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https://www.readbyqxmd.com/read/28096041/advance-care-planning-in-adults-with-congenital-heart-disease-a-patient-priority
#1
Lisa X Deng, Lacey P Gleason, Abigail M Khan, David Drajpuch, Stephanie Fuller, Leah A Goldberg, Christopher E Mascio, Sara L Partington, Lynda Tobin, Yuli Y Kim, Adrienne H Kovacs
BACKGROUND: Adult congenital heart disease (ACHD) patients with moderate or great defect complexity are at risk for premature death. Although early engagement in advance care planning (ACP) is recommended, previous research suggests that it seldom occurs. METHODS: This study investigated ACHD patient preferences for ACP and factors that impact preferences. ACHD patients completed an ACP preferences questionnaire, the Hospital Anxiety and Depression Scale and a measure of attachment styles...
January 4, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28078082/core-components-for-effective-infection-prevention-and-control-programmes-new-who-evidence-based-recommendations
#2
Julie Storr, Anthony Twyman, Walter Zingg, Nizam Damani, Claire Kilpatrick, Jacqui Reilly, Lesley Price, Matthias Egger, M Lindsay Grayson, Edward Kelley, Benedetta Allegranzi
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28074586/the-theory-and-practice-of-surrogate-decision-making
#3
David Wendler
When a patient lacks decision-making capacity and has not left a clear advance directive, there is now widespread agreement that patient-designated and next-of-kin surrogates should implement substituted judgment within a process of shared decision-making. Specifically, after discussing the "best scientific evidence available, as well as the patient's values, goals, and preferences" with the patient's clinicians, the patient-designated or next-of-kin surrogate should attempt to determine what decision the patient would have made in the circumstances...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074585/a-good-death
#4
Tia Powell, Adira Hulkower
A good death is hard to find. Family members tell us that loved ones die in the wrong place-the hospital-and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28073146/value-based-care-in-hepatology
#5
REVIEW
Mario Strazzabosco, John I Allen, Elizabeth O Teisberg
The migration from legacy fee-for-service reimbursement to payments linked to high value health care is accelerating in the United States because of new legislation and re-design of payments from the Centers for Medicare and Medicaid Services (CMS). Since patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Since chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices ...
January 10, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28069712/an-evidence-based-medicine-approach-to-antihyperglycemic-therapy-in-diabetes-mellitus-to-overcome-overtreatment
#6
Anil N Makam, Oanh K Nguyen
Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions...
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/28065700/integrating-supportive-care-principles-into-dialysis-decision-making-a-primer-for-palliative-medicine-providers
#7
Alvin H Moss
Despite advances in pre-dialysis care and dialysis technology, patients with advanced chronic kidney disease and end-stage renal disease continue to experience multiple comorbidities, a high symptom burden, a shortened life expectancy and substantial physical, emotional, and spiritual suffering. Patients with acute kidney injury and end-stage renal disease, especially if they are older, often undergo prolonged hospitalizations, greater use of intensive medical treatment, and limited survival. Unfortunately, most nephrologists are not trained to conduct shared decision-making conversations to elicit patients' values, preferences, and goals for treatment and address their patients' multifactorial suffering...
January 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28064399/harnessing-the-therapist-effect-in-patient-centered-mental-health-care-decision-making
#8
James F Boswell, Michael J Constantino, David R Kraus
In this commentary, we address the critical importance of the research literature documenting therapist differences in skill and outcomes. In particular, we focus on the implications of therapist differences for patient-centered decision making, including the matching of patients to specific psychotherapists who have empirically-based track records of positive performance. In addition, we present preliminary results from a grant supported study of patients' values and preferences regarding the use of provider performance track records in routine mental health care decision making...
January 7, 2017: Administration and Policy in Mental Health
https://www.readbyqxmd.com/read/28063865/evaluation-of-a-mastery-learning-intervention-on-hospitalists-code-status-discussion-skills
#9
Rashmi K Sharma, Eytan Szmuilowicz, Adeboye Ogunseitan, Sasha F Jones, Jessica A Montalvo, Kevin J O'Leary, Diane B Wayne
CONTEXT: Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. OBJECTIVES: The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062650/euthanasia-embedded-in-palliative-care-responses-to-essentialistic-criticisms-of-the-belgian-model-of-integral-end-of-life-care
#10
Jan L Bernheim, Kasper Raus
The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects...
January 6, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28062339/defining-advance-care-planning-for-adults-a-consensus-definition-from-a-multidisciplinary-delphi-panel
#11
Rebecca L Sudore, Hillary D Lum, John J You, Laura C Hanson, Diane E Meier, Steven Z Pantilat, Daniel D Matlock, Judith A C Rietjens, Ida J Korfage, Christine S Ritchie, Jean S Kutner, Joan M Teno, Judy Thomas, Ryan D McMahan, Daren K Heyland
BACKGROUND: Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. OBJECTIVE: To develop a consensus definition of ACP for adults. DESIGN: Delphi Panel SETTING/PARTICIPANTS: Participants included a multidisciplinary panel of international ACP experts consisting of 52 clinicians, researchers, and policy leaders from 4 countries, and a patient/surrogate advisory committee...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28061965/report-of-the-acr-s-economics-committee-on-value-based-payment-models
#12
Giles W Boland, Lucille Glenn, Shlomit Goldberg-Stein, Saurabh Jha, Mark Mangano, Samir Patel, Kurt A Schoppe, David Seidenwurm, John Lohnes, Ezequiel Silva, Richard Abramson, Daniel J Durand, Laura Pattie, Pamela Kassing, Richard E Heller
A major outcome of the current health care reform process is the move away from unrestricted fee-for-service payment models toward those that are based on the delivery of better patient value and outcomes. The authors' purpose, therefore, is to critically evaluate and define those components of the overall imaging enterprise that deliver meaningful value to both patients and referrers and to determine how these components might be measured and quantified. These metrics might then be used to lobby providers and payers for sustainable payment solutions for radiologists and radiology services...
January 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28061771/s2o-a-software-tool-for-integrating-research-data-from-general-purpose-statistic-software-into-electronic-data-capture-systems
#13
Philipp Bruland, Martin Dugas
BACKGROUND: Data capture for clinical registries or pilot studies is often performed in spreadsheet-based applications like Microsoft Excel or IBM SPSS. Usually, data is transferred into statistic software, such as SAS, R or IBM SPSS Statistics, for analyses afterwards. Spreadsheet-based solutions suffer from several drawbacks: It is generally not possible to ensure a sufficient right and role management; it is not traced who has changed data when and why. Therefore, such systems are not able to comply with regulatory requirements for electronic data capture in clinical trials...
January 7, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28058555/commentary-on-the-consensus-statement-of-the-american-society-of-breast-surgeons-on-contralateral-prophylactic-mastectomy
#14
EDITORIAL
Sharyl J Nass, Larissa Nekhlyudov
The increasing rate of contralateral prophylactic mastectomy (CPM) led the American Society of Breast Surgeons (ASBrS) to issue an evidence-based consensus statement on CPM, as well as a discussion guide that health care providers can use to facilitate shared decision making with patients considering CPM for unilateral breast cancer. This article suggests several ways to improve the discussion guide by eliciting patient values and preferences and by providing more current, detailed, and balanced information about the potential risks and benefits of CPM...
January 5, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28049375/comparative-effectiveness-of-treatment-choices-for-graves-hyperthyroidism-a-historical-cohort-study
#15
Vishnu Sundaresh, Juan P Brito, Prabin Thapa, Rebecca S Bahn, Marius N Stan
Introduction The optimum therapy for Graves' Disease (GD) is chosen following discussion between physician and patient regarding benefits, drawbacks, potential side effects, and logistics of the various treatment options and takes into account patient values and preferences. This cohort study aimed to provide useful information for this discussion regarding the usage, efficacy and adverse effect profile of radioactive iodine (RAI), antithyroid drugs (ATDs), and thyroidectomy in a tertiary healthcare facility...
January 3, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28043713/what-do-patient-values-and-preferences-mean-a-taxonomy-based-on-a-systematic-review-of-qualitative-papers
#16
REVIEW
Carla M Bastemeijer, Lennard Voogt, Johannes P van Ewijk, Jan A Hazelzet
OBJECTIVE: In order to deliver good healthcare quality, it should explicitly be taken into account what patients value in healthcare. This study reviews qualitative studies in which patients express what they value. Based on this body of literature a preliminary taxonomy is designed. METHODS: A systematic review of qualitative papers on what patients' value. RESULTS: 22 studies out of a total of 3259 met the inclusion criteria. After critical appraisal, data extraction was carried out by two researchers independently and revealed values related to 1) the individual patient; 2) the expected behavior of professionals and 3) the interaction between patients and professionals...
December 24, 2016: Patient Education and Counseling
https://www.readbyqxmd.com/read/28041600/study-protocol-for-the-option-randomised-controlled-trial-on-the-effect-of-prioritising-treatment-goals-among-older-patients-with-cancer-in-a-palliative-setting
#17
M E Stegmann, J Schuling, T J N Hiltermann, A K L Reyners, H Burger, M Y Berger, A J Berendsen
PURPOSE: Traditionally, general practitioners (GPs) are not involved in cancer-related treatment decisions, despite their often long relationship with patients, and their unique position to explore patients' values, especially with older patients. Therefore, we designed a randomised controlled trial to study the effect, on self-efficacy related to treatment decisions, of a conversation about treatment goals between GPs and patients with cancer in a palliative setting. METHODS: We aim to include 168 patients aged ≥70 years with a diagnosis of non-curable cancer, due to consult their oncologist about treatment options...
February 2017: Maturitas
https://www.readbyqxmd.com/read/28032892/facing-the-dilemma-of-patient-centred-psoriasis-care-a-qualitative-study-identifying-patient-needs-in-dermatological-outpatient-clinics
#18
L R Khoury, L Skov, T Møller
BACKGROUND: Caregivers must be aware of patients' current needs by providing care responsive to the patients' values and preferences and by identifying what approach improves and encourages patients to participate in their treatment and disease management. Patients with psoriasis healthcare needs perhaps change as medical knowledge improves, new drugs emerge and the healthcare system improves its efficiency due to constant structural development. OBJECTIVES: To explore the unmet needs and health perceptions of people with psoriasis, regarding interaction with clinicians and the structure inherent to consultations in a hospital outpatient dermatological clinic...
December 29, 2016: British Journal of Dermatology
https://www.readbyqxmd.com/read/28012883/patient-perspectives-on-communication-of-individualized-survival-estimates-in-heart-failure
#19
Madhav Narayan, Jacqueline Jones, Laura B Portalupi, Colleen K Mcllvennan, Daniel D Matlock, Larry A Allen
BACKGROUND: Despite the availability of validated risk scores for survival in heart failure (HF), individualized estimates are not typically provided directly to patients. METHODS AND RESULTS: We explored patient perspectives regarding conveyance of individualized Seattle Heart Failure Model (SHFM) survival estimates. In 2014 and 2015, 24 HF patients completed a semi-structured interview at initial offering of SHFM survival estimates (baseline) and a follow-up interview...
December 21, 2016: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28009732/patient-reported-limitations-to-surgical-buy-in-a-qualitative-study-of-patients-facing-high-risk-surgery
#20
Michael J Nabozny, Jacqueline M Kruser, Nicole M Steffens, Kristen E Pecanac, Karen J Brasel, Eva H Chittenden, Zara Cooper, Martin F McKneally, Margaret L Schwarze
OBJECTIVE: To characterize how patients buy-in to treatments beyond the operating room and what limits they would place on additional life-supporting treatments. BACKGROUND: During a high-risk operation, surgeons generally assume that patients buy-in to life-supporting interventions that might be necessary postoperatively. How patients understand this agreement and their willingness to participate in additional treatment is unknown. METHODS: We purposively sampled surgeons in Toronto, Ontario, Boston, Massachusetts, and Madison, Wisconsin, who are good communicators and routinely perform high-risk operations...
January 2017: Annals of Surgery
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