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Poor end-of-life care

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https://www.readbyqxmd.com/read/28938252/emotional-impact-of-end-of-life-decisions-on-professional-relationships-in-the-icu-an-obstacle-to-collegiality
#1
Alexandra Laurent, Magalie Bonnet, Gilles Capellier, Pierre Aslanian, Paul Hebert
OBJECTIVES: End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. DESIGN: Qualitative study with clinical interviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28893206/efficacy-of-blood-flow-restriction-exercise-during-dialysis-for-end-stage-kidney-disease-patients-protocol-of-a-randomised-controlled-trial
#2
Matthew J Clarkson, Steve F Fraser, Paul N Bennett, Lawrence P McMahon, Catherine Brumby, Stuart A Warmington
BACKGROUND: Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients...
September 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28889141/case-report-a-case-of-pericardial-effusion-presenting-to-primary-care
#3
N K Devaraj
This is a rare but interesting case of Mr. MZ who had a lifethreatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient...
August 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28876970/responding-to-ten-common-delirium-misconceptions-with-best-evidence-an-educational-review-for-clinicians
#4
Mark A Oldham, Nina M Flanagan, Ariba Khan, Olga Boukrina, Edward R Marcantonio
Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists...
September 6, 2017: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/28872748/30-day-mortality-after-systemic-anticancer-treatment-as-a-real-world-quality-of-care-indicator-the-northland-experience
#5
Edmond Ang, Los Vincent Newton
BACKGROUND: Systemic Anticancer Treatment (SACT) at the end of life is considered poor practice due to futility and associated toxicities. Consequently, 30-Day Mortality after SACT is increasingly recognised as a potential real world quality of care indicator in medical oncology. AIMS: Whangarei Base Hospital (WBH) provides outpatient SACT treatment to all patients living in the Northland region of New Zealand. The goal of this study is to report our 30 Day mortality after SACT and to contribute to the experience of its use in Australasia...
September 5, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28871833/facing-death-in-medical-training-a-view-from-students-in-mexico
#6
Asunción Álvarez-Del Río, Ma Luisa Marván, Julieta Gómez Avalos
This study explores how medical students feel about caring for terminally ill patients as well as how their medical courses prepare them for addressing end-of-life (EOL) issues with patients. Four hundred and five Mexican medical students were surveyed through the Student Views on Death questionnaire. The vast majority of students (94%) felt that physicians should inform patients of their impending death. Most students said they felt comfortable talking with (61%) or examining (76%) terminally ill patients...
January 1, 2017: Omega
https://www.readbyqxmd.com/read/28871637/deaths-and-end-of-life-decisions-differed-between-neonatal-and-paediatric-intensive-care-units-at-the-same-children-s-hospital
#7
Maartje C Snoep, Nicolaas J G Jansen, Floris Groenendaal
AIM: We compared neonatal deaths and end-of-life decisions in a neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU) in a Dutch tertiary children's hospital. SUBJECTS: All 235 full-term infants who died within 28 days of life between 2003-2013 in the NICU (n=199) and PICU (n=36) were retrospectively studied. RESULTS: The median length of stay was three days in the NICU and seven days in the PICU (p=0.003). The main reasons for NICU stays were asphyxia (52...
September 4, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28870280/glucose-and-cholesterol-stabilization-in-patients-with-type-2-diabetes-mellitus-with-depressive-and-anxiety-symptoms-by-problem-solving-therapy-in-primary-care-centers-in-mexico-city
#8
Valerio Villamil-Salcedo, Blanca E Vargas-Terrez, Jorge Caraveo-Anduaga, Jorge González-Olvera, Adriana Díaz-Anzaldúa, José Cortés-Sotres, Magdalena Pérez-Ávila
Aim The aim of this study was to determine if the problem-solving therapy (PST) helps control metabolic variables in patients with type 2 diabetes mellitus (T2DM) who show depressive and anxiety symptoms. BACKGROUND: T2DM is a chronic-degenerative multifactorial disease. It is considered one of the main public health problems in the world, and it represents an important social and economic burden. It is frequently associated with major depression and anxiety disorders, which are related with high glycated hemoglobin (HbA1c) concentrations and poor metabolic control...
September 5, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28869693/diabetes-prevalence-and-its-impact-on-health-related-quality-of-life-in-tuberculosis-patients
#9
Ali Nasir Siddiqui, Khalid Umer Khayyam, Nahida Siddiqui, Rohit Sarin, Manju Sharma
OBJECTIVE: To determine the prevalence of diabetes mellitus (DM), assess its influence on health-related quality of life (HRQoL) among TB patients. METHODS: In this prospective study, eligible patients at three primary health care centers in urban slum region of South Delhi, India, underwent blood glucose screening at treatment initiation. HRQoL scores were determined by conducting face-to-face interviews using Dhingra and Rajpal (DR-12) scale at pretreatment, end of intensive phase and end of the treatment...
September 4, 2017: Tropical Medicine & International Health: TM & IH
https://www.readbyqxmd.com/read/28864486/how-can-primary-care-enhance-end-of-life-care-for-liver-disease-qualitative-study-of-general-practitioners-perceptions-and-experiences
#10
Holly Standing, Helen Jarvis, James Orr, Catherine Exley, Mark Hudson, Eileen Kaner, Barbara Hanratty
BACKGROUND: Liver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor. Little is known about general practitioners' (GPs) perceptions of their role in managing end-stage liver disease. OBJECTIVE: To explore GPs' experiences and perceptions of how primary care can enhance end-of-life care for patients with liver disease...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28838779/predictors-of-emergency-department-attendance-by-people-with-dementia-in-their-last-year-of-life-retrospective-cohort-study-using-linked-clinical-and-administrative-data
#11
Katherine E Sleeman, Gayan Perera, Robert Stewart, Irene J Higginson
INTRODUCTION: A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear. METHODS: Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013). RESULTS: Of 4867 patients, 78...
August 8, 2017: Alzheimer's & Dementia: the Journal of the Alzheimer's Association
https://www.readbyqxmd.com/read/28836854/an-update-on-the-developing-mitotic-inhibitors-for-the-treatment-of-non-small-cell-carcinoma
#12
REVIEW
Paola Claudia Sacco, Cesare Gridelli
Mitosis is necessary to sustain life and is followed immediately by cell division into two daughter cells. Microtubules play a key role in the formation of the mitotic spindle apparatus and cytokinesis at the end of mitosis. Various anti-microtubule agents such as taxanes and vinca alkaloids are widely used in the treatment of advanced non-small cell lung cancer (NSCLC) but their use is associated with hematologic toxicity profile, acquired resistance and hypersensitivity reactions. Areas covered: The Nab-paclitaxels are the more recent antimitotic agents approved in NSCLC showing a better tolerability and activity when compared to previous ones...
September 2017: Expert Opinion on Emerging Drugs
https://www.readbyqxmd.com/read/28834888/trend-analysis-of-end-of-life-care-between-hospice-and-nonhospice-groups-of-cancer-patients-in-taiwan-for-2002-11
#13
Jui-Kun Chiang, Yang-Cheng Lee, Yee-Hsin Kao
The aim of the study is to examine the effect of hospice care on quality of end-of-life (EOL) care for patients with advanced cancer in Taiwan between 2002 and 2011.It is a population-based longitudinal study following National Health Insurance medical care claims of hospice and nonhospice patients with advanced cancer in their last month of life.Utilization of hospice service doubled from 10.5% to 21.5% over the study period. Of 12,682 patients identified as having advanced cancer, 7975 (62.88%) were found to have 1 or more quality indicators (QIs) of poor EOL cancer care...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28831636/survival-and-level-of-care-among-breast-cancer-patients-with-brain-metastases-treated-with-whole-brain-radiotherapy
#14
Gabriella Frisk, Beatrice Tinge, Sara Ekberg, Sandra Eloranta, L Magnus Bäcklund, Elisabet Lidbrink, Karin E Smedby
PURPOSE: The benefit of whole brain radiotherapy (WBRT) for late stage breast cancer patients with brain metastases has been questioned. In this study we evaluated survival and level of care (hospital or home) following WBRT in a population-based cohort by personal and tumor characteristics. METHODS: We identified 241 consecutive patients with breast cancer and brain metastases receiving WBRT in Stockholm, Sweden, 1999-2012. Through review of medical records, we collected data on prognostic determinants including level of care before and after WBRT...
August 22, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28827062/the-effectiveness-of-advance-care-planning-in-improving-end-of-life-outcomes-for-people-with-dementia-and-their-carers-a-systematic-review-and-critical-discussion
#15
REVIEW
Josie Dixon, Maria Karagiannidou, Martin Knapp
CONTEXT: End of life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value and under-treatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end of life outcomes for people with dementia and their carers. OBJECTIVE: To systematically and critically review empirical evidence concerning the effectiveness of ACP in improving end of life outcomes for people with dementia and their carers...
August 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28820231/interventions-for-treating-persistent-pain-in-survivors-of-torture
#16
REVIEW
Emma Baird, Amanda C de C Williams, Leslie Hearn, Kirstine Amris
BACKGROUND: Persistent (chronic) pain is a frequent complaint in survivors of torture, particularly but not exclusively pain in the musculoskeletal system. Torture survivors may have no access to health care; where they do, they may not be recognised when they present, and the care available often falls short of their needs. There is a tendency in state and non-governmental organisations' services to focus on mental health, with poor understanding of persistent pain, while survivors may have many other legal, welfare, and social problems that take precedence over health care...
August 18, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28804862/oncological-patients-in-the-intensive-care-unit-prognosis-decision-making-therapies-and-end-of-life-care
#17
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/28792485/operational-details-of-the-five-domains-model-and-its-key-applications-to-the-assessment-and-management-of-animal-welfare
#18
REVIEW
David J Mellor
In accord with contemporary animal welfare science understanding, the Five Domains Model has a significant focus on subjective experiences, known as affects, which collectively contribute to an animal's overall welfare state. Operationally, the focus of the Model is on the presence or absence of various internal physical/functional states and external circumstances that give rise to welfare-relevant negative and/or positive mental experiences, i.e., affects. The internal states and external circumstances of animals are evaluated systematically by referring to each of the first four domains of the Model, designated "Nutrition", "Environment", "Health" and "Behaviour"...
August 9, 2017: Animals: An Open Access Journal From MDPI
https://www.readbyqxmd.com/read/28792079/mentoring-relationship-quality-and-maltreated-children-s-coping
#19
Ashley A Chesmore, Lindsey M Weiler, Heather N Taussig
Coping strategies are believed to protect against the harmful effects of maltreatment on children's psychosocial outcomes. Caregivers are thought to be critical in helping children develop adaptive coping strategies, yet many maltreated children have poor and/or insecure relationships with their parents. A quality relationship with a caring, non-parental adult (e.g., a mentor), however, may be one strategy to promote healthy coping among maltreated children. Children (N = 154) in this study participated in a mentoring and skill-based program for maltreated preadolescents placed in foster care...
August 9, 2017: American Journal of Community Psychology
https://www.readbyqxmd.com/read/28783450/health-care-use-by-older-adults-with-acute-myeloid-leukemia-at-the-end-of-life
#20
Rong Wang, Amer M Zeidan, Stephanie Halene, Xiao Xu, Amy J Davidoff, Scott F Huntington, Nikolai A Podoltsev, Cary P Gross, Steven D Gore, Xiaomei Ma
Purpose Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML). End-of-life care is particularly relevant for older adults with AML because of their poor prognosis. Methods We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment...
August 7, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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