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End of life discussions

Hajime Ohno, Hirokazu Sato, Yasuhiro Fukushima
To achieve the goals of Paris Agreement, global society is directing much effort in substantially reducing greenhouse gas (GHG) emissions. In addition to energy-related efforts, prevention of carbon release into the atmosphere with carbon capture and storage (CCS) and/or utilization of biomass resources is considered indispensable to achieving the global objective. In this study, considering carbon-containing goods as carbon reservoirs in our society similar to forests and reservoirs enabling CCS, the flow of materially utilized carbon was quantified by input-output-based material flow analysis (IO-MFA)...
March 16, 2018: Environmental Science & Technology
Rieke Schnakenberg, Lukas Radbruch, Christine Kersting, Friederike Frank, Stefan Wilm, Denise Becka, Klaus Weckbecker, Markus Bleckwenn, Johannes M Just, Michael Pentzek, Birgitta Weltermann
BACKGROUND: Although general practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations. OBJECTIVES: This postal survey asked German GPs about their counselling for end-of-life decisions. METHODS: In 2015, a two-sided questionnaire was mailed to 959 GPs. GPs were asked for details of their consultations on ADs: frequency, duration, template use, and whether they have own ADs...
December 2018: European Journal of General Practice
Daniel Stow, Fiona E Matthews, Stephen Barclay, Steve Iliffe, Andrew Clegg, Sarah De Biase, Louise Robinson, Barbara Hanratty
Background: recognising that a patient is nearing the end of life is essential, to enable professional carers to discuss prognosis and preferences for end of life care. Objective: investigate whether an electronic frailty index (eFI) generated from routinely collected data, can be used to predict mortality at an individual level. Design: historical prospective case control study. Setting: UK primary care electronic health records...
March 13, 2018: Age and Ageing
Che-Wei Lin, Elizabeth H Chang, Daniel L Clinciu, Yun-Ting Peng, Wen-Chen Huang, Chien-Chih Wu, Jen-Chieh Wu, Yu-Chuan Li
BACKGROUND AND OBJECTIVE: Objective Structured Clinical Examination (OSCE) has been used in many areas of healthcare training over the years. However, it constantly needs to be upgraded and enhanced due to technological and teaching changes. We aim at implementing an integrative OSCE method which employs informatics via the virtual patient within the pharmacy education curriculum at Taipei Medical University to enhance the pharmacy students' competence for using and disseminating information and to also improve critical thinking and clinical reasoning...
May 2018: Computer Methods and Programs in Biomedicine
Issam Bennis, Vincent De Brouwere, Zakaria Belrhiti, Hamid Sahibi, Marleen Boelaert
BACKGROUND: Cutaneous Leishmaniasis (CL) is a parasitic skin disease, linked to poverty, and belonging to the group of Neglected Tropical Diseases. Depending on the severity, the type of lesions or scars, and the context, CL can lead to self- and social stigma influencing the quality of life and psychological well-being of the patient. This dimension is, however, little documented for the most common, localized form of cutaneous leishmaniasis (LCL). We aimed to describe the current knowledge on the psychological burden and the stigma related to LCL...
March 15, 2018: BMC Public Health
Fabiola Fuchs, Martin Robausch
BACKGROUND: The topic of "medical oversupply at the end-of-life" is being discussed intensively internationally. The aim of this paper is to present the data of end-of-life care in one region in Austria (Lower Austria). METHODS: The data basis for the end-of-life indicators was the routine data (secondary data analysis) of the Lower Austrian District Health Insurance Fund (NÖGKK) from 2015. The basic population consisted of persons with inpatient hospitalization with a cancer diagnosis...
March 13, 2018: Wiener Medizinische Wochenschrift
Lindsay J Blazin, Cherilyn Cecchini, Catherine Habashy, Erica C Kaye, Justin N Baker
Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers...
March 11, 2018: Children
Kristi Soileau, Nanette Elster
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care...
January 1, 2018: Journal of Palliative Care
Julie L Masters, Paige M Toller, Nancy J Kelley, Lyn M Holley
Death is among the most avoided topics of conversation. Although end-of-life planning may greatly benefit individuals and their survivors, research and practice indicate that family, friends, and even health care providers resist discussing end-of-life plans. Consequences of not planning ahead have created a public health issue. This article describes a community-level intervention that facilitates those necessary conversations among elders who have at least begun to talk with others about their wishes. A free, three-part educational workshop series on end-of-life planning titled "Begin with the End in Mind" was developed at a midwestern university...
March 12, 2018: Gerontology & Geriatrics Education
I Hawes, A D Jungblut, E D Matys, R E Summons
The Cryogenian (~717-636 Ma) is characterized by widespread glaciation and dramatic fluctuations in biogeochemical cycling during the Sturtian and Marinoan glaciations. The Snowball Earth hypothesis posits that during this period, ice-covered oceans of more or less global extent shut down or greatly diminished photosynthesis in the marine realm. However, rather than suffering a catastrophic loss of biodiversity, fossil evidence suggests that major eukaryotic lineages survived and, indeed, the end of the Cryogenian marks the onset of a rapid diversification of eukaryotic life...
March 12, 2018: Geobiology
Mary M Mitchell, Eric D Hansen, Tuo-Yen Tseng, Meng Shen, Cynda Rushton, Tom Smith, Nancy Hutton, Jennifer Wolfe, Lee Bone, Jeanne Keruly, Lawrence Wissow, Amy R Knowlton
CONTEXT & OBJECTIVE: Advance care planning (ACP) rates remain low, especially among people who are HIV positive, disadvantaged, and African American. While ACP can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. METHODS: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, MD, who had histories of illicit drug use...
March 8, 2018: Journal of Pain and Symptom Management
Ariel Amir, Nathalie Q Balaban
For many decades, the wedding of quantitative data with mathematical modeling has been fruitful, leading to important biological insights. Here, we review some of the ongoing efforts to gain insights into problems in microbiology - and, in particular, cell-cycle progression and its regulation - through observation and quantitative analysis of the natural fluctuations in the system. We first illustrate this idea by reviewing a classic example in microbiology - the Luria-Delbrück experiment - and discussing how, in that case, useful information was obtained by looking beyond the mean outcome of the experiment, but instead paying attention to the variability between replicates of the experiment...
March 8, 2018: Trends in Microbiology
Graziano Bargiggia, Maurizio Ruggeri, Gaia Ortalli, Simona Gabrielli, Paola Rodari, Lorenzo D'Antiga, Claudio Farina
Chagas disease (CD) is an uncommon disease in Europe. Its epidemiology has changed because of mass migration from Latin America to Europe. Herein we describe a congenital case of CD in a Bolivian newborn in Bergamo, the main city of residence for the Bolivian community in Italy. At delivery, serological analyses evidenced IgG antibodies against Trypanosoma cruzi both in the child and mother, as expected. Hemoscopic analyses on peripheral blood were repeatedly negative during the first months of life. Eventually, thanks to T...
March 1, 2018: Le Infezioni in Medicina
Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen, Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand
BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale...
March 6, 2018: Archives of Gerontology and Geriatrics
Fiona Ma MacCormick, Charlotte Emmett, Paul Paes, Julian C Hughes
BACKGROUND: Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking. AIM: To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors. DESIGN: The data presented in this paper were collected as part of a wider research study of end-of-life care in an acute hospital setting...
March 9, 2018: Journal of Medical Ethics
Brittany N Krekeler, Elizabeth Wendt, Cameron Macdonald, Jason Orne, David O Francis, Rebecca Sippel, Nadine P Connor
Importance: It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population. Objective: Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes. Design, Setting, and Participants: Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months) Data were collected from an ongoing clinical trial (NCT02138214), and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics...
March 8, 2018: JAMA Otolaryngology—Head & Neck Surgery
Anne L Donovan, J Matthew Aldrich, A Kendall Gross, Denise M Barchas, Kevin C Thornton, Hildy M Schell-Chaple, Michael A Gropper, Angela K M Lipshutz
OBJECTIVES: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives...
March 7, 2018: Critical Care Medicine
Andrea Postier, Kris Catrine, Stacy Remke
Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child's end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community...
March 7, 2018: Children
Patrick M Harrington, Claire N Harrison
The outlook for patients with myeloproliferative neoplasms, particularly myelofibrosis, has improved in recent years, with greater understanding of the pathogenesis and the subsequent development of a plethora of new agents. Areas covered: This article will discuss some of the advances in the field in recent years and explore in greater detail some of the most advanced emerging agents as well as those with greatest potential. An extensive literature review has been performed to identify recent clinical trials and any relevant pre-clinical work...
March 8, 2018: Expert Review of Hematology
Fanny Guglielmucci, Isabella G Franzoi, Michela Bonafede, Francesca V Borgogno, Federica Grosso, Antonella Granieri
Aim: A cancer diagnosis-and in particular a Malignant Mesothelioma (MM) one-breaks the somatopsychic balance of the individual, compromising the quality of residual life and giving rise to many negative emotions difficult to integrate and to elaborate (such as depression, fears, anxieties, hopelessness, guilt, shame, and rage). Several national and international guidelines acknowledged the importance of evaluating psychological and socio-relational features in MM patients and their caregiver. However, only few studies have investigated the subjective experience of MM patients and even less research has focused on the caregivers' experience...
2018: Frontiers in Psychology
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