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Poor end-of-life care

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https://www.readbyqxmd.com/read/28432089/preparing-future-doctors-for-palliative-care-views-of-course-organisers
#1
Steven Walker, Jane Gibbins, Paul Paes, Stephen Barclay, Astrid Adams, Madawa Chandratilake, Faye Gishen, Philip Lodge, Bee Wee
BACKGROUND: Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown. OBJECTIVE: To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction. METHODS: An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools...
April 21, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28387570/seeking-and-accepting-u-s-clergy-theological-and-moral-perspectives-informing-decision-making-at-the-end-of-life
#2
Justin J Sanders, Vinca Chow, Andrea C Enzinger, Tai-Chung Lam, Patrick T Smith, Rebecca Quiñones, Andrew Baccari, Sarah Philbrick, Gloria White-Hammond, John Peteet, Tracy A Balboni, Michael J Balboni
BACKGROUND: People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework. OBJECTIVE: We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness...
April 7, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28361048/screening-for-hypertension-in-children-and-adolescents-methodology-and-current-practice-recommendations
#3
REVIEW
Michaela N Lewis, Ibrahim F Shatat, Shannon M Phillips
Hypertension (HTN) requires urgent, uniform, and consistent attention across all frontiers of pediatric health care not only because of established links between the onset of HTN during one's youth and its sustenance throughout adulthood but also because of the sequelae associated with the disease's trajectory, such as cardiovascular disease, end organ damage, and decreased quality of life. Although national guidelines for the diagnosis and management of pediatric HTN have been available for nearly 40 years, knowledge and recognition of the problem by clinicians remain poor due to a host of influencing factors...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28358269/gaps-in-understanding-the-experiences-of-homecare-workers-providing-care-for-people-with-dementia-up-to-the-end-of-life-a-systematic-review
#4
Valerie D'Astous, Ruth Abrams, Tushna Vandrevala, Kritika Samsi, Jill Manthorpe
This systematic review of the literature explores the perspectives and experiences of homecare workers providing care for people with dementia living at home up to the end of life. A search of major English language databases in 2016 identified 378 studies on the topic, of which 12 met the inclusion criteria. No empirical research was identified that specifically addressed the research question. However, synthesis of the findings from the broader literature revealed three overarching themes: value of job role, emotional labour and poor information and communication...
January 1, 2017: Dementia
https://www.readbyqxmd.com/read/28341400/the-breath-of-life-patients-experiences-of-breathing-during-and-after-mechanical-ventilation
#5
Hege S Haugdahl, Helena Dahlberg, Pål Klepstad, Sissel L Storli
INTRODUCTION: Breathlessness is a prevalent and distressing symptom in intensive care, underestimated by nurses and physicians. Therefore, to develop a more comprehensive understanding of this problem, the study had two aims: to compare patients' self-reported scores of breathlessness obtained during mechanical ventilation (MV) with experiences of breathlessness later recalled by patients and: to explore the lived experience of breathing during and after MV. METHOD: A qualitatively driven sequential mixed method design combining prospective observational breathlessness data at the end of a spontaneous breathing trial (SBT) and follow up data from 11 post-discharge interviews...
March 21, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28339313/palliative-care-in-surgery-defining-the-research-priorities
#6
Elizabeth J Lilley, Zara Cooper, Margaret L Schwarze, Anne C Mosenthal
Given the acute and often life-limiting nature of surgical illness, as well as the potential for treatment to induce further suffering, surgical patients have considerable palliative care needs. Yet, these patients are less likely to receive palliative care than their medical counterparts and palliative care consultations often occur when death is imminent, reflecting poor quality end-of-life care. Surgical patients would likely benefit from early palliative care delivered alongside surgical treatment to promote goal-concordant decision making and to improve patients' physical, emotional, social, and spiritual well-being and quality of life...
March 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28282238/changes-in-the-sleep-wake-rhythm-sleep-quality-mood-and-quality-of-life-of-patients-receiving-treatment-for-lung-cancer-a-longitudinal-study
#7
Wen-Pei Chang, Chia-Chin Lin
Studies on the diurnal sleep-wake rhythm of patients with lung cancer have mostly examined patients cross-sectionally, whereas the effects of lung cancer treatment over time have rarely been considered. Through long-term longitudinal tracking of patients with lung cancer, this study examined changes in their sleep-wake rhythm, sleep quality, anxiety, depressive symptoms, fatigue and quality of life (QoL) at various treatment stages. In addition, factors affecting their QoL were explored. Hierarchical linear modeling was adopted to analyze a convenience sample of 82 patients with lung cancer...
2017: Chronobiology International
https://www.readbyqxmd.com/read/28271872/barriers-to-and-opportunities-for-palliative-care-development-in-the-eastern-mediterranean-region
#8
REVIEW
Ibtihal Fadhil, Gemma Lyons, Sheila Payne
The 22 countries of WHO's Eastern Mediterranean Region are experiencing an increase in the burden of non-communicable diseases (NCDs), including cancer. Of the six WHO regions, the Eastern Mediterranean Region is projected to have the greatest increase in cancer incidence in the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in the European Region and the Region of the Americas. With increasing numbers of deaths from cancer, palliative care should be available to relieve suffering in patients with advanced disease and at the end of life...
March 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28246074/delirium-after-mechanical-ventilation-in-intensive-care-units-the-cognitive-and-psychosocial-assessment-capa-study-protocol
#9
Daniella Bulic, Michael Bennett, Helen Rodgers, Mary Nourse, Patrick Rubie, Jeffrey Cl Looi, Frank Van Haren
BACKGROUND: In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment...
February 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28242792/survival-gains-from-first-line-systemic-therapy-in-metastatic-non-small-cell-lung-cancer-in-the-u-s-1990-2015-progress-and-opportunities
#10
Joshua A Roth, Bernardo H L Goulart, Arliene Ravelo, Holli Kolkey, Scott D Ramsey
BACKGROUND: Approximately 190,000 Americans are diagnosed with non-small cell lung cancer (NSCLC) annually, and about half have metastatic (Stage IV) disease. These patients have historically had poor survival prognosis, but several new therapies introduced since 2000 provide options for improved outcomes. The objectives of this study were to quantify survival gains from 1990, when best supportive care (BSC) only was standard, to 2015 and to estimate the impact of expanded use of systemic therapies in clinically appropriate patients...
February 27, 2017: Oncologist
https://www.readbyqxmd.com/read/28242134/system-level-barriers-and-facilitators-for-foregoing-or-withdrawing-dialysis-a-qualitative-study-of-nephrologists-in%C3%A2-the%C3%A2-united-states-and-england
#11
Vanessa Grubbs, Delphine S Tuot, Neil R Powe, Donal O'Donoghue, Catherine A Chesla
BACKGROUND: Despite a growing body of literature suggesting that dialysis does not confer morbidity or mortality benefits for all patients with chronic kidney failure, the initiation and continuation of dialysis therapy in patients with poor prognosis is commonplace. Our goal was to elicit nephrologists' perspectives on factors that affect decision making regarding end-stage renal disease. STUDY DESIGN: Semistructured, individual, qualitative interviews. METHODOLOGY: Participants were purposively sampled based on age, race, sex, geographic location, and practice type...
February 24, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28224693/analysis-of-team-types-based-on-collaborative-relationships-among-doctors-home-visiting-nurses-and-care-managers-for-effective-support-of-patients-in-end-of-life-home-care
#12
Junko Fujita, Sakiko Fukui, Sumie Ikezaki, Chizuru Otoguro, Mayuko Tsujimura
AIM: To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. METHODS: A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis...
February 21, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28216866/home-based-palliative-services-under-two-local-self-government-institutions-of-kerala-india-an-assessment-of-compliance-with-policy-and-guidelines-to-local-self-government-institutions
#13
Rajeev Jayalakshmi, Chatterjee Chopra Suhita
BACKGROUND: In contrast to India's poor performance in palliative and end-of-life care, the state of Kerala has gained considerable attention for its palliative care (PC) policy. This study tried to understand the structure, organization, and delivery of the program currently offered to the rural population, and its conformity to the state's PC policy and guidelines for Local Self-government Institutions (LSGIs). MATERIALS AND METHODS: A descriptive research design involving a review of Kerala palliative policy and guidelines for LSGIs was followed by direct field observation and interviews of stakeholders...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28214237/knowledge-attitudes-and-preferences-of-advance-decisions-end-of-life-care-and-place-of-care-and-death-in-hong-kong-a%C3%A2-population-based-telephone-survey-of-1067-adults
#14
Roger Yat-Nork Chung, Eliza Lai-Yi Wong, Nicole Kiang, Patsy Yuen-Kwan Chau, Janice Y C Lau, Samuel Yeung-Shan Wong, Eng-Kiong Yeoh, Jean W Woo
OBJECTIVES: According to the 2015 Quality of Death Index published by the Intelligence Unit of the Economist, Hong Kong is ranked 22nd in terms of quality of palliative care in the world, behind many other major developed countries in Asia, including Taiwan, Singapore, Japan, and South Korea. The objectives of the present study were to describe the knowledge, attitude, and preferences of the general Hong Kong adult population across different age groups regarding end-of-life (EOL) care decisions, place of care and death, as well as advance directive (AD)...
April 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28212579/suicidal-ideation-among-chinese-cancer-inpatients-of-general-hospitals-prevalence-and-correlates
#15
Bao-Liang Zhong, Si-Heng Li, Shu-Yan Lv, Shun-Li Tian, Zhi-Dong Liu, Xu-Bin Li, Hong-Qing Zhuang, Ran Tao, Wei Zhang, Chuan-Jun Zhuo
Cancer patients are at high risk for suicide, particularly when they are informed about the cancer diagnosis or hospitalized for cancer treatment. Therefore, oncology healthcare settings such as large general hospitals in China, may represent an ideal setting to identify and treat suicidality in cancer patients. However, the clinical epidemiology of suicidality of Chinese cancer patients remains largely unknown. This study examined the prevalence and correlates of suicidal ideation among Chinese cancer inpatients of large general hospitals...
February 15, 2017: Oncotarget
https://www.readbyqxmd.com/read/28208905/n-acetylcysteine-combined-with-home-based-physical-activity-effect-on-health-related-quality-of-life-in-stable-copd-patients-a-randomised-controlled-trial
#16
Vijay Tukaram Salve, Jitesh S Atram
INTRODUCTION: Quality of life is adversely affected in Chronic Obstructive Pulmonary Disease (COPD), due to irreversible, progressive nature of the disease and limitations of current treatment options available. One of the important aim of treatment of COPD is to improve Quality of Life (QoL). Cigarette smoke contains numerous free radicals and other oxidants. Oxidative stress has been implicated in pathogenesis, progression of disease and exacerbation in COPD. Pulmonary tuberculosis, outdoor and indoor air pollution and many others are aetiologies of COPD in non-smokers...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28199030/lessons-learned-from-the-science-of-caring-extending-the-reach-of-psychosocial-oncology-the-international-psycho-oncology-society-2016-sutherland-award-lecture
#17
Barry D Bultz
In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment or end of life distress. These observations are usually based on clinical acumen not on metrics...
February 15, 2017: Psycho-oncology
https://www.readbyqxmd.com/read/28169857/intersection-of-prognosis-and-palliation-in-neurocritical-care
#18
Michael Rubin, Jordan Bonomo, J Claude Hemphill
PURPOSE OF REVIEW: Difficult discussions regarding end-of-life care are common in neurocritical care. Because of a patient's neurological impairment, decisions regarding continuing or limiting aggressive care must often be made by patients' families in conjunction with medical providers. This review provides perspective on three major aspects of this circumstance: prognostication, family-physician discussions, and determination of death (specifically as it impacts on organ donation). RECENT FINDINGS: Numerous studies have now demonstrated that prediction models developed from populations of brain-injured patients may be misleading when applied to individual patients...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28156664/association-between-anti-cholinergic-burden-and-delirium-among-patients-with-advanced-cancer-referred-to-a-palliative-care-consult-service
#19
Joseph Baidoo, Vishidha Reddy Balankari, Jessica Marie Waletich-Flemming, Marvin Delgado-Guay, Jimin Wu, Diane D Liu, Eduardo Bruera
213 Background: Delirium occurs in about 45-60% hospitalized patients and 80-85% at the end of life. Predisposing factors include anti-cholinergic medications as is often cited in the geriatric literature. Our study aimed to demonstrate the association of anti-cholinergic burden and delirium in patients with advanced cancer. METHODS: Retrospective review of 775 consecutive patients seen by the palliative care inpatient consult team. Demographic data, MDAS, ECOG, and anti-cholinergic drugs were determined...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156634/randomized-trial-of-early-integrated-palliative-and-oncology-care
#20
Areej El-Jawahri, William F Pirl, Vicki A Jackson, Elyse R Park, Anthony Back, Alona Muzikansky, Mihir Kamdar, Simone Rinaldi, Juliet Jacobsen, Emily R Gallagher, Joel Fishbein, Justin Eusebio, Harry VanDusen, Jennifer S Temel
104 Background: Early palliative care (PC) improves outcomes in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) and in patients identified by clinicians as having poor prognosis, advanced cancer. We evaluated the impact of early, integrated palliative and oncology care in patients with newly diagnosed lung and gastrointestinal (GI) cancer. METHODS: Between 5/2/11 and 7/20/15, we randomly assigned patients with newly diagnosed incurable lung (NSCLC, small cell, mesothelioma) or GI (pancreas, hepatobiliary, gastric, esophageal) cancer to PC integrated with oncology care (monthly visits with PC) or usual oncology care...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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