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terminally ill patients

Russell Blackwelder
Aligning patient goals with treatment plans is an ongoing challenge in the current healthcare environment. Particularly in patients with multiple comorbidities and terminal illness, this planning is even more important. This poem, which tells the story of a dying patient, highlights the significance of prioritizing patient values and the teamwork it often takes to achieve patient goals. In this case, the patient's goal was to make it to his granddaughter's wedding and give a special toast at the reception. A team of healthcare professionals assembled and attempted to align our objectives with his, and this poem tells of that journey...
January 1, 2018: International Journal of Psychiatry in Medicine
Fur-Hsing Wen, Jen-Shi Chen, Wen-Chi Chou, Chia-Hsun Hsieh, Wen-Cheng Chang, Ming-Mo Hou, Siew Tzuh Tang
CONTEXT/OBJECTIVES: Our study addressed important knowledge gaps about trajectories of distinct conjoint symptom-functional states, i.e., patterns for different levels of combined symptom distress and functional impairment, over cancer patients' last year and their ability to predict survival. METHODS: We identified distinct symptom-functional states and explored their changes over 317 terminally ill cancer patients' last year by a transition model using hidden Markov modeling...
March 12, 2018: Journal of Pain and Symptom Management
Kristi Soileau, Nanette Elster
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care...
January 1, 2018: Journal of Palliative Care
Thomas R Egnew
Many clinicians may feel poorly prepared to manage patient suffering resulting from the travails of chronic illness. This essay explores the thesis that chronically and terminally ill patients can be holistically healed by transcending the suffering occasioned by the degradations of their illnesses. Suffering is conveyed as a story and clinicians can encourage healing by co-constructing patients' illness stories. By addressing the inevitable existential conflicts uncovered in patients' narratives and helping them edit their stories to promote acceptance and meaning, suffering can be transcended...
March 2018: Annals of Family Medicine
Anas Nooh, Krista Goulding, Marc H Isler, Sophie Mottard, Annie Arteau, Norbert Dion, Robert Turcotte
BACKGROUND: Bone metastases represent the most frequent cause of cancer-related pain, affecting health-related quality of life and creating a substantial burden on the healthcare system. Although most bony metastatic lesions can be managed nonoperatively, surgical management can help patients reduce severe pain, avoid impending fracture, and stabilize pathologic fractures. Studies have demonstrated functional improvement postoperatively as early as 6 weeks, but little data exist on the temporal progress of these improvements or on the changes in quality of life over time as a result of surgical intervention...
March 2018: Clinical Orthopaedics and related Research
Marianne Goudreault, Nago Humbert, France Gauvin, Monia Marzouki, Catherine K Beaumier, Dickens St-Vil, Nelson Piché
INTRODUCTION: Pediatric surgeons are often involved in the management of severely or terminally ill patients. However, articles addressing their specific roles in the context of palliative care are almost inexistent. We sought to characterize the involvement of pediatric surgeons caring for children near end of life. METHODS: Chart review of children who had a procedure under general anesthesia within 6months of their death over a five-year period at a tertiary children's hospital (excluding traumas and neonatology cases)...
February 9, 2018: Journal of Pediatric Surgery
Carole P Kaufmann, Dominik Stämpfli, Nadine Mory, Kurt E Hersberger, Markus L Lampert
INTRODUCTION: Identifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge. OBJECTIVE: To develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients' answers. DESIGN: Prospective validation study. SETTING: Two mid-sized hospitals (300-400 beds)...
March 9, 2018: BMJ Open
David E Leaf, Edward D Siew, Michele F Eisenga, Karandeep Singh, Finnian R Mc Causland, Anand Srivastava, T Alp Ikizler, Lorraine B Ware, Adit A Ginde, John A Kellum, Paul M Palevsky, Myles Wolf, Sushrut S Waikar
BACKGROUND AND OBJECTIVES: Dysregulated mineral metabolism is a common and potentially maladaptive feature of critical illness, especially in patients with AKI, but its association with death has not been comprehensively investigated. We sought to determine whether elevated plasma levels of the osteocyte-derived, vitamin D-regulating hormone, fibroblast growth factor 23 (FGF23), are prospectively associated with death in critically ill patients with AKI requiring RRT, and in a general cohort of critically ill patients with and without AKI...
March 8, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Vanessa Romotzky, Julia Strupp, Alexander Hayn, Jens Ulrich Rüffer, Judith Grümmer, Raymond Voltz
OBJECTIVE: We aimed to elucidate the views on life as narrated by patients in palliative care (PC) to find out what patients deem to be essential in their life, whether something has changed concerning their view of life in light of the disease, and whether interviewees would like to give others something to take with them. METHOD: Data were collected from narrative audio and video interviews with 18 inpatients in a specialized PC unit. Interviews were recorded and transcribed verbatim and analyzed using qualitative content analysis applying MAXQDA software...
March 8, 2018: Palliative & Supportive Care
Caitlin V Bucher, A J Day, Maria Carvalho
Since the number of prescriptions for opioid medications have continued to rise, there have been questions about the safety of using opioids in pain management. Traditionally, opioid analgesics were reserved for a few select conditions, such as terminal illness and surgery, but currently opioids have been readily prescribed for multiple conditions. The objective of this manuscript is to clarify the current state of opioid use and to discuss alternative transdermal analgesic therapies in pain management. Transdermal compounded medications are patient-specific and customizable to include different types of drugs, in various dosage strengths, that are to be delivered simultaneously in one application...
January 2018: Journal of Opioid Management
Alexander K C Leung, Benjamin Barankin, Kin Fon Leong
BACKGROUND: Staphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS. DATA SOURCES: A PubMed search was completed in Clinical Queries using the key terms "Staphylococcal scalded skin syndrome" and "Ritter disease"...
March 5, 2018: World Journal of Pediatrics: WJP
Jennifer B Seaman
No abstract text is available yet for this article.
February 1, 2018: American Journal of Geriatric Psychiatry
Marco Warth, Jens Kessler, Josien van Kampen, Beate Ditzen, Hubert J Bardenheuer
OBJECTIVES: Music therapy (MT) holds a promising potential to meet emotional and existential needs in palliative care patients. The aim of the present pilot study was to assess the feasibility, acceptance and potential effectiveness of a novel MT intervention to improve life closure and spiritual well-being of terminally ill patients with cancer receiving palliative care. METHODS: The 'Song of Life' (SOL) intervention was provided on two consecutive sessions containing a biographical interview and a live performance of a song with high biographical relevance to the patient in a lullaby style...
March 2, 2018: BMJ Supportive & Palliative Care
Ann Bonner, Shirley Chambers, Helen Healy, Wendy Hoy, Geoff Mitchell, Adrian Kark, Sharad Ratanjee, Patsy Yates
BACKGROUND: There is increasing recognition of the clinical need for timely and coordinated supportive and palliative care for those with terminal organ failure. OBJECTIVE: To describe symptoms, quality of life and supportive care needs in the anticipated 12-month period prior to death in adults with chronic kidney disease (CKD) stages 4 or 5. METHOD: An observational, prospective, longitudinal design was used to follow 19 patients. The measures used were the Chronic Kidney Disease-Symptom Burden Index (CKD-SBI), the Australian Karnofsky Performance Scale (AKPS), the Functional Assessment of Chronic illness Therapy Palliative-14 (FACIT PAL-14), the Assessment of Quality of Life 6 Dimensions (AQoL-6D) and the Sheffield Profile for Assessment and Referral for Care (SPARC)...
February 28, 2018: Journal of Renal Care
Angelika Feichtner, Dietmar Weixler, Alois Birklbauer
In some cases terminally ill patients fear of prolonged dying and suffering can manifest itself in the voluntary refusal of food and fluids, aiming to accelerate the dying process. This represents a considerable area of conflict, because of the ethical responsibility to not aid a person's death but also to respect a patients autonomy.There is a clear separation between an assisted suicide and following a patient's wishes. Not to accept the voluntary refusal of FVNF would have to be considered as forced treatment of patients while they are capable of self-determination...
February 27, 2018: Wiener Medizinische Wochenschrift
Philippa J Cahill, Christine R Sanderson, Elizabeth A Lobb, Jane L Phillips
Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site...
2018: Pilot and Feasibility Studies
Cheng-Jeng Tai, Yeu-Ching Shi, Chen-Jei Tai, Li-Jen Kuo, Ray-Jade Chen, Yu-Jia Chang, Ching Tzao, Chih-Hsiung Wu, Chun-Chao Chang, Hung-Yi Chiou, Ching-Hua Su
Context • Taiwanofungus camphoratus is a parasitic mushroom found in the heartwood of Cinnamomum kanehirai and is used as a nutritional supplement. It has an anticancer action, both alone and synergistically with amphotericin B (AmB). Objective • The study intended to assess the efficacy of a T camphoratus ethanol extract (TCEE) combined with AmB for patients with metastatic cancer whose cancer did not respond to multiline chemotherapy or who were unwilling to receive chemotherapy. Design • The research team performed a retrospective analysis as a pilot study...
February 24, 2018: Alternative Therapies in Health and Medicine
Hui-Shan Shen, Szu-Yin Chen, Denise Shuk Ting Cheung, Shu-Yi Wang, Lee Jung Jae, Chia-Chin Lin
CONTEXT: No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings. OBJECTIVES: To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCU) or intensive care units (ICU). METHODS: A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU...
February 20, 2018: Journal of Pain and Symptom Management
José Canihuante, Pedro Pérez
INTRODUCTION: It is common for terminally ill patients to have a reduced fluid intake, which often results in a need for more medical support. However, it is not clear if this measure has a real clinical impact. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data from primary studies and generated a summary of findings table using the GRADE approach...
February 12, 2018: Medwave
Rena Pombo, Etta Johnson, Alejandra Gamboa, Bennet Omalu
Manic episodes induced by antidepressant withdrawal are rarely reported. Mirtazapine is a tetracyclic, piperazinoazepine compound and is a noradrenergic, adrenergic, serotonergic, histaminergic, and muscarinic-antagonist antidepressant that is used for the treatment of major depression and other psychiatric illnesses. There are several reported cases of manic/hypomanic episodes induced by mirtazapine withdrawal based on suspected clinical symptoms that were not confirmed by autopsy and toxicology. We present the first reported case of mirtazapine withdrawal-induced mania/hypomania associated with sudden death and confirmed by autopsy and toxicology...
October 2017: Journal of Pharmacology & Pharmacotherapeutics
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