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End of life discussions

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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/29343173/effects-of-two-feedback-interventions-on-end-of-life-outcomes-in-nursing-home-residents-with-dementia-a-cluster-randomized-controlled-three-armed-trial
#2
Jannie A Boogaard, Henrica Cw de Vet, Mirjam C van Soest-Poortvliet, Johannes R Anema, Wilco P Achterberg, Jenny T van der Steen
BACKGROUND: Despite increased attention for palliative care in dementia, recent studies found burdensome symptoms and unmet family caregiver needs in the last phase of life. Feedback is being used to improve the quality of palliative care, but we do not know how effective it is. AIM: To assess the effect of two feedback strategies on perceived quality of end-of-life care and comfort in dying nursing home residents with dementia. METHODS: In a cluster-randomized controlled trial, the End-of-Life in Dementia-Satisfaction With Care and the End-of-Life in Dementia-Comfort Assessment in Dying scales were completed by bereaved family caregivers of residents with dementia of 18 Dutch nursing homes...
January 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29341962/withdrawal-of-life-sustaining-therapy
#3
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/29341551/reflection-on-curative-treatment-versus-palliation-of-symptoms-in-end-of-life-care
#4
Teresa Bridget Dowling
The conflicting tasks of treating or managing disease and preparing patients and their families for the end of life are well documented in haematology and palliative care settings. This article is a reflection on practice by a nursing student who was in the fourth year of an internship, and discusses a case study involving a woman at the end of life. It considers the approach to palliative and end of life care adopted in an oncology and haematology ward where there was a reluctance to be realistic about the limitations of treatments among some healthcare practitioners, who did not want to dispel unrealistic expectations of the patient's recovery as a result of continuing treatment...
January 17, 2018: Nursing Standard
https://www.readbyqxmd.com/read/29340478/the-long-and-successful-journey-of-electrochemically-active-amino-acids-from-fundamental-adsorption-studies-to-potential-surface-engineering-tools
#5
André H B Dourado, Fabián C Pastrián, Susana I Córdoba DE Torresi
Proteins have been the subject of electrochemical studies. It is possible to apply electrochemical techniques to obtain information about their structure due to the presence of five electroactive amino acids that can be oriented to the outside of the peptidic chain. These amino acids are L-Tryptophan (L-Trp), L-Tyrosine (L-Tyr), L-Histidine (L-His), L-Methionine (L-Met) and L-Cysteine (L-Cys); their electrochemical behavior being subject of extensive research, but it is still controversial. No spectroscopic investigations have been reported on L-Trp, and due to the short life time of the intermediates, ex situ techniques cannot be employed, leading to a never-ending discussion about possible intermediates...
January 11, 2018: Anais da Academia Brasileira de Ciências
https://www.readbyqxmd.com/read/29337583/sudden-death-aversion-avoiding-superior-options-because-they-feel-riskier
#6
Jesse Walker, Jane L Risen, Thomas Gilovich, Richard Thaler
We present evidence of sudden-death aversion (SDA)-the tendency to avoid "fast" strategies that provide a greater chance of success, but include the possibility of immediate defeat, in favor of "slow" strategies that reduce the possibility of losing quickly, but have lower odds of ultimate success. Using a combination of archival analyses and controlled experiments, we explore the psychology behind SDA. First, we provide evidence for SDA and its cost to decision makers by tabulating how often NFL teams send games into overtime by kicking an extra point rather than going for the 2-point conversion (Study 1) and how often NBA teams attempt potentially game-tying 2-point shots rather than potentially game-winning 3-pointers (Study 2)...
January 15, 2018: Journal of Personality and Social Psychology
https://www.readbyqxmd.com/read/29337413/participation-of-relatives-in-the-care-of-cancer-patients-in-hospital-a-scoping-review
#7
REVIEW
E Partanen, T Lemetti, E Haavisto
The purpose of the review was to describe what kind of research has been conducted concerning relatives' participation in the care of cancer patients in hospital and how relatives have participated in the care. Data (n = 9) were identified through a manual search and by searching the electronic databases (n = 8) Cinahl, PubMed and Cochrane Library and analysed with deductive content analysis. According to the review, participation in the concrete care appeared as taking care of comprehensive care and the quality of care, helping with daily activities and helping the healthcare professionals...
January 16, 2018: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29336107/centrality-of-spirituality-religion-in-the-culture-of-palliative-care-service-in-indonesia-an-ethnographic-study
#8
Erna Rochmawati, Rick Wiechula, Kate Cameron
Experiencing life-threatening illness could impact on an individual's spirituality or religious beliefs. In this paper, we report on a study which explored cultural elements that influence the provision of palliative care for people with cancer. A contemporary ethnographic approach was adopted. Observations and interviews were undertaken over 3 months with 48 participants, including palliative care staff, patients, and their families. An ethnographic data analysis framework was adopted to assist in the analysis of data at item, pattern, and structural levels...
January 16, 2018: Nursing & Health Sciences
https://www.readbyqxmd.com/read/29335364/experimental-manipulation-of-telomere-length-does-it-reveal-a-corner-stone-role-for-telomerase-in-the-natural-variability-of-individual-fitness
#9
REVIEW
F Criscuolo, S Smith, S Zahn, B J Heidinger, M F Haussmann
Telomeres, the non-coding ends of linear chromosomes, are thought to be an important mechanism of individual variability in performance. Research suggests that longer telomeres are indicative of better health and increased fitness; however, many of these data are correlational and whether these effects are causal are poorly understood. Experimental tests are emerging in medical and laboratory-based studies, but these types of experiments are rare in natural populations, which precludes conclusions at an evolutionary level...
March 5, 2018: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
https://www.readbyqxmd.com/read/29335033/should-capacity-assessments-be-performed-routinely-prior-to-discussing-advance-care-planning-with-older-people
#10
Oleg Kiriaev, Emme Chacko, J D Jurgens, Meagan Ramages, Phillipa Malpas, Gary Cheung
BACKGROUND: People with dementia receive worse end of life care compared to those with cancer. Barriers to undertaking advanced care planning (ACP) in people with dementia include the uncertainty about their capacity to engage in such discussions. The primary aim of this study was to compare the Advance Care Planning-Capacity Assessment Vignette tool (ACP-CAV) with a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify demographic and cognitive functioning variables that may predict whether a person has capacity to discuss ACP...
January 16, 2018: International Psychogeriatrics
https://www.readbyqxmd.com/read/29331475/end-of-life-care-for-patients-with-advanced-kidney-disease-in-the-us-veterans-affairs-health-care-system-2000-2011
#11
Susan P Y Wong, Margaret K Yu, Pamela K Green, Chuan-Fen Liu, Paul L Hebert, Ann M O'Hare
BACKGROUND: Little is known about patterns of end-of-life care for patients with advanced kidney disease not treated with maintenance dialysis. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: A sample of 14,071 patients with sustained estimated glomerular filtration rates < 15mL/min/1.73m2 treated in the US Veterans Affairs health care system who died during 2000 to 2011. Before death, 12,756 of these patients had been treated with dialysis, 503 had been discussing and/or preparing for dialysis therapy, and for 812, there had been a decision not to pursue dialysis therapy...
January 10, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29327100/-provision-of-palliative-care-for-people-with-advanced-dementia
#12
REVIEW
J Diehl-Schmid, L Riedl, U Rüsing, J Hartmann, M Bertok, C Levin, J Hamann, M Arcand, S Lorenzl, B Feddersen, R J Jox
As a result of a literature-based expert process, this review provides an overview about the principles of palliative care for people with advanced dementia that are relevant for clinical practice. In particular, the indications, impact and aims of palliative care for advanced dementia are described. Life-prolonging measures and management of symptoms at the end of life are discussed. Furthermore, the overview focuses on the legal basis of decision making.
January 11, 2018: Der Nervenarzt
https://www.readbyqxmd.com/read/29323412/microsystems-of-recovery-in-homeless-services-the-influence-of%C3%A2-service-provider-values-on-service-users-recovery-experiences
#13
Rachel M Manning, Ronni Michelle Greenwood
There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration...
January 11, 2018: American Journal of Community Psychology
https://www.readbyqxmd.com/read/29321079/the-enactment-stage-of-end-of-life-decision-making-for-children
#14
Jane Elizabeth Sullivan, Lynn Heather Gillam, Paul Terence Monagle
OBJECTIVES: Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process...
January 11, 2018: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29317084/-reversal-of-neuromuscular-block-with-sugammadex-in-five-heart-transplant-pediatric-recipients
#15
Ricardo Vieira Carlos, Marcelo Luis Abramides Torres, Hans Donald de Boer
Heart transplantation is a frequent procedure in the treatment of end-stage cardiac dysfunction. Therefore, these patient populations will also be more frequent exposed to other more common surgical procedures after their transplantation. Anesthesiologist should be aware in their assessment of these patients, especially regarding some specific issues related to patients with a history of heart transplantation, like reversal of neuromuscular block. Several reports described that cholinesterase inhibitors drugs, like neostigmine, may produce a dose-dependent life-threatening bradycardia in heart transplant recipients while other publication described the safe use of neostigmine...
January 6, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29314264/a-practical-guide-for-the-care-of-patients-with-end-stage-renal-disease-near-the-end-of-life
#16
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/29310331/eliciting-community-perspectives-on-research-with-older-adults-living-with-hiv-through-focus-groups
#17
Annie L Nguyen, Brandon Brown, Jeff Taylor, Marlene Estevez, Rick Loftus
Approximately half of all people living with HIV in the US are age 50 and older. Existing research highlights the health challenges of these individuals, but little work has focused on gathering input about concerns in participating in HIV and aging research. Prior to designing a prospective cohort study on HIV and aging, we elicited feedback from potential participants on general attitudes toward participation in a prospective HIV cohort study, and perspectives on important research topics relevant to older adults living with HIV...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29305321/factors-associated-with-symptom-relief-in-end-of-life-care-in-residential-care-homes-a-national-register-based-study
#18
Sofia Andersson, Kristofer Årestedt, Olav Lindqvist, Carl-Johan Fürst, Margareta Brännström
BACKGROUND: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life. AIM: To explore the presence of symptoms and symptom relief, and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care. METHOD: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (n=22 855)...
January 2, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29302827/colonic-perforation-due-to-severe-cytomegalovirus-disease-in-granulomatosis-with-polyangiitis-after-immunosuppression
#19
REVIEW
Alessandra Soriano, Nazareno Smerieri, Stefano Bonilauri, Loredana De Marco, Alberto Cavazza, Carlo Salvarani
Granulomatosis with polyangiitis (GPA) is a small-vessel necrotizing granulomatous vasculitis typically involving upper airways, lungs, and kidneys, which may lead to end-organ damage and life-threatening complications. Major infections during GPA course represent a considerable concern in the management of the disease. Cytomegalovirus (CMV) infection and disease are rare but significant complications in the course of GPA being associated with high morbidity and mortality rates. Colonic perforation due to CMV colitis is exceedingly rare and has so far almost exclusively been documented in HIV, renal transplant, and systemic lupus erythematosus patients...
January 4, 2018: Clinical Rheumatology
https://www.readbyqxmd.com/read/29302599/what-are-the-ethical-aspects-surrounding-the-collegial-decisional-process-in-limiting-and-withdrawing-treatment-in-intensive-care
#20
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of expressing themselves...
December 2017: Annals of Translational Medicine
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