.com/read/28955296/spinocerebellar-ataxia-type-2-clinicogenetic-aspects-mechanistic-insights-and-management-approaches
#5
REVIEW
Luis C Velázquez-Pérez, Roberto Rodríguez-Labrada, Juan Fernandez-Ruiz
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant cerebellar ataxia that occurs as a consequence of abnormal CAG expansions in the ATXN2 gene. Progressive clinical features result from the neurodegeneration of cerebellum and extra-cerebellar structures including the pons, the basal ganglia, and the cerebral cortex. Clinical, electrophysiological, and imaging approaches have been used to characterize the natural history of the disease, allowing its classification into four distinct stages, with special emphasis on the prodromal stage, which is characterized by a plethora of motor and non-motor features...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28928181/development-of-core-outcome-sets-for-effectiveness-trials-of-interventions-to-prevent-and-or-treat-delirium-del-cors-study-protocol
#6
Louise Rose, Meera Agar, Lisa D Burry, Noll Campbell, Mike Clarke, Jacques Lee, Najma Siddiqi, Valerie J Page
INTRODUCTION: Delirium is a common, serious and potentially preventable condition with devastating impact on the quality of life prompting a proliferation of interventional trials. Core outcome sets aim to standardise outcome reporting by identifying outcomes perceived fundamental for measurement in trials of a specific interest area. Our aim is to develop international consensus on two core outcome sets for trials of interventions to prevent and/or treat delirium, irrespective of study population...
September 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28918428/modification-of-cardiovascular-pharmacotherapy-in-palliative-care-patients-with-cancer-narrative-review
#7
Tomasz Pasierski
Palliative care cancer patients are treated with many drugs especially at the end of life. Limiting of polypharmacy a decreases the risk of associated adverse effects, medical errors and harmful drug interactions The time lag to benefit of many medications used for cardiovascular diseases or risk factors like hypertension, hypercholesterolemia is frequently longer than palliative care cancer patient's life expectancy. It is ethically appropriate to modify, even to discontinue cardiovascular pharmacotherapy when there is no prospect of benefit...
September 13, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28916237/ethics-and-palliative-care-in-the-perinatal-world
#8
REVIEW
Colleen M Marty, Brian S Carter
The perinatal world is unique in its dutiful consideration of two patients along the lines of decision-making and clinical management - the fetus and the pregnant woman. The potentiality of the fetus-newborn is intertwined with the absolute considerations for the woman as autonomous patient. From prenatal diagnostics, which may be quite extensive, to potential interventions prenatally, postnatal resuscitation, and neonatal management, the fetus and newborn may be anticipated to survive with or without special needs and technology, to have a questionable or guarded prognosis, or to live only minutes to hours...
September 13, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28910224/an-ethical-analysis-of-euthanasia-and-physician-assisted-suicide-rejecting-euthanasia-and-accepting-physician-assisted-suicide-with-palliative-care
#9
Benjamin Shibata
No abstract text is available yet for this article.
January 2017: Journal of Legal Medicine
https://www.readbyqxmd.com/read/28905726/compassionate-release-policy-reform-physicians-as-advocates-for-human-dignity
#10
Andreas Mitchell, Brie Williams
A rapidly aging correctional population has led to an increasing number of patients with serious progressive and terminal illnesses in correctional settings. "Compassionate release" describes a range of policies offering early release or parole to incarcerated patients with serious or debilitating illnesses. However, in many states that have compassionate release policies, few patients are actually granted release. We describe how the continued incarceration of patients with serious or debilitating illness can constitute a violation of human dignity if appropriate palliative care is unavailable...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28904010/vitamin-d-supplementation-to-palliative-cancer-patients-protocol-of-a-double-blind-randomised-controlled-trial-palliative-d
#11
Maria Helde-Frankling, Jenny Bergqvist, Caritha Klasson, Marie Nordström, Jonas Höijer, Peter Bergman, Linda Björkhem-Bergman
BACKGROUND: According to a small pilot study on palliative cancer patients at our ward, vitamin D supplementation had beneficial effects on pain (measured as opioid consumption), infections and quality of life (QoL) without having any significant side effects. OBJECTIVE: The primary objective of the 'Palliative-D' study is to test the hypothesis that vitamin D supplementation for 12 weeks reduces opioid consumption. The secondary objectives are to study if reduction of antibiotic consumption and fatigue as well as improvement in QoL assessments can be observed...
September 13, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28864693/ablation-with-irreversible-electroporation-in-patients-with-advanced-perihilar-cholangiocarcinoma-alpaca-a-multicentre-phase-i-ii-feasibility-study-protocol
#12
Robert J S Coelen, Jantien A Vogel, Laurien G P H Vroomen, Eva Roos, Olivier R C Busch, Otto M van Delden, Foke van Delft, Michal Heger, Jeanin E van Hooft, Geert Kazemier, Heinz-Josef Klümpen, Krijn P van Lienden, Erik A J Rauws, Hester J Scheffer, Henk M Verheul, Jan de Vries, Johanna W Wilmink, Barbara M Zonderhuis, Marc G Besselink, Thomas M van Gulik, Martijn R Meijerink
INTRODUCTION: The majority of patients with perihilar cholangiocarcinoma (PHC) has locally advanced disease or distant lymph node metastases on presentation or exploratory laparotomy, which makes them not eligible for resection. As the prognosis of patients with locally advanced PHC or lymph node metastases in the palliative setting is significantly better compared with patients with organ metastases, ablative therapies may be beneficial. Unfortunately, current ablative options are limited...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28859792/how-medicine-has-changed-the-end-of-life-for-patients-with-cardiovascular-disease
#13
REVIEW
Haider J Warraich, Adrian F Hernandez, Larry A Allen
Advances in medicine have changed how patients experience the end of life. With longer life spans, there has also been an increase in years lived with disability. The clustering of illnesses in the last years of life is particularly pronounced in patients with cardiovascular disease. At the end of life, patients with cardiovascular disease are more symptomatic, less likely to die at home, and less likely to receive high-quality palliative care. Social determinants have created widening disparities in end-of-life care...
September 5, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28854050/forensic-nursing-and-the-palliative-approach-to-care-an-empirical-nursing-ethics-analysis
#14
David Kenneth Wright, Brandi Vanderspank-Wright, Dave Holmes, Elise Skinner
BACKGROUND: A movement is underway to promote a palliative approach to care in all contexts where people age and live with life-limiting conditions, including psychiatric settings. Forensic psychiatry nursing-a subfield of mental health nursing- focuses on individuals who are in conflict with the criminal justice system. We know little about the values of nurses working in forensic psychiatry, and how these values might influence a palliative approach to care for frail and aging patients...
August 2, 2017: International Journal of Palliative Nursing
https://www.readbyqxmd.com/read/28835736/health-care-professionals-experiences-and-needs-when-delivering-end-of-life-care-to-children-a-qualitative-study
#15
Eva Bergsträsser, Eva Cignacco, Patricia Luck
Pediatric end-of-life care (EOL care) entails challenging tasks for health care professionals (HCPs). Little is known about HCPs' experiences and needs when providing pediatric EOL care in Switzerland. This study aimed to describe the experiences and needs of HCPs in pediatric EOL care in Switzerland and to develop recommendations for the health ministry. The key aspect in EOL care provision was identified as the capacity to establish a relationship with the dying child and the family. Barriers to this interaction were ethical dilemmas, problems in collaboration with the interprofessional team, and structural problems on the level of organizations...
2017: Palliative Care
https://www.readbyqxmd.com/read/28827943/the-philosophical-and-cultural-situatedness-of-spirituality-at-the-end-of-life-in-india
#16
Hamilton Inbadas
The sustained interest in exploring the spiritual domain at end of life in the Indian context reflects the recognition of its significance as an integral part of palliative care. A key aspect of findings from studies so far is the identification of challenges, inadequacies, limitations and ethical dilemmas in relation to spirituality at the end of life. India is known for its rich spiritual heritage and has unique ways of understanding, experiencing and expressing spirituality. The philosophical and cultural frames of reference, with which communities in India make sense of life, death and dying, determine the characteristics of Indian spirituality at the end of life...
July 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28827063/beyond-simple-planning-existential-dimensions-of-conversations-with-patients-at-risk-of-dying-from-heart-failure
#17
Valerie Schulz, Allison Crombeen, Denise Marshall, Joshua Shadd, Kori LaDonna, Lorelei Lingard
INTRODUCTION: Despite the recent promotion of communication guides to improve decision-making with patients nearing the end of their lives, these conversations remain challenging. Deeper and more comprehensive understanding of communication barriers that undermine discussions and decisions with patients at risk of dying from heart failure (HF) are vital for informing communication in healthcare. OBJECTIVES: To explore experiences and perspectives of patients with advanced HF, their caregivers and providers, regarding conversations for patients at risk of dying from HF...
August 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28818633/patient-and-caregiver-reported-assessment-tools-for-palliative-care-summary-of-the-2017-ahrq-technical-brief
#18
Rebecca Aslakson, Sydney M Dy, Renee F Wilson, Julie Waldfogel, Allen Zhang, Sarina R Isenberg, Alex Blair, Joshua Sixon, Karen A Robinson
CONTEXT: Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. OBJECTIVES: To (1) summarize palliative care assessment tools completed by or with patients or caregivers, and (2) identify needs for future tool development and evaluation. METHODS: We completed: (1) a systematic review of systematic reviews; (2) a supplemental search of previous reviews and websites, and/or (3) a targeted search for primary articles when no tools existed in a domain...
August 14, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28807699/communication-challenges-of-oncologists-and-intensivists-caring-for-pediatric-oncology-patients-a-qualitative-study
#19
Folasade Odeniyi, Pamela G Nathanson, Theodore E Schall, Jennifer K Walter
CONTEXT: The families of oncology patients requiring intensive care often face increasing complexity in communication with their providers, particularly when patients are cared for by providers from different disciplines. OBJECTIVE: To describe experiences and challenges faced by pediatric oncologists and intensivists and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions (GCDs). METHODS: We conducted semi-structured interviews with a convenience sample of ten physicians, including pediatric oncology and intensive care attendings and fellows...
August 11, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28795404/palliative-drug-treatments-for-breathlessness-in-cystic-fibrosis
#20
REVIEW
Nishant Jaiswal, Meenu Singh, Amit Agarwal, Kiran K Thumburu
BACKGROUND: Cystic fibrosis is a life-limiting autosomal recessive genetic illness. A feeling of shortness of breath is common in cystic fibrosis, especially as the disease progresses. Reversing the underlying cause is the priority when treating breathlessness (dyspnoea), but when it is not feasible, palliation (easing) becomes the primary goal to improve an individual's quality of life. A range of drugs administered by various routes have been used, but no definite guidelines are available...
August 10, 2017: Cochrane Database of Systematic Reviews
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