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End of life discussions

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https://www.readbyqxmd.com/read/28817780/us-internists-awareness-and-use-of-overtreatment-guidelines-a-national-survey
#1
Kira L Ryskina, Eric S Holmboe, Elizabeth Bernabeo, Rachel M Werner, Judy A Shea, Judith A Long
OBJECTIVES: To assess physician views and perceived adoption of overtreatment guidelines and measure whether adoption of these guidelines influenced the recommendation of a targeted service. STUDY DESIGN: A cross-sectional survey mailed from July 2014 to January 2015 to 902 internists who completed residency between 2003 and 2013, randomly selected from the American Medical Association Masterfile. METHODS: Poisson regression was used to model the rate of recommending a targeted service included in the guidelines, based on the level of guideline adoption...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28816605/end-of-life-in-disney-and-pixar-films-an-opportunity-for-engaging-in-difficult-conversation
#2
Kelly E Tenzek, Bonnie M Nickels
This study expanded upon previous scholarship by examining end-of-life (EOL) depictions and messages of death within Disney and Pixar animated films. We argue Disney and Pixar depictions of EOL and death can provide critical opportunities for discussing death and dying processes with children and adults alike. A content analysis of 57 movies resulted in a total of 71 character deaths. These instances of death became the discourse used for analysis. The EOL discourse was coded based on five categories (character status, depiction of death, death status, emotional reaction, and causality)...
January 1, 2017: Omega
https://www.readbyqxmd.com/read/28816567/how-close-are-we-to-implementing-a-genetic-risk-score-for-coronary-heart-disease
#3
Katherine Beaney, Fotios Drenos, Steve E Humphries
Genome-wide association meta-analysis have now identified more than 150 loci where common variants (SNPs) are significantly associated with coronary heart disease (CHD) and CHD end points. Areas Covered: The authors review publications from their own laboratory and published recently where identified CHD risk SNPs are used in combination, and "scaled" by their effect size, to create a "weighted" Genetic risk Score (GRS), which, in combination with an individual's classical CHD risk factors, can be used to identify those at overall low, intermediate and high future risk...
August 17, 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28815535/history-discovery-and-classification-of-lncrnas
#4
Julien Jarroux, Antonin Morillon, Marina Pinskaya
The RNA World Hypothesis suggests that prebiotic life revolved around RNA instead of DNA and proteins. Although modern cells have changed significantly in 4 billion years, RNA has maintained its central role in cell biology. Since the discovery of DNA at the end of the nineteenth century, RNA has been extensively studied. Many discoveries such as housekeeping RNAs (rRNA, tRNA, etc.) supported the messenger RNA model that is the pillar of the central dogma of molecular biology, which was first devised in the late 1950s...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28814131/what-factors-influence-women-s-perceptions-of-their-systemic-recurrence-risk-after-breast-cancer-treatment
#5
Kamaria L Lee, Nancy K Janz, Brian J Zikmund-Fisher, Reshma Jagsi, Lauren P Wallner, Allison W Kurian, Steven J Katz, Paul Abrahamse, Sarah T Hawley
BACKGROUND: Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS: Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754)...
August 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28813202/artificial-hydration-at-the-end-of-life
#6
Alexandria J Bear, Elizabeth A Bukowy, Jayshil J Patel
Initiation or continuation of artificial hydration (AH) at the end of life requires unique considerations. A combination of ethical precedents and medical literature may provide clinical guidance on how to use AH at the end of life. The purpose of this review is to describe the ethical framework for and review current literature relating to the indications, benefits, and risks of AH at the end of life. Provider, patient, and family perspectives will also be discussed.
August 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28809591/reducing-inappropriate-non-steroidal-anti-inflammatory-prescription-in-primary-care-patients-with-chronic-kidney-disease
#7
David M Keohane, Thomas Dennehy, Kenneth P Keohane, Eamonn Shanahan
Purpose The purpose of this paper is to reduce inappropriate non-steroidal anti-inflammatory prescribing in primary care patients with chronic kidney disease (CKD). Once diagnosed, CKD management involves delaying progression to end stage renal failure and preventing complications. It is well established that non-steroidal anti-inflammatories have a negative effect on kidney function and consequently, all nephrology consensus groups suggest avoiding this drug class in CKD. Design/methodology/approach The sampling criteria included all practice patients with a known CKD risk factor...
August 14, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28807700/unfinished-business-in-families-of-terminally-ill-with-cancer-patients
#8
Ryoko Yamashita, Harue Arao, Ayumi Takao, Eiko Masutani, Tatsuya Morita, Yasuo Shima, Yoshiyuki Kizawa, Satoru Tsuneto, Maho Aoyama, Mitsunori Miyashita
CONTEXT: Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. OBJECTIVES: To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business...
August 11, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28806221/admission-to-intensive-care-for-palliative-care-or-potential-organ-donation-demographics-circumstances-outcomes-and-resource-use
#9
Andrew Melville, Gali Kolt, David Anderson, Joanna Mitropoulos, David Pilcher
OBJECTIVES: To describe the characteristics, circumstances, change over time, resource use, and outcomes of patients admitted to ICUs in Australia and New Zealand for the purposes of "palliative care of a dying patient" or "potential organ donation," and compare with actively managed ICU patients. DESIGN: A retrospective study of data from the Australian and New Zealand Intensive Care Society Adult Patient Database and a nested cohort analysis of a single center...
August 11, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28806026/physician-perceptions-of-barriers-to-advance-care-planning
#10
Lauren Fanta, Jill Tyler
BACKGROUND: Numerous studies have confirmed the importance of advance care planning. Despite the benefits of directed end-of-life discussions, a variety of barriers including discomfort with the topic, physician ideology, lack of time and reimbursement, delaying discussions, and lack of training impede physicians from facilitating these crucial conversations with their patients. This study aims to understand physicians' perceptions to additional barriers to advance care planning with patients and their families...
July 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28805710/analysis-of-the-pathogenic-factors-and-management-of-dry-eye-in-ocular-surface-disorders
#11
REVIEW
Marcella Nebbioso, Paola Del Regno, Magda Gharbiya, Marta Sacchetti, Rocco Plateroti, Alessandro Lambiase
The tear film represents the interface between the eye and the environment. The alteration of the delicate balance that regulates the secretion and distribution of the tear film determines the dry eye (DE) syndrome. Despite having a multifactorial origin, the main risk factors are female gender and advanced age. Likewise, morphological changes in several glands and in the chemical composition of their secretions, such as proteins, mucins, lipidics, aqueous tears, and salinity, are highly relevant factors that maintain a steady ocular surface...
August 13, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28804867/sources-of-distress-for-physicians-and-nurses-working-in-swiss-neonatal-intensive-care-units
#12
Sabine D Klein, Hans Ulrich Bucher, Manya J Hendriks, Ruth Baumann-Hölzle, Jürg C Streuli, Thomas M Berger, Jean-Claude Fauchère, On Behalf Of The Swiss Neonatal End-Of-Life Study Group
BACKGROUND: Medical personnel working in intensive care often face difficult ethical dilemmas. These may represent important sources of distress and may lead to a diminished self-perceived quality of care and eventually to burnout. AIMS OF THE STUDY: The aim of this study was to identify work-related sources of distress and to assess symptoms of burnout among physicians and nurses working in Swiss neonatal intensive care units (NICUs). METHODS: In summer 2015, we conducted an anonymous online survey comprising 140 questions about difficult ethical decisions concerning extremely preterm infants...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28804862/oncological-patients-in-the-intensive-care-unit-prognosis-decision-making-therapies-and-end-of-life-care
#13
Ewelina Biskup, Fengfeng Cai, Marcus Vetter, Stephan Marsch
The effectiveness of intensive care unit (ICU) care for cancer patients remains controversial. Advances in antitumour and supportive care led to major improvements in outcomes of oncological patients in the ICU. Improved cancer therapies and supportive management of organ dysfunctions have contributed to improved survival rates. As a consequence, the number of cancer patients requiring ICU admission is rising. Frequently, cancer patients have a poor performance status and are vulnerable. It is a heterogeneous population, where the nature and curability of the neoplasm and the severity of critical illness cause a plethora of issues about ICU admissions...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28803353/palliative-care-in-ovarian-carcinoma-patients-a-personalized-approach-of-a-team-work-a-review
#14
REVIEW
Yakir Segev, Lior Segev, Meirav Schmidt, Ron Auslender, Ofer Lavie
Most ovarian cancer patients are diagnosed in an advanced stage; and after the initial treatment experience disease recurrence, which eventually becomes palliative. Many questions arise in this setting including how to address patients in the palliative setting, how to discuss end-of-life issues, and how to manage symptoms. In this review, we discuss the timing and setting of end-of-life discussion in the context of end-stage ovarian cancer. We review the approach to relieving disease burden by improving and decreasing symptoms...
August 12, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28802638/spiritual-perspectives-of-emergency-medicine-doctors-and-nurses-in-caring-for-end-of-life-patients-a-mixed-method-study
#15
Yingting Zhang, Rakhee Yash Pal, Wai San Wilson Tam, Alice Lee, Mabel Ong, Lay Hwa Tiew
BACKGROUND: End-of-life care is becoming more prevalent in the Emergency Department. Quality end-of-life care includes spiritual support. As spirituality is a relatively vague concept, understanding healthcare professionals' spiritual perspectives is important. AIMS: To explore the perspectives of Emergency Department doctors and nurses in (i) spirituality, (ii) spiritual care domain in end-of-life care and (iii) factors influencing spiritual care provision in the Emergency Department...
August 9, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28797850/advance-care-planning-in-palliative-care-for-people-with-intellectual-disabilities-a-systematic-review
#16
REVIEW
Hille Voss, Anique Vogel, Annemieke Ma Wagemans, Anneke L Francke, Job Fm Metsemakers, Annemie M Courtens, Anke Je de Veer
CONTEXT: Advance care planning (ACP) is defined as a person-centred, ongoing process of communication that facilitates patients' understanding, reflection and discussion of goals, values and preferences for future care. There is evidence for the general palliative care population that ACP increases compliance with patients' end-of-life preferences and improves quality of care near the end of life. OBJECTIVES: To gain insight into what is known about the use and effects of ACP in palliative care for people with intellectual disabilities (ID)...
August 7, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28796716/an-intensive-simulation-based-communication-course-for-pediatric-critical-care-medicine-fellows
#17
Erin M Johnson, Melinda F Hamilton, R Scott Watson, Rene Claxton, Michael Barnett, Ann E Thompson, Robert Arnold
OBJECTIVE: Effective communication among providers, families, and patients is essential in critical care but is often inadequate in the PICU. To address the lack of communication education pediatric critical care medicine fellows receive, the Children's Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication course. Pediatric critical care medicine trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the Pediatric Critical Care Communication course...
August 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28793184/survey-highlights-the-need-for-specific-interventions-to-reduce-frequent-conflicts-between-healthcare-professionals-providing-paediatric-end-of-life-care
#18
Marie-Anne Archambault-Grenier, Marie-Hélène Roy-Gagnon, France Gauvin, Hubert Doucet, Nago Humbert, Sanja Stojanovic, Antoine Payot, Sylvie Fortin, Annie Janvier, Michel Duval
AIMS: This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. METHODS: A questionnaire was distributed to all 2,300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. RESULTS: Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%)...
August 9, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28792358/meaning-reconstruction-process-after-suicide-life-story-of-a-japanese-woman-who-lost-her-son-to-suicide
#19
Daisuke Kawashima, Kenji Kawano
Although Japan has a high suicide rate, there is insufficient research on the experiences of suicide-bereaved individuals. We investigated the qualitative aspects of the meaning reconstruction process after a loss to suicide. We conducted a life-story interview using open-ended questions with one middle-aged Japanese woman who lost her son to suicide. We used a narrative approach to transcribe and code the participant's narratives for analysis. The analysis revealed three meaning groups that structured the participant's reactions to the suicide: making sense of her son's death and life, relationships with other people, and reconstruction of a bond with the deceased...
September 2017: Omega
https://www.readbyqxmd.com/read/28782701/a-systematic-review-of-end-of-life-care-communication-skills-training-for-generalist-palliative-care-providers-research-quality-and-reporting-guidance
#20
REVIEW
Lisa Jane Brighton, Jonathan Koffman, Amy Hawkins, Christine McDonald, Suzanne O'Brien, Vicky Robinson, Shaheen A Khan, Rob George, Irene J Higginson, Lucy Ellen Selman
CONTEXT: End of life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Whilst many training programmes now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. OBJECTIVES: To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported...
August 3, 2017: Journal of Pain and Symptom Management
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