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End of life discussions

Magnolia Cardona-Morrell, Amanda Chapman, Robin M Turner, Ebony Lewis, Blanca Gallego-Luxan, Michael Parr, Ken Hillman
AIM: To investigate associations between clinical parameters - beyond the evident physiological deterioration and limitations of medical treatment - with in-hospital death for patients receiving Rapid Response System (RRS) attendances. METHODS: Retrospective case-control analysis of clinical parameters for 328 patients aged 60 years and above at their last RRS call during admission to a single teaching hospital in the 2012-2013 calendar years. Generalised estimating equation modelling was used to compare the deceased with a randomly selected sample of those who had RRS calls and survived admission (controls), matched by age group, sex, and hospital ward...
October 18, 2016: Resuscitation
Olga Tursunov, Nathan I Cherny, Freda DeKeyser Ganz
PURPOSE/OBJECTIVES: To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. DESIGN: Descriptive comparative study.
. SETTING: Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. SAMPLE: A convenience sample of 34 family members of dying patients receiving palliative sedation...
November 1, 2016: Oncology Nursing Forum
Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
(no author information available yet)
At The Christie NHS Foundation Trust, Manchester, concerns that end of life care discussions were occurring too late in breast cancer cases led to earlier introduction of palliative care. Benefits include reduced hospital admissions during end of life and improved symptom management. The authors encourage nurses to support an integrated approach to enhance care provision for patients.
October 12, 2016: Nursing Standard
H Olschewski, J Behr, H Bremer, M Claussen, P Douschan, M Halank, M Held, M M Hoeper, S Holt, H Klose, S Krüger, T J Lange, F Reichenberger, D Skowasch, S Ulrich, H Wilkens, W Seeger
The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH) but also some aspects of pulmonary hypertension (PH) associated with chronic lung disease. The European Guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, sGC stimulators) have not been sufficiently investigated in other forms of PH. Therefore, the European Guidelines do not recommend the use of these drugs in patients with chronic lung disease and PH...
October 2016: Deutsche Medizinische Wochenschrift
Sara Gianella, Jeff Taylor, Timothy R Brown, Andy Kaytes, Cristian L Achim, David J Moore, Susan J Little, Ron J Ellis, Davey M Smith
Despite extensive investigations, we still do not fully understand the dynamics of the total body HIV reservoir and how sub-reservoirs in various compartments relate to one another. Studies using macaque models are enlightening but eradication strategies will still need to be tested in humans. To take the next steps in understanding and eradicating HIV reservoirs throughout the body, we propose to develop a "peri-mortem translational research model" of HIV-infected individuals (called 'The Last Gift'), which is similar to existing models in cancer research...
October 14, 2016: AIDS
Emilie Cauchie, Mathieu Gand, Gilles Kergourlay, Bernard Taminiau, Laurent Delhalle, Nicolas Korsak, Georges Daube
In order to control food losses and wastage, monitoring the microbial diversity of food products, during processing and storage is important, as studies have highlighted the metabolic activities of some microorganisms which can lead to spoilage. Knowledge of this diversity can be greatly improved by using a metagenetic approach based on high throughput 16S rRNA gene sequencing, which enables a much higher resolution than culture-based methods. Moreover, the Jameson effect, a phenomenon described by Jameson in 1962, is often used to classify bacterial strains within an ecosystem...
October 12, 2016: International Journal of Food Microbiology
Abby R Rosenberg, Joanne Wolfe, Lori Wiener, Maureen Lyon, Chris Feudtner
Importance: For clinicians caring for adolescent patients living with progressive, life-threatening illness, discussions regarding prognosis, goals of care, and treatment options can be extremely challenging. While clinicians should respect and help to facilitate adolescents' emerging autonomy, they often must also work with parents' wishes to protect patients from the emotional distress of hearing bad news. Observations: We reviewed the ethical justifications for and against truth-telling, and we considered the published ethical and practice guidance, as well as the perspectives of patients, parents, and clinicians involved in these cases...
October 17, 2016: JAMA Pediatrics
Dawn Schroeder, Wendy Duggleby, Brenda L Cameron
BACKGROUND: In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identified a deleterious mutation, the risk for hereditary breast cancer (HBC) can still be high when there is a strong family history. Little is known about how an awareness of risk for HBC impacts the everyday lives of unaffected women (no personal history for breast and/or ovarian cancer) in these families. OBJECTIVE: The aim of this study is to explore how unaffected women, living in BRCA1/2-negative families, experience living with risk for HBC...
October 4, 2016: Cancer Nursing
Rohini Prashar, K K Venkat
Kidney transplantation is well established as the best treatment option for end-stage kidney disease. It confers not only a better quality of life but also a significant survival advantage compared to dialysis. However, despite significant improvement in short-term kidney transplant graft survival over the past three decades, long-term graft survival remains suboptimal. Concerns about the possible contribution of chronic calcineurin inhibitor (CNI) nephrotoxicity to late allograft failure and other serious adverse effects of currently used immunosuppressive agents (especially corticosteroids) have led to increasing interest in developing regimens which may better preserve kidney allograft function and minimize other immunosuppression-related problems without increasing the risk of rejection...
September 2016: Advances in Chronic Kidney Disease
Franca Benini, Roberta Vecchi, Pierina Lazzarin, Momcilo Jankovic, Luciano Orsi, Luca Manfredini, Paola Drigo, Valentina Sellaroli, Michele Gangemi, Marco Spizzichino, Marcello Orzalesi
PURPOSE: The death of a child is a devastating and tragic event for all those involved. This charter aims to help healthcare workers and people assisting terminally ill children to recognize some important rights of the child, with some related suggestions. We consider it important to have a trace of this process, based on the skillfulness of long-lasting experts. METHODS: In September 2012, a group of professionals working with children affected by incurable illness in Italy launched a project to formulate the charter...
October 8, 2016: Tumori
Osamu Muramoto
BACKGROUND: This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference...
October 13, 2016: Philosophy, Ethics, and Humanities in Medicine: PEHM
Jaclyn Yoong, Aleece MacPhail, Gael Trytel, Prashanti Yalini Rajendram, Margaret Winbolt, Joseph E Ibrahim
Objective Limitation of Medical Treatment (LMT) forms are an essential element of end-of-life care. Decision making around LMT is complex and often involves patients with dementia. Despite the complexity, junior doctors frequently play a central role in completing LMT forms. The present study sought perspectives from a range of stakeholders (hospital clinicians, medical education personnel, legal and advocacy staff) about junior doctors' roles in completing LMT forms in general and for patients with dementia...
October 14, 2016: Australian Health Review: a Publication of the Australian Hospital Association
Kerstin Herzer, Guido Gerken
Chronic hepatitis C virus (HCV) infection is one of the primary causes of hepatocellular carcinoma and liver transplantation (LT). Graft loss due to hepatitis C (HCV) recurrence is a serious problem after LT. Thus, the approval of interferon-free direct-acting antiviral (DAA) regimens has important implications in the LT setting. The findings of controlled trials have confirmed the safety and the excellent efficacy of most DAA combinations, and these findings have been confirmed by reports of high rates of sustained virologic response in the real-life setting...
August 2016: Visc Med
L Badet, X Matillon, R Codas, J Branchereau, G Karam, M-O Timsit, R Thuret, F Kleinclauss
OBJECTIVES: To perform a State of The Art about the different aspects of pancreas transplantation such as indications, technical features, immunosuppressive strategies and outcomes of simultaneous pancreas-kidney transplantation. MATERIAL AND METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database ( and Embase ( using different associations of the following keywords (MESH) : « pancreas transplantation; kidney transplantation; simultaneous pancreas-kidney transplantation; immunosuppression »...
October 6, 2016: Progrès en Urologie
Silvia Villa, Friederike Kendel, Lionne Venderbos, Tiziana Rancati, Chris Bangma, Peter Carroll, Louis Denis, Laurence Klotz, Ida J Korfage, Athene J Lane, Tiziana Magnani, Ken Mastris, Antti Rannikko, Monique Roobol, Bruce Trock, Roderick Van den Bergh, Hendrik Van Poppel, Riccardo Valdagni, Lara Bellardita
BACKGROUND: Literature on the health-related quality of life (HRQoL) for men with localized prostate cancer (PCa) on active surveillance (AS) shows a need for methodological guidance regarding HRQoL issues and how to address them. OBJECTIVE: The European School of Oncology Task Force (ESO TF) aimed to identify a core set of research questions and related measures to include in AS HRQoL studies. DESIGN, SETTING, AND PARTICIPANTS: A modified Delphi study was used to reach consensus on AS HRQoL research topics and tools between 2014 and 2015...
October 6, 2016: European Urology
F Phillips, C H S Ruxton
This paper presents a report of a nutrition conference held at EXPO 2015 in Milan. Over the course of a day, seven speakers from four continents discussed the evidence and scientific processes that underpin the development of dietary guidelines, highlighting issues and challenges at each stage. These include the quality of studies associating disease outcomes with diet, specifically a reliance on observational studies, short duration of intervention trials, low statistical power and lack of follow-up. Concerns were raised over the oversimplification of dietary messages which promote carbohydrates in general without evidence of benefit, while restricting fats when meta-analyses suggests that different fatty acids have different effects on disease risk...
October 6, 2016: Public Health
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Morgan Price
BACKGROUND: Many health system and health Information and Communication Technology (ICT) projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling (CCM) was designed to assist stakeholders in considering healthcare system changes using a patient centric approach. METHODS: The CCM approach is described...
October 4, 2016: BMC Health Services Research
Yaming Li, Jianhui Li
Death with dignity is a significant issue in modern bioethics. In modern healthcare, the wide use of new technologies at the end of life has caused heated debate on how to protect human dignity. The key point of contention lies in the different understandings of human dignity and the dignity of death. Human dignity has never been a clear concept in Western ethical explorations, and the dignity of death has given rise to more confusions. Although there is no such term as "dignity" in Confucian ethics, there are discussions of a number of ideas related to human dignity and the dignity of death...
October 5, 2016: Theoretical Medicine and Bioethics
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