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End if life

Douglas W Jones, Kirsten Dansey, Allen D Hamdan
Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled...
October 20, 2016: Vascular and Endovascular Surgery
James Tattersall
Current guidelines focus on conventional dialysis defined as 3-5 hours, three times per week, and suggest that longer or more frequent dialysis be considered. This paper presents the case for considering that shorter or less frequent dialysis should also be considered. More frequent and/or longer dialysis facilitates control of fluid overload, blood pressure, and phosphate levels. These benefits will require time to translate into probable hard outcome improvement. Patients are unlikely to participate in productive or pleasurable activities while undergoing dialysis in center or traveling to treatment...
October 20, 2016: Seminars in Dialysis
Martin Dobricki, Paul Pauli
Almost all living species regularly explore environments that they experience as pleasant, aversive, arousing or frightening. We postulate that such exploratory behavior and emotional experience both are regulated based on the interdependent perception of one's body and stimuli that collectively define a spatial context such as a cliff. Here we examined this by testing if the interaction of the sensory input on one's gait and the sensory input on the spatial context is modulating both the emotional experience of the environment and its exploration through head motion...
October 2016: Heliyon
Nirbhay N Singh, Giulio E Lancioni, Bryan T Karazsia, Jeffrey Chan, Alan S W Winton
Caregivers of individuals with intellectual and developmental disabilities (IDD) often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT) the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS) and Training-as-Usual (TAU) for caregivers in a congregate care facility for individuals with severe and profound IDD...
2016: Frontiers in Psychology
Melanie Ott, Débora Marques, Christina Funk, Susanne M Bailer
BACKGROUND: Herpes simplex virus type 1 (HSV1), a member of the alphaherpesvirinae, can cause recurrent facial lesions and encephalitis. Two membrane envelopment processes, one at the inner nuclear membrane and a second at cytoplasmic membranes are crucial for a productive viral infection. Depending on the subfamily, herpesviruses encode more than 11 different transmembrane proteins including members of the tail-anchored protein family. HSV1 encodes three tail-anchored proteins pUL34, pUL56 and pUS9 characterized by a single hydrophobic region positioned at their C-terminal end that needs to be released from the ribosome prior to posttranslational membrane insertion...
October 20, 2016: Virology Journal
Nicola Vargas, Loredana Tibullo, Emanuela Landi, Giovanni Carifi, Alfonso Pirone, Antonio Pippo, Immacolata Alviggi, Renato Tizzano, Elisa Salsano, Francesco Di Grezia, Maria Vargas
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity...
October 19, 2016: Aging Clinical and Experimental Research
Amber Mills, Anne Walker, Michele Levinson, Alison M Hutchinson, Gemma Stephenson, Anthea Gellie, George Heriot, Harvey Newnham, Megan Robertson
OBJECTIVE: To determine the prevalence of resuscitation orders and Advance Care Plans, and the relationship with Medical Emergency Team (MET) calls. METHOD: A point prevalence review of patient records at five Victorian hospital services. RESULTS: One thousand nine hundred and thirty-four patient records were reviewed, and 230 resuscitation orders and 15 Advance Care Plans found. Significantly, more resuscitation orders were found at public hospitals...
October 19, 2016: Australasian Journal on Ageing
Edward J Wing
With the wider availability of antiretrovirals, the world's HIV population is aging. More than 10% of the 34.5 million HIV+ individuals worldwide are over the age of 50 and the average age continues to increase. In the US more than 50% of the 1.3 million people with HIV are over 50 and by the year 2030 it is estimated that 70% will be over the age of 50. Although the life expectancy of HIV+ people has increased dramatically, it still lags behind HIV- individuals. There is controversy about whether HIV itself accelerates the aging process...
October 15, 2016: International Journal of Infectious Diseases: IJID
Saverio Cinieri, Arlene Chan, Kadri Altundag, An Vandebroek, Nicole Tubiana-Mathieu, Agusti Barnadas, Patricia Dodyk, Silvia Lazzarelli, Michiel Botha, Daniel Rauch, Gustavo Villanova, Ugur Coskun
BACKGROUND: The purpose of this study was to evaluate the efficacy of 3 first-line chemotherapy combination regimens for HER2-negative metastatic breast cancer (mBC). PATIENTS AND METHODS: In this open-label, 3-arm, randomized phase II trial, patients were randomized to all-oral NORCAP (vinorelbine/capecitabine), GEMPAC (gemcitabine/paclitaxel), or GEMDOC (gemcitabine/docetaxel) as first-line chemotherapy for HER2-negative mBC. Stratification factors were center, previous (neo)adjuvant anthracycline, and age...
June 25, 2016: Clinical Breast Cancer
Markus Gerber, Katharina Endes, Christian Herrmann, Flora Colledge, Serge Brand, Lars Donath, Oliver Faude, Uwe Pühse, Henner Hanssen, Lukas Zahner
PURPOSE: A better understanding of how social and environmental contexts impact on childhood overweight/obesity is needed to develop more effective prevention strategies. Because the relationship between physical activity, stress and obesity measures has received limited attention, this study examined for the first time in first grade schoolchildren whether physical activity and fitness moderate the relationship between psychosocial stress and obesity-related measures. METHODS: 325 children (51% girls, Mage=7...
October 14, 2016: Medicine and Science in Sports and Exercise
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Michel E Safar
Mid-life elevated BP is classically associated with a raised systemic vascular resistance. A classical interpretation of the association between aortic stiffness and blood pressure (BP) invokes hypertension as a simple form of premature aging that increases stress on the arterial wall and accelerates age-related stiffening of the aorta. Recent clinical and experimental data have called into question the directionality of this sequence of events associating stiffness and hypertension.Therefore an initial abnormality in stiffness may antedate and contribute initially to the pathogenesis of hypertension, namely isolated systolic hypertension...
September 2016: Journal of Hypertension
Theofania Tsironi, Efimia Dermesonlouoglou, Marianna Giannoglou, Eleni Gogou, George Katsaros, Petros Taoukis
The aim of the study was to develop and test the applicability of predictive models for shelf-life estimation of ready-to-eat (RTE) fresh cut salads in realistic distribution temperature conditions in the food supply chain. A systematic kinetic study of quality loss of RTE mixed salad (lollo rosso lettuce-40%, lollo verde lettuce-45%, rocket-15%) packed under modified atmospheres (3% O2, 10% CO2, 87% N2) was conducted. Microbial population (total viable count, Pseudomonas spp., lactic acid bacteria), vitamin C, colour and texture were the measured quality parameters...
October 3, 2016: International Journal of Food Microbiology
(no author information available yet)
'Let's liberate the term tender loving care from its end of life connotations and see if love, as the essential ingredient that influences the "how" of what we do, can be a guiding principle to good management and quality improvement'.
September 14, 2016: Nursing Standard
Kristina M Shumard, Jeffrey M Denney, Kristen Quinn, Arnold S Grandis, Paul W Whitecar, John Bailey, Rubymel J Jijon-Knupp, Chenchen Huang, Kendra Kesty, Brian C Brost, Joshua F Nitsche
OBJECTIVE: Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students. METHODS: During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill...
October 2016: Family Medicine
Ashok Kumar Saxena, Geetanjali T Chilkoti, Anand K Chopra, Basu Dev Banerjee, Tusha Sharma
BACKGROUND: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. METHODS: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included...
October 2016: Korean Journal of Pain
Max Wolff, Klaus-Martin Krönke, John Venz, Anja Kräplin, Gerhard Bühringer, Michael N Smolka, Thomas Goschke
Self-control is commonly assumed to depend on executive functions (EFs). However, it is unclear whether real-life self-control failures result from deficient EF competencies or rather reflect insufficient conflict-induced mobilization of executive control, and whether self-control depends more critically on function-specific EF competencies or general executive functioning (GEF), that is, common competencies that underlie all EFs. Here we investigated whether failure-related action versus state orientation, a personality trait related to the conflict-induced mobilization of cognitive control, moderates the effect of general and function-specific control competencies on self-control...
October 13, 2016: Journal of Experimental Psychology. General
Christophoros Christophorou, Styliani Kleanthous, Dimosthenis Georgiadis, Donato M Cereghetti, Panayiotis Andreou, Cindy Wings, Eleni Christodoulou, George Samaras
Based on the demographic changes and the rapid increase of older population in Europe, major challenges are expected to rise, both in the economy as well as the society, whether the dominant care model for supporting elderly in living independently at home continues to rely on informal and formal caregivers' assistance. To respond to the above challenges, assistive technologies are called to develop Information and Communication Technology (ICT) services for supporting seniors to remain active and independent, for as long as possible, in their chosen home environment...
September 2016: Healthcare Technology Letters
Fiona Brigid McDonald, Kumaran Chandrasekharan, Richard J A Wilson, Shabih U Hasan
Maternal cigarette smoke (CS) exposure exhibits a strong epidemiological association with Sudden Infant Death Syndrome but other environmental stressors, including infection, hyperthermia and hypoxia have also been postulated as important risk factors. This study examines if maternal CS exposure causes maladaptations within homeostatic control networks by influencing the response to lipopolysaccharide, heat stress and/or hypoxia in neonatal rats. Pregnant dams were exposed to CS or parallel sham treatments daily for the length of gestation...
October 12, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Ravindra B Ghooi, Kelly Dhru, Sheela Jaywant
Many individuals at the end of life are unable to convey their wishes regarding medical treatments. Advance directives (ADs) or living wills (LWs) allow them to crystallise their wishes in a written form so that these can be carried out if the relevant situation arises. In many countries, ADs are legally valid and enforceable; they reduce the use of life-sustaining treatments, which often merely prolong life without improving or even maintaining the quality of life. Such treatment puts a financial burden on the patient's family, often leading to penury...
October 2016: Indian Journal of Medical Ethics
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