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End of life discussions

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https://www.readbyqxmd.com/read/28643812/-conscience-clause-in-end-of-life-care
#1
Ludovica De Panfilis, Daniela Cattaneo, Luisanna Cola, Maddalena Gasparini, Corinna Porteri, Daniela Tarquini, Alessandro Tiezzi, Simone Veronese, Silvia Zullo, Eugenio Pucci
The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento"...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28642163/perianal-structures-in-myrmecophilous-subterranean-aphids-insecta-hemiptera-aphididae-comparative-morphology-of-trophobiotic-organ-with-its-first-description-in-lachninae
#2
Mariusz Kanturski, Jagna Karcz, Natalia Kaszyca, Łukasz Depa
Scanning electron microscopy (SEM) and light stereoscopic microscopy (LSM) were used for the first time to elucidate the external morphology of the so called "trophobiotic organ" on the end of abdomen of apterous viviparous females of six aphid species (Insecta: Hemiptera: Aphididae), representatives of the myrmecophilous, subterranean aphids from the subfamilies Anoeciinae (Anoecia furcata), Eriosomatinae (Forda formicaria, Geoica utricularia, Tetraneura ulmi), and Lachninae (Protrama flavescens, Trama troglodytes)...
June 19, 2017: Arthropod Structure & Development
https://www.readbyqxmd.com/read/28641541/-stress-is-80-years-old-from-hans-selye-original-paper-in-1936-to-recent-advances-in-gi-ulceration
#3
Sandor Szabo, Masashi Yoshida, Janos Filakovszky, Gyorgy Juhasz
The first scientific publication on 'general adaption syndrome', or as we know today 'biologic stress' has been published in Nature in 1936 by the 29-year old Hans Selye. His results in that short publication that contained no references or illustrations, were based on experiments in rats that were exposed to severe insults/stressors, but his idea about a 'nonspecific bodily response' originated from his observations of sick patients whom he had seen as a medical students and young clinician. Autopsy of stressed rats revealed three major, grossly visible changes: hyperemia and enlargement of the adrenals, atrophy of the thymus and lymph nodes as well as hemorrhagic gastric erosions/ulcers (the "stress triad")...
June 22, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28639084/early-palliative-care-for-patients-with-hematologic-malignancies-is-it-really-so-difficult-to-achieve
#4
REVIEW
Thomas W LeBlanc, Eric J Roeland, Areej El-Jawahri
Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors...
June 21, 2017: Current Hematologic Malignancy Reports
https://www.readbyqxmd.com/read/28635218/-nasal-irrigation-for-the-treatment-of-vasomotor-rhinitis-a-pilot-study
#5
L Lin, Q Lu, X Y Tang, F Dai, J J Wei
Objective: To observe the therapeutic effect of simple 3.0% saline nasal irrigation and combined treatment of 3.0% saline nasal irrigation and budesonide nasal spray for vasomotor rhinitis (VMR), and explore the long-term effect for VMR. Through examination of levels of substance P (SP) and mucin (MUC)5B in nasal lavage fluid, the mechanisms of nasal irrigation treatment for VMR was discussed. Methods: One hundred and one patients from Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University with VMR were randomly divided into 4 groups...
June 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/28630131/-it-s-a-hard-conversation-to-have-healthcare-professionals-views-concerning-advance-care-discussions-with-young-people-affected-by-life-limiting-neuromuscular-diseases-an-interview-study
#6
Andy Hiscock, Stephen Barclay
OBJECTIVE: Life-limiting neuromuscular disease, such as some of the muscular dystrophies, are often diagnosed in early childhood: when death comes, commonly in the second or third decade of life, patients rarely have advance care plans in place or documented end-of-life care preferences. There is very limited literature concerning the discussions about end-of-life plans healthcare professionals have with young people affected by life-limiting neuromuscular diseases. The aim of this study was to investigate the views and experiences of healthcare professionals concerning having discussions about advance care plans and end-of-life care with teenagers and young adult patients affected by life-limiting neuromuscular diseases...
June 19, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28629916/a-medical-student-perspective-on-physician-assisted-suicide
#7
John Y Rhee, Katharine A Callaghan, Philip Allen, Amanda Stahl, Martin T Brown, Alexandra Tsoi, Grace McInerney, Ana-Maria G Dumitru
Physician assisted suicide and euthanasia (PAS/E) has been increasingly discussed and debated in the public square, including in professional medical organizations. However, the medical student perspective on the debate has been essentially absent. We present a medical student perspective on the PAS/E debate as future doctors and those about to enter the profession. We argue that PAS/E is not in line with the core principles of medicine, and the focus should rather be on providing high-quality end-of-life and palliative care...
June 16, 2017: Chest
https://www.readbyqxmd.com/read/28628623/use-of-the-deka-arm-for-amputees-with-brachial-plexus-injury-a-case-series
#8
Linda Resnik, Christopher Fantini, Gail Latlief, Samuel Phillips, Nicole Sasson, Eve Sepulveda
OBJECTIVE: Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm. METHODS: This was a mixed-methods study utilizing qualitative (e.g. interview, survey) and quantitative data (e.g. self-report and performance measures). Subject 1, a current prosthesis user, had a shoulder arthrodesis...
2017: PloS One
https://www.readbyqxmd.com/read/28622379/end-of-life-care-for-people-with-dementia-the-views-of-health-professionals-social-care-service-managers-and-frontline-staff-on-key-requirements-for-good-practice
#9
Richard Philip Lee, Claire Bamford, Marie Poole, Emma McLellan, Catherine Exley, Louise Robinson
BACKGROUND: Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. METHODS AND FINDINGS: Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads...
2017: PloS One
https://www.readbyqxmd.com/read/28616221/time-timing-talking-and-training-findings-from-an-exploratory-action-research-study-to-improve-quality-of-end-of-life-care-for-minority-ethnic-kidney-patients
#10
Emma Wilkinson, Gurch Randhawa, Edwina Brown, Maria Da Silva Gane, John Stoves, Graham Warwick, Tahira Mir, Regina Magee, Sue Sharman, Ken Farrington
Background. With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. Aim. This study purposively explored South Asian patients' experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Methods. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28602377/end-of-life-care-in-the-treatment-of-heart-failure-in-older-adults
#11
REVIEW
John Arthur McClung
Heart failure presents unique challenges to the clinician who desires to provide excellent and humane care near the end of life. Accurate prediction of mortality in the individual patient is complicated by a chronic disease that is punctuated by recurrent acute episodes and sudden death. Health care providers continue to have difficulty communicating effectively with terminally ill patients and their caregivers regarding end-of-life care preferences, all of which needs to occur earlier rather than later. This article also discusses various means of providing palliative care, and specific issues regarding device therapy, cardiopulmonary resuscitation, and palliative sedation with concurrent discussion of the ethical ramifications and pitfalls of each...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28600658/clinical-ethics-support-for-healthcare-personnel-an-integrative-literature-review
#12
Dara Rasoal, Kirsti Skovdahl, Mervyn Gifford, Annica Kihlgren
This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice...
June 9, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28599819/between-the-best-way-to-deliver-patient-care-and-chaos-and-low-clinical-value-general-practitioners-and-practice-managers-views-on-data-sharing
#13
Mila Petrova, Matthew Barclay, Sam S Barclay, Stephen I G Barclay
OBJECTIVE: In the UK, General Practitioners and Practice Managers are key to enabling health information exchange (typically referred to as 'data sharing'). This study aimed to survey GPs and PMs for familiarity, engagement with and perceptions of patient data sharing. METHODS: Cross-sectional survey. All 107 general practices in England's second largest Clinical Commissioning Group, Cambridgeshire & Peterborough CCG. Descriptive statistics; hierarchical logistic regression; thematic analysis...
August 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28595818/do-not-resuscitate-orders-and-high-risk-pediatric%C3%A2-surgery-professional-nuisance-or%C3%A2-medical%C3%A2-necessity
#14
Lauren M Baumann, Kibileri Williams, Fizan Abdullah, Richard J Hendrickson, Tolulope A Oyetunji
BACKGROUND: There is a paucity of data in the literature regarding end-of-life care and do-not-resuscitate (DNR) status of the pediatric surgical patient, although invasive procedures are frequently performed in very high risk and critically ill children. Despite significant efforts in adult medicine to enhance discussions around end-of-life care, little is known about similar endeavors in the pediatric population. METHODS: A retrospective review of the National Surgical Quality Improvement Program Pediatric database was performed...
May 11, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28594366/rf-emf-risk-perception-revisited-is-the-focus-on-concern-sufficient-for-risk-perception-studies
#15
Peter M Wiedemann, Frederik Freudenstein, Christoph Böhmert, Joe Wiart, Rodney J Croft
An implicit assumption of risk perception studies is that concerns expressed in questionnaires reflect concerns in everyday life. The aim of the present study is to check this assumption, i.e., the extrapolability of risk perceptions expressed in a survey, to risk perceptions in everyday life. To that end, risk perceptions were measured by a multidimensional approach. In addition to the traditional focus on measuring the magnitude of risk perceptions, the thematic relevance (how often people think about a risk issue) and the discursive relevance (how often people think about or discuss a risk issue) of risk perceptions were also collected...
June 8, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28593019/rural-physicians-scope-of-practice-on-remote-islands-a-case-report-of-severe-pneumonia-that-required-overnight-artificial-airway-management
#16
Ryuichi Ohta, Akira Shimabukuro
Objective: To clarify the scope of practice on rural islands of Okinawa. Patient: A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours. Discussion: In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care. Conclusion: This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa...
May 2017: Journal of Rural Medicine: JRM
https://www.readbyqxmd.com/read/28592468/improving-health-care-provider-communication-in-end-of-life-decision-making
#17
Tracey Wilson, Cathy Haut, Bimbola Akintade
Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28587771/hypercholesterolemia-the-role-of-pcsk9
#18
REVIEW
Quantil M Melendez, Sreevidhya T Krishnaji, Catherine J Wooten, Dayami Lopez
Heart disease ends the life of more people than any other disease in the United States. High levels of low density lipoprotein (LDL)-cholesterol cause heart diseases by increasing the formation of atherosclerotic plaques. Proprotein convertase subtilisin/kexin-9 (PCSK9) indirectly regulates plasma LDL levels by controlling the LDL receptor expression at the plasma membrane. PCSK9 also appears to modulate glucose intolerance, insulin resistance, abdominal obesity, inflammation, and hypertension. The magnitude of PCSK9's involvement in the onset of these metabolic abnormalities appears to be associated with age, sex, and ethnic background...
June 3, 2017: Archives of Biochemistry and Biophysics
https://www.readbyqxmd.com/read/28587143/improving-outcomes-in-patients-with-crc-the-role-of-patient-reported-outcomes-an-esdo-report
#19
REVIEW
Eric Van Cutsem, Aimery De Gramont, Geoffrey Henning, Philippe Rougier, Franck Bonnetain, Thomas Seufferlein
Colorectal cancer is one of the most commonly diagnosed cancers worldwide and nearly half of patients will develop metastatic disease at some point during the course of their disease. The goal of anticancer therapy in this context is to extend survival, while trying to maximise the patient's health-related quality of life. To this end, we need to understand how to incorporate patient-reported outcomes into clinical trials and routine practice to accurately assess if treatment strategies are providing clinical benefit for the patient...
May 26, 2017: Cancers
https://www.readbyqxmd.com/read/28583175/are-advance-directives-helpful-for-good-end-of-life-decision-making-a-cross-sectional-survey-of-health-professionals
#20
Eimantas Peicius, Aurelija Blazeviciene, Raimondas Kaminskas
BACKGROUND: This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives...
June 5, 2017: BMC Medical Ethics
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