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End of life communication

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https://www.readbyqxmd.com/read/29345092/-known-unknowns-examining-the-burden-of-neurocognitive-impairment-in-the-end-stage-renal-failure-population
#1
REVIEW
Scott Wilson, Arup Dhar, Peter Tregaskis, Gavin Lambert, David Barton, Rowan Walker
The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains which are associated with hospitalisation, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggests that dialysis patients manifest NCI at rates 3-5 fold higher than the general population with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates...
January 18, 2018: Nephrology
https://www.readbyqxmd.com/read/29344747/healthcare-based-on-cloud-electrocardiogram-system-a-medical-center-experience-in-middle-taiwan
#2
Xiu-Shu Zhang, Fang-Yie Leu, Ching-Wen Yang, Lai-Shiun Lai
Electrocardiogram (ECG) as one of the best methods to measure irregular heartbeats is a dispensable method for doctor to diagnose Acute Myocardial Infarction (AMI) patients. Most medical centers in Taiwan implement the reduction of Door to Balloon (D2B) time, which is defined as the time interval starting when an Acute-Myocardial-Infarction patient arrives at the Emergency Department, and ending when a catheter guide wire crosses the culprit lesion as the acute-myocardial-infarction treatment on the patient in the cardiac catheterization room...
January 17, 2018: Journal of Medical Systems
https://www.readbyqxmd.com/read/29343169/patients-and-carers-perspectives-of-palliative-care-in-general-practice-a-systematic-review-with-narrative-synthesis
#3
Emilie Green, Selena Knight, Merryn Gott, Stephen Barclay, Patrick White
BACKGROUND: General practitioners have overall responsibility for community care, including towards end of life. Current policy places generalists at the centre of palliative care provision. However, little is known about how patients and carers understand the general practitioner's role. AIMS: To explore patient and carer perspectives of (1) the role of the general practitioner in providing palliative care to adult patients and (2) the facilitators and barriers to the general practitioner's capacity to fulfil this perceived role...
January 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29341962/withdrawal-of-life-sustaining-therapy
#4
Barbara G Jericho
PURPOSE OF REVIEW: The aim of this review is to examine literature relating to the withdrawal of life-sustaining therapy (WLST). RECENT FINDINGS: Discussions regarding end-of-life issues in adults and children are not occurring comprehensively. Discussions relating to the WLST in the pediatric population varies by institution and may vary by race, age, health insurance, diagnosis, and severity of illness. Completing advance directives prior to placement of life-sustaining treatments is not consistent practice...
January 15, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29327799/what-is-needed-to-prepare-speech-pathologists-to-work-in-adult-palliative-care
#5
Ashleigh Pascoe, Lauren J Breen, Naomi Cocks
BACKGROUND: Speech pathologists have a pivotal role in palliative care, assisting patients with swallowing and communication disorders, yet very little is known about the preparedness of speech pathologists to work in this field. AIMS: To investigate the preparedness of speech pathologists for working in palliative care. The term 'palliative care' was viewed as an encompassing umbrella term incorporating the management/reduction of symptoms and improvement in a person's quality of life at any point of the disease progression...
January 12, 2018: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/29325474/visual-representation-of-medical-information-the-importance-of-considering-the-end-user-in-the-design-of-medical-illustrations
#6
Emma Scheltema, Stephen Reay, Greg Piper
This practice led research project explored visual representation through illustrations designed to communicate often complex medical information for different users within Auckland City Hospital, New Zealand. Media and tools were manipulated to affect varying degrees of naturalism or abstraction from reality in the creation of illustrations for a variety of real-life clinical projects, and user feedback on illustration preference gathered from both medical professionals and patients. While all users preferred the most realistic representations of medical information from the illustrations presented, patients often favoured illustrations that depicted a greater amount of information than professionals suggested was necessary...
January 12, 2018: Journal of Visual Communication in Medicine
https://www.readbyqxmd.com/read/29314264/a-practical-guide-for-the-care-of-patients-with-end-stage-renal-disease-near-the-end-of-life
#7
Amar D Bansal, Jane O Schell
Most patients who rely on dialysis for treatment of end-stage renal disease (ESRD) never receive a kidney transplant. Therefore, it is important for nephrology providers to feel comfortable discussing the role of dialysis near the end of life (EOL). Advance care planning (ACP) is an ongoing process of learning patient values and goals in an effort to outline preferences for current and future care. This review presents a framework for how to incorporate ACP in the care of dialysis patients throughout the kidney disease course and at the EOL...
January 3, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29313774/communicating-with-pediatric-families-at-end-of-life-is-not-a-fantasy
#8
Connie M Ulrich, Kim Mooney-Doyle, Christine Grady
No abstract text is available yet for this article.
January 2018: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/29311368/education-research-difficult-conversations-in-neurology-lessons-learned-from-medical-students
#9
Monica E Lemmon, Charlene Gamaldo, Rachel Marie E Salas, Ankita Saxena, Tiana E Cruz, Renee D Boss, Roy E Strowd
OBJECTIVE: To characterize features of medical student exposure to difficult conversations during a neurology core clerkship. METHODS: This was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient-clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care...
January 9, 2018: Neurology
https://www.readbyqxmd.com/read/29307363/brain-metastasis-clinical-manifestations-symptom-management-and-palliative-care
#10
Thomas Noh, Tobias Walbert
Patients who have brain metastases can suffer from a medley of symptoms, including headaches, seizures, cognitive impairment, fatigue, and focal deficits. As therapies have evolved, so has the management of these symptoms as patients survive longer. This chapter focuses on the clinical presentation of brain metastases, the treatment of those symptoms, and palliation in end-of-life management. Brain metastases are the most common cerebral malignancy. They can present with various symptoms, which can have significant impact on patients' quality of life throughout the course of their disease...
2018: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29306523/palliative-and-end-of-life-care-for-lesbian-gay-bisexual-and-transgender-lgbt-cancer-patients-and-their-caregivers
#11
REVIEW
Kristin G Cloyes, William Hull, Andra Davis
OBJECTIVE: To identify the unique needs of lesbian, gay, bisexual, and transgender (LGBT) cancer patients and caregivers, and review recommendations supporting more effective and inclusive palliative and end-of-life care. DATA SOURCES: Published research and clinical guidelines. CONCLUSION: Transitions in care raise particular challenges for LGBT patients, including provider communication, perceptions of safety and acceptance, and assessing and respecting patients' definitions of family and spirituality...
January 3, 2018: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/29305500/euthanasia-and-palliative-sedation-in-belgium
#12
Raphael Cohen-Almagor, E Wesley Ely
The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia...
January 4, 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29301524/what-does-complex-mean-in-palliative-care-triangulating-qualitative-findings-from-3-settings
#13
Emma Carduff, Sarah Johnston, Catherine Winstanley, Jamie Morrish, Scott A Murray, Juliet Spiller, Anne Finucane
BACKGROUND: Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. METHODS: Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings...
January 4, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29297900/-talking-about-unspeakable-insights-from-patient-centered-medicine-to-palliative-paternalism
#14
Silvia Maria Luisa Del Negro, Lidia Borghi, Daris Ferrari, Elena Vegni
The literature highlights the importance of involving the patient as a partner of care, using a patient-centered approach aimed at improving a process of share decision-making. However, there are clinical situations in which a shared decision-making process is difficult and its actual achievement is even more complex, as in the case of end-of-life decisions, in which a decision about death is a tremendous weight for both patients and their caregivers. In such situations, we wonder what kind of position physicians should assume in order to be patient-centered but also to reduce the patient suffering...
December 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29290525/-some-were-certainly-better-than-others-bereaved-parents-judgements-of-healthcare-providers-in-the-paediatric-intensive-care-unit-a-grounded-theory-study
#15
Ashleigh E Butler, Beverley Copnell, Helen Hall
OBJECTIVE: To explore bereaved parents' judgements of healthcare providers, as part of a larger study examining their perceptions of the death of a child in the paediatric intensive care unit. RESEARCH METHODOLOGY: Constructivist grounded theory. SETTING: Four Australian paediatric intensive care units. MAIN OUTCOME MEASURES: Semi-structured, audio recorded interviews were undertaken with 26 bereaved parents 6-48 months after their child's death...
December 29, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29290330/affective-science-and-avoidant-end-of-life-communication-can-the-science-of-emotion-help-physicians-talk-with-their-patients-about-the-end-of-life
#16
Jesse A Soodalter, Greg J Siegle, Michele Klein-Fedyshin, Robert Arnold, Yael Schenker
Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure...
December 11, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/29288287/a-contemporary-paradigm-integrating-spirituality-in-advance-care-planning
#17
Katie Lutz, Stefan R Rowniak, Prabjot Sandhu
In the 25 years since advance care planning first drew the attention of the national healthcare and legal systems, gains in the rate of advance care directive completion have been negligible despite the effort of researchers, ethicists, and lawmakers. With the benefit of sophisticated healthcare technology, patients are living longer. Despite the benefits of increased longevity, it is widely acknowledged that enough has not been done to adequately address end-of-life care decisions at the crossroads between medical futility and quality of life...
December 29, 2017: Journal of Religion and Health
https://www.readbyqxmd.com/read/29284551/family-care-conferences-in-long-term-care-exploring-content-and-processes-in-end-of-life-communication
#18
Pamela Durepos, Sharon Kaasalainen, Tamara Sussman, Deborah Parker, Kevin Brazil, Susan Mintzberg, Alyssa Te
OBJECTIVE: End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada...
December 29, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29283871/resources-for-educating-training-and-mentoring-all-physicians-providing-palliative-care
#19
James Downar
This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care...
January 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29283870/resources-for-educating-training-and-mentoring-nurses-and-unregulated-nursing-care-providers-in-palliative-care-a-review-and-expert-consultation
#20
Barbara Pesut, Madeleine Greig
BACKGROUND: Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE: To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care providers who care for Canadians experiencing life-limiting illness and their families. METHODS: This is a systematic search and narrative review in the Canadian context...
January 2018: Journal of Palliative Medicine
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