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https://www.readbyqxmd.com/read/29911623/characterization-of-complex-chronic-pain-patients
#1
E-B Hysing, T Gordh, R Karlsten, L Smith
Aims Treatment of the most complex chronic pain patients, often not accepted in regular pain management programs, remains a challenge.To beable todesign interventions for these patients we must know what characterize them. The aim of this study was to characterize a subgroup of pain patients, treated in our in-patient rehabilitation programme, organized at the University Hospital in Uppsala, the only tertiary treatment for pain patients in Sweden. Methods The study was approved by the Regional Ethical Review Board in Uppsala (Dnr 2010/182)...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29907553/development-and-evaluation-of-an-ethical-guideline-for-decisions-to-limit-life-prolonging-treatment-in-advanced-cancer-protocol-for-a-monocentric-mixed-method-interventional-study
#2
Katsiaryna Laryionava, Katja Mehlis, Elena Bierwirth, Friederike Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C Winkler
BACKGROUND: Many patients with advanced cancer receive chemotherapy close to death and are referred too late to palliative or hospice care, and therefore die under therapy or in intensive care units. Oncologists still have difficulties in involving patients appropriately in decisions about limiting tumor-specific or life-prolonging treatment. OBJECTIVE: The aim of this Ethics Policy for Advanced Care Planning and Limiting Treatment Study is to develop an ethical guideline for end-of-life decisions and to evaluate the impact of this guideline on clinical practice regarding the following target goals: reduction of decisional conflicts, improvement of documentation transparency and traceability, reduction of distress of the caregiver team, and better knowledge and consideration of patients' preferences...
June 15, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29871680/leadership-in-palliative-medicine-moral-ethical-and-educational
#3
Nathan Emmerich
BACKGROUND: Making particular use of Shale's analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine's distinctive morality or ethos, albeit one that should still be seen in terms of medical morality or the ethos of medicine...
June 5, 2018: BMC Medical Ethics
https://www.readbyqxmd.com/read/29843493/surrogate-decision-making-of-chemotherapy-consent-do-we-really-provide-informed-consent-of-chemotherapy-for-patients
#4
Jung Hye Kwon, Sun Kyung Baek, Bong-Seog Kim, Su-Jin Koh, Hee Kyung Ahn, Joo Han Lim, Chiyeon Lim, Do Yeun Kim
Background/Aims: Despite increased demand for cancer patient's to make their own decisions based on an adequate understanding of what is involved in chemotherapy, the primary signing agent and the reasons for surrogate signing have not been appropriately evaluated. Methods: The ethics committee of the palliative medicine subgroup of the Korean Cancer Study Group designed this study and solid cancer patients to whom chemotherapy was offered, from seven institutions, were evaluated...
May 31, 2018: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29807491/palliative-care-nursing-involvement-in-end-of-life-decision-making-qualitative-secondary-analysis
#5
Pablo Hernández-Marrero, Emília Fradique, Sandra Martins Pereira
BACKGROUND: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. OBJECTIVES: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices...
January 1, 2018: Nursing Ethics
https://www.readbyqxmd.com/read/29783851/the-death-debate-penumbra-conundrum
#6
Robert F Johnson
Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE)...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29776973/challenges-in-end-of-life-dementia-care
#7
REVIEW
Anne A Fetherston, Grace Rowley, Charlotte L Allan
Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild-moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals' prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection...
May 18, 2018: Evidence-based Mental Health
https://www.readbyqxmd.com/read/29776669/-the-role-of-end-of-life-palliative-sedation-medical-and-ethical-aspects-review
#8
REVIEW
Miriam S Menezes, Maria das Graças Mota da Cruz de Assis Figueiredo
BACKGROUND AND OBJECTIVE: Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the issue regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas...
May 15, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29768072/an-integrated-developmental-four-year-medical-school-curriculum-in-palliative-care-a-longitudinal-content-evaluation-based-on-national-competency-standards
#9
Erin M Denney-Koelsch, Robert Horowitz, Timothy Quill, Constance D Baldwin
BACKGROUND: While palliative care (PC) competencies for medical school graduates have been defined, the lack of established curriculum models and assessment tools hampers curricular evaluation. OBJECTIVE: To describe the scope and content of the University of Rochester's longitudinal, integrated four-year PC curriculum after 17 years of implementation, review student evaluative responses, and compare the curriculum to national competency standards. DESIGN AND SETTING: Combining and reorganizing a published PC curriculum assessment tool and a list of medical school PC competencies, we created a novel nine-topic framework to assess the content coverage of our curriculum...
May 16, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29767825/-palliative-sedation-development-and-consensus-of-a-german-language-documentation-template
#10
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29764891/developing-a-complex-intervention-to-support-timely-engagement-with-palliative-care-for-patients-with-advanced-cancer-in-primary-and-secondary-care-in-the-uk-a-study-protocol
#11
Julia Hackett, Hilary Bekker, Michael I Bennett, Paul Carder, Jean Gallagher, Claire Henry, Suzanne Kite, Sally Taylor, Galina Velikova, Lucy Ziegler
INTRODUCTION: For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29751362/low-prevalence-of-palliative-care-and-ethics-consultations-for-children-with-chronic-critical-illness
#12
Renee D Boss, Alison Falck, Naomi Goloff, Nancy Hutton, Alison Miles, Miriam Shapiro, Elliott M Weiss, Pamela K Donohue
Medical advances over the past two decades have increased the numbers of children who survive serious conditions. Mortality from premature birth and genetic syndromes has improved such that more clinicians offer, and more families request, interventions to prolong their child's life. While some interventions promise cure, others result in chronic disease states that require ongoing medical care. This article is protected by copyright. All rights reserved.
May 11, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29742044/end-of-life-decision-making-in-palliative-care-and-recommendations-of-the-council-of-europe-qualitative-secondary-analysis-of-interviews-and-observation-field-notes
#13
Sandra Martins Pereira, Emília Fradique, Pablo Hernández-Marrero
BACKGROUND: End-of-life decisions (ELDs) are embedded in clinical, sociocultural, political, economic, and ethical concerns. In 2014, the Council of Europe (CoE) through its Committee on Bioethics launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations," aiming at improving decision-making processes and empowering professionals in making ELDs. OBJECTIVE: To analyze if end-of-life decision making in palliative care (PC) is consistent with this Guide and to identify if disputed/controversial issues are part of current ELDs...
May 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29736869/muslim-physicians-and-palliative-care-attitudes-towards-the-use-of-palliative-sedation
#14
George Muishout, Hanneke W M van Laarhoven, Gerard Wiegers, Ulrike Popp-Baier
BACKGROUND: Muslim norms concerning palliative sedation can differ from secular and non-Muslim perceptions. Muslim physicians working in a Western environment are expected to administer palliative sedation when medically indicated. Therefore, they can experience tension between religious and medical norms. OBJECTIVE: To gain insight into the professional experiences of Muslim physicians with palliative sedation in terms of religious and professional norms. DESIGN: Interpretative phenomenological study using semi-structured interviews to take a closer look at the experiences of Muslim physicians with palliative sedation...
May 8, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29736119/professional-quality-of-life-among-professional-care-providers-at-cancer-palliative-care-centers-in-bengaluru-india
#15
Amanpreet Kaur, Mahendra P Sharma, Santosh K Chaturvedi
Context: Being a professional care provider at cancer palliative care settings is demanding and stressful. Literature has indicated the prevalence of high burnout (BO) and distress; however, there is a dearth of studies in India, with no study available on professional quality of life in the field of palliative care. Aims: The aim of the present study was to explore the professional quality of life, namely-compassion satisfaction [CS], burnout [BO], and secondary traumatic stress [STS] among professional care providers at cancer palliative care centers...
April 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29714995/issues-in-geriatric-care-medical-decision-making
#16
Jayesh Patel, Richard J Ackermann
Medical decision-making capacity (DMC), which is determined by clinicians, is the ability of patients to understand information about options for their care, express a choice among those options, appreciate the benefits and risks of those options, and explain the reasoning behind their particular choice. DMC differs from competence, which is a legal concept concerning the mental ability of individuals to be responsible for their decisions and actions. A variety of instruments can be used to assess DMC. If it is determined that a patient lacks DMC, clinicians have an ethical obligation to seek out a surrogate decision-maker...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29708014/the-difficulties-of-discharging-hospice-patients-to-care-homes-at-the-end-of-life-a-focus-group-study
#17
Tabitha Thomas, Gemma Clarke, Stephen Barclay
BACKGROUND: Discharge from inpatient palliative care units to long-term care can be challenging. In the United Kingdom, hospice inpatients move to a care home if they no longer require specialist palliative care and cannot be discharged home. There is evidence to suggest that patients and families find the prospect of such a move distressing. AIM: To investigate the issues that arise when patients are transferred from hospice to care home at the end of life, from the perspective of the hospice multidisciplinary team...
April 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29689298/-suffering-in-palliative-sedation-conceptual-analysis-and-implications-for-decision-making-in-clinical-practice
#18
Claudia Bozzaro, Jan Schildmann
Palliative sedation is an increasingly used and, simultaneously, challenging practice at the end of life. Many controversies associated with this therapy are rooted in implicit differences regarding the understanding of "suffering" as a prerequisite for palliative sedation. The aim of this study is to inform the current debates by a conceptual analysis of two different philosophical accounts of suffering-1) the subjective and holistic concept and 2) the objective and gradual concept-and by a clinical-ethical analysis of the implications of each account for decisions about palliative sedation...
April 22, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29669562/comfort-in-palliative-sedation-compas-a-transdisciplinary-mixed-method-study-protocol-for-linking-objective-assessments-to-subjective-experiences
#19
Stefaan Six, Steven Laureys, Jan Poelaert, Johan Bilsen, Peter Theuns, Reginald Deschepper
BACKGROUND: In case of untreatable suffering at the end of life, palliative sedation may be chosen to assure comfort by reducing the patient's level of consciousness. An important question here is whether such sedated patients are completely free of pain. Because these patients cannot communicate anymore, caregivers have to rely on observation to assess the patient's comfort. Recently however, more sophisticated techniques from the neurosciences have shown that sometimes consciousness and pain are undetectable with these traditional behavioral methods...
April 18, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29666139/last-year-of-life-study-cologne-lyol-c-protocol-for-a-cross-sectional-mixed-methods-study-to-examine-care-trajectories-and-transitions-in-the-last-year-of-life-until-death
#20
Julia Strupp, Gloria Hanke, Nicolas Schippel, Holger Pfaff, Ute Karbach, Christian Rietz, Raymond Voltz
INTRODUCTION: The last year of life constitutes a particularly vulnerable phase for patients, involving nearly all health and social care structures. Yet, little scientific evidence is available that provides insight into the trajectories including the number and types of care setting transitions, transitions into palliative care and the dying phase. Only few studies have focused on difficulties associated with having to move between health and social care settings in the last year of life, although patients face a significant risk of adverse events...
April 17, 2018: BMJ Open
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