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Poor end-of-life care

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https://www.readbyqxmd.com/read/29330999/reasons-of-self-discharge-from-nursery-of-a-tertiary-care-hospital
#1
Rabia Abbas, Khawaja Ahmad Irfan Waheed, Talal Waqar, Muhammad Anwar, Rafia Gul, Sikandar Hayat, Syeda Tehseen Fatima, Muhammad Azhar
BACKGROUND: Patients who leave against medical advice (LAMA) from a health facility is a recognized problem. In neonatology practice this issue is particularly sensitive as repercussions can be severe. The purpose of this study was to evaluate the factors influencing the decision of parents to self-discharge their babies against medical advice. METHODS: This descriptive case series was conducted in the Department of Neonatology, of the Children's Hospital and the Institute of Child Health, Lahore from January to June 2015...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/29313654/lung-cancer-clinical-presentation-and-diagnosis
#2
Kelly M Latimer
In the absence of screening, most patients with lung cancer are not diagnosed until later stages, when the prognosis is poor. The most common symptoms are cough and dyspnea, but the most specific symptom is hemoptysis. Digital clubbing, though rare, is highly predictive of lung cancer. Symptoms can be caused by the local tumor, intrathoracic spread, distant metastases, or paraneoplastic syndromes. Clinicians should suspect lung cancer in symptomatic patients with risk factors. The initial study should be chest x-ray, but if results are negative and suspicion remains, the clinician should obtain a computed tomography scan with contrast...
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29311368/education-research-difficult-conversations-in-neurology-lessons-learned-from-medical-students
#3
Monica E Lemmon, Charlene Gamaldo, Rachel Marie E Salas, Ankita Saxena, Tiana E Cruz, Renee D Boss, Roy E Strowd
OBJECTIVE: To characterize features of medical student exposure to difficult conversations during a neurology core clerkship. METHODS: This was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient-clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care...
January 9, 2018: Neurology
https://www.readbyqxmd.com/read/29303003/development-and-content-validity-of-the-behavioral-assessment-screening-tool-bast%C3%AE
#4
Shannon B Juengst, Lauren Terhorst, Brad E Dicianno, Janet P Niemeier, Amy K Wagner
PURPOSE: Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTβ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. METHODS: This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7)...
January 5, 2018: Disability and Rehabilitation
https://www.readbyqxmd.com/read/29301524/what-does-complex-mean-in-palliative-care-triangulating-qualitative-findings-from-3-settings
#5
Emma Carduff, Sarah Johnston, Catherine Winstanley, Jamie Morrish, Scott A Murray, Juliet Spiller, Anne Finucane
BACKGROUND: Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. METHODS: Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings...
January 4, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29297392/summary-findings-from-a-mixed-methods-study-on-identifying-and-responding-to-maternal-and-newborn-illness-in-seven-countries-implications-for-programs
#6
Danielle Charlet, Allisyn C Moran, Supriya Madhavan
BACKGROUND: There is a lack of systematic information documenting recognition of potentially life-threatening complications and decisions to seek care, as well as reaching care and the specific steps in that process. In response to this gap in knowledge, a multi-country mixed methods study was conducted to illuminate the dynamics driving Delays 1 and 2 across seven countries for maternal and newborn illness and death. METHODS: A common protocol and tools were developed, adapted by each of seven study teams depending on their local context (Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda, and Nepal)...
December 21, 2017: Journal of Health, Population, and Nutrition
https://www.readbyqxmd.com/read/29290525/-some-were-certainly-better-than-others-bereaved-parents-judgements-of-healthcare-providers-in-the-paediatric-intensive-care-unit-a-grounded-theory-study
#7
Ashleigh E Butler, Beverley Copnell, Helen Hall
OBJECTIVE: To explore bereaved parents' judgements of healthcare providers, as part of a larger study examining their perceptions of the death of a child in the paediatric intensive care unit. RESEARCH METHODOLOGY: Constructivist grounded theory. SETTING: Four Australian paediatric intensive care units. MAIN OUTCOME MEASURES: Semi-structured, audio recorded interviews were undertaken with 26 bereaved parents 6-48 months after their child's death...
December 29, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29288521/indigenous-cultural-competence-a-dental-faculty-curriculum-review
#8
C Forsyth, M Irving, M Tennant, S Short, J Gilroy
BACKGROUND: Indigenous Australians have more than double the rate of poor oral health than their non-Indigenous counterparts. Cultural competence of dental and oral health practitioners is fundamental to health care and quality of life in addressing health disparities in minority cultural groups in Australia. Higher education curricula reviews have identified the need for institutions to incorporate Indigenous culture and knowledge more widely into the curricula to improve educational outcomes for Indigenous Australians and to increase cultural competence for all students...
December 30, 2017: European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe
https://www.readbyqxmd.com/read/29284551/family-care-conferences-in-long-term-care-exploring-content-and-processes-in-end-of-life-communication
#9
Pamela Durepos, Sharon Kaasalainen, Tamara Sussman, Deborah Parker, Kevin Brazil, Susan Mintzberg, Alyssa Te
OBJECTIVE: End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada...
December 29, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29258492/oncology-nurses-perceptions-of-obstacles-and-role-at-the-end-of-life-care-cross-sectional-survey
#10
Aurelija Blaževičienė, Jamesetta A Newland, Vilija Čivinskienė, Renea L Beckstrand
BACKGROUND: Major obstacles exist in the care of patients at the end of life: lack of time, poor or inadequate communication, and lack of knowledge in providing care. Three possible nursing roles in care decision-making were investigated: Information Broker, Supporter, and Advocate. The purpose of this study was to examine obstacles faced by oncology nurses in providing end-of-life (EOL) care and to examine roles of nurses in providing care. METHODS: A descriptive, cross-sectional, correlational design was applied...
December 19, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29251606/issues-in-access-to-end-of-life-care-in-low-resource-areas
#11
Yogesh Jain, Gajanan Phutke
Even though 1% of people require palliative and end-of-life care in low-resource situations, it remains an uncharted arena. Yet it is as important as curative care to alleviate suffering. Palliative care is not only a need in cancer and HIV disease; but is needed in a diverse group of illnesses ranging from tuberculosis, renal failures, paraplegia to chronic lung diseases. In a lower resource setting, the gaps in palliation may be the need for more technology and interventions or more healthcare professionals...
October 25, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/29227577/management-of-pain-in-end-stage-renal-disease-patients-short-review
#12
REVIEW
Rupesh Raina, Vinod Krishnappa, Mona Gupta
Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes...
December 11, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29191293/cardiac-transplantation-current-outcomes-and-contemporary-controversies
#13
REVIEW
Michelle M Kittleson, Jon A Kobashigawa
Despite advances in pharmacologic and device treatment of chronic heart failure, long-term morbidity and mortality remain high, and many patients progress to end-stage heart failure. Over the last 5 decades, heart transplantation (HTx) has become the preferred therapy for select patients with end-stage heart disease. However, although HTx has become standard of care for the management of end-stage heart failure, challenges continue to exist. The number of patients with end-stage heart failure is increasing, whereas the number of donor organs remains constant and a limiting factor in HTx...
December 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29178866/a-scoping-review-of-palliative-care-for-children-in-low-and-middle-income-countries
#14
Hatoko Sasaki, Marie-Charlotte Bouesseau, Joan Marston, Rintaro Mori
BACKGROUND: Ninety-eight percent of children needing palliative care live in low- and middle-income countries (LMICs), and almost half of them live in Africa. In contrast to the abundance of data on populations in high income countries, the current data on populations in LMICs is woefully inadequate. This study aims to identify and summarize the published literature on the need, accessibility, quality, and models for palliative care for children in LMICs. METHODS: A scoping review was performed following the method of Arksey and O'Malley...
November 25, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29178567/prognostic-markers-in-congenital-diaphragmatic-hernia-left-ventricular-diameter-and-pulmonary-hypertension
#15
Derya Karpuz, Dilek Giray, Yalcin Celik, Olgu Hallioglu
BACKGROUND: The aim of the study is to predict prognosis of newborns with congenital diaphragmatic hernia (CDH) with the left ventricular diameter and estimated pulmonary artery pressure values. METHODS: Patients in the newborn unit in 2012-2016 were screened retrospectively. Echocardiographic measurements of 35 patients with isolated left lateral CDH and 25 healthy newborn were compared in the first 24h of life. RESULTS: The mean values ​​of left ventricular end-diastolic (LVEDD) and end-systolic (LVESD) diameters, and ejection fraction were significantly lower in the patients...
November 27, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29171379/collaborative-care-for-screen-positive-elders-with-major-depression-casper-plus-a-multicentred-randomised-controlled-trial-of-clinical-effectiveness-and-cost-effectiveness
#16
Katharine Bosanquet, Joy Adamson, Katie Atherton, Della Bailey, Catherine Baxter, Jules Beresford-Dent, Jacqueline Birtwistle, Carolyn Chew-Graham, Emily Clare, Jaime Delgadillo, David Ekers, Deborah Foster, Rhian Gabe, Samantha Gascoyne, Lesley Haley, Jahnese Hamilton, Rebecca Hargate, Catherine Hewitt, John Holmes, Ada Keding, Helen Lewis, Dean McMillan, Shaista Meer, Natasha Mitchell, Sarah Nutbrown, Karen Overend, Steve Parrott, Jodi Pervin, David A Richards, Karen Spilsbury, David Torgerson, Gemma Traviss-Turner, Dominic Trépel, Rebecca Woodhouse, Simon Gilbody
BACKGROUND: Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management...
November 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29156054/hospice-care-cancer-directed-therapy-and-medicare-expenditures-among-older-patients-dying-with-malignant-brain-tumors
#17
Laura L Dover, Caleb R Dulaney, Courtney P Williams, John B Fiveash, Bradford E Jackson, Paula P Warren, Elizabeth A Kvale, D Hunter Boggs, Gabrielle B Rocque
Background: End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors. Methods: This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary (PMBT) or secondary (SMBT) malignant brain tumor receiving care within a Southeastern cancer community network including academic and community hospitals from 2012-2015...
November 15, 2017: Neuro-oncology
https://www.readbyqxmd.com/read/29143390/chemotherapy-and-healthcare-utilisation-near-the-end-of-life-in-patients-with-cancer
#18
K J G Schulkes, I C van Walree, L J R van Elden, F van den Bos, L van Huis-Tanja, J-W J Lammers, D Ten Bokkel Huinink, M E Hamaker
The quality of medical care delivered to patients with cancer near the end of life is a significant issue. Previous studies have defined several areas suggestive of aggressive cancer treatment as potentially representing poor quality care. The primary objective of current analysis was to examine chemotherapy and healthcare utilisation in the last 3 months of life among patients with cancer that received palliative chemotherapy. Patients were selected from the hospital administration database of the Diakonessenhuis Utrecht, the Netherlands...
November 16, 2017: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29130405/what-is-the-role-of-community-at-the-end-of-life-for-people-dying-in-advanced-age-a-qualitative-study-with-bereaved-family-carers
#19
Merryn Gott, Janine Wiles, Tess Moeke-Maxwell, Stella Black, Lisa Williams, Ngaire Kerse, Gabriella Trussardi
BACKGROUND: New public health approaches to palliative care prioritise the role of community at end of life. However, little is known about community support for the increasing numbers of people dying in advanced age. AIM: To explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. DESIGN: A constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis...
January 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29121886/the-strange-case-of-mr-h-starting-dialysis-at-90%C3%A2-years-of-age-clinical-choices-impact-on-ethical-decisions
#20
Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
BACKGROUND: Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at "extreme" ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. CASE PRESENTATION: Mr...
November 9, 2017: BMC Medical Ethics
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