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End of life issues

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https://www.readbyqxmd.com/read/28098622/physician-assisted-suicide-and-euthanasia-in-the-icu-a-dialogue-on-core-ethical-issues
#1
Ewan C Goligher, E Wesley Ely, Daniel P Sulmasy, Jan Bakker, John Raphael, Angelo E Volandes, Bhavesh M Patel, Kate Payne, Annmarie Hosie, Larry Churchill, Douglas B White, James Downar
OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28095941/preparation-for-the-end-of-life-and-life-completion-during-late-stage-lung-cancer-an-exploratory-analysis
#2
Gail Adorno, Cara Wallace
OBJECTIVE: Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions...
January 18, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28095906/cost-of-physician-led-home-visit-care-zaitaku-care-compared-with-hospital-care-at-the-end-of-life-in-japan
#3
Kentaro Kinjo, Tomoko Sairenji, Hidenobu Koga, Yasuhiro Osugi, Shin Yoshida, Hidefumi Ichinose, Yasunori Nagai, Hiroshi Imura, Jeannette E South-Paul, Mark Meyer, Yoshihisa Honda
BACKGROUND: Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan...
January 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28095759/living-with-end-stage-renal-disease
#4
Karen Schipper, Elleke Landeweer, Tineke A Abma
BACKGROUND: Living with a renal disease often reduces quality of life because of the stress it entails. No attention has been paid to the moral challenges of living with renal disease. OBJECTIVES: To explore the moral challenges of living with a renal disease. RESEARCH DESIGN: A case study based on qualitative research. We used Walker's ethical framework combined with narrative ethics to analyse how negotiating care responsibilities lead to a new perspective on moral issues...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28081556/stressful-events-and-circumstances-reported-by-patients-prior-to-being-prescribed-antidepressants
#5
Morgyn Hartdegen, Kerry Gibson, Claire Cartwright, John Read
AIMS: This study investigates the extent to which those who receive a prescription for antidepressants perceive psychosocial stressors to be significant in their difficulties. METHODS: This study draws on a survey of adults prescribed antidepressants. It analyses 1,683 responses to an open-ended question that enquired about difficult events and circumstances participants experienced in the time leading up to receiving an antidepressant prescription. RESULTS: Sixty-five percent of respondents described experiencing one or more stressful events or circumstances, with 19 % reporting two and 20% reporting three or more...
January 13, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28076529/relationships-between-oncohematopediatrics-mothers-and-children-in-communicating-bad-news
#6
Selene Beviláqua Chaves Afonso, Maria Cecília de Souza Minayo
We present a study about the relations between pediatric oncological haematologists, mothers, and children in sharing bad news (BN) in a public hospital in Rio de Janeiro. The text emphasizes the intertwining of technique and emotions for the treatment of children with diagnoses in which the fatal outcome is always a probability. We used a qualitative approach, privileging participant observation and open interviews with oncologists (at this service all professionals were female) and mothers. We sought to understand the importance of communication which includes expressions and control of emotions; bioethical issues that require sensitivity, serenity, and truth about approaching the end of life; and how the professionals balance proximity to children and families and objectivity in their activity...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28075655/experiences-and-preferences-for-end-of-life-care-for-young-adults-with-cancer-and-their-informal-carers-a-narrative-synthesis
#7
Nothando Ngwenya, Charlotte Kenten, Louise Jones, Faith Gibson, Susie Pearce, Mary Flatley, Rachael Hough, L Caroline Stirling, Rachel M Taylor, Geoff Wong, Jeremy Whelan
To review the qualitative literature on experiences of and preferences for end-of-life care of people with cancer aged 16-40 years (young adults) and their informal carers. A systematic review using narrative synthesis of qualitative studies using the 2006 UK Economic and Social Research Council research methods program guidance. Seven electronic bibliographic databases, two clinical trials databases, and three relevant theses databases were searched from January 2004 to October 2015. Eighteen articles were included from twelve countries...
January 11, 2017: Journal of Adolescent and Young Adult Oncology
https://www.readbyqxmd.com/read/28074585/a-good-death
#8
Tia Powell, Adira Hulkower
A good death is hard to find. Family members tell us that loved ones die in the wrong place-the hospital-and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28063905/trichloroethylene-induced-formic-aciduria-in-the-male-c57-bl-6-mouse
#9
Edward A Lock, Paul Keane, Philip H Rowe, John R Foster, Daniel Antoine, Christopher M Morris
1, 1, 2-Trichloroethylene (TCE) is of environmental concern, due to evaporation while handling, chemical processing and leakage from chemical waste sites, leading to its contamination of ground water and air. For several decades there has been issues about possible long term health effects of TCE but recently the International Agency for Research on Cancer (IARC) and the US Environmental Protection Agency classified TCE as a human carcinogen. Links having been established between occupational exposures and kidney cancer and possible links to non-Hodgkin lymphoma and liver cancer, but there is more still more to learn...
January 4, 2017: Toxicology
https://www.readbyqxmd.com/read/28063859/assessing-palliative-care-content-in-dementia-care-guidelines-a-systematic-review
#10
REVIEW
Pamela Durepos, Abigail Wickson-Griffiths, Afeez Abiola Hazzan, Sharon Kaasalainen, Vasilia Vastis, Lisa Battistella, Alexandra Papaioannou
CONTEXT: Families of persons with dementia continue to report unmet needs during end-of-life. Strategies to improve care and quality of life for persons with dementia include development of clinical practice guidelines (CPG) and an integrative palliative approach. OBJECTIVES: We aimed to assess palliative care content in dementia CPGs in order to identify the presence or limitations of recommendations and discussion pertaining to common issues or domains affected by illness as described by the Canadian Hospice Palliative Care 'Square of Care'...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062352/collusions-between-patients-and-clinicians-in-end-of-life-care-why-clarity-matters
#11
Friedrich Stiefel, Kenji Nakamura, Takeshi Terui, Kunihiko Ishitani
Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, un-reflected behaviours and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for both, patient and clinician. After an introductory definition of collusion, two archetypal situations of collusion - based on material from a regular supervision of a palliative care specialist by a liaison psychiatrist - and means of working through collusion are presented...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28057511/principles-and-strategies-for-improving-the-prevention-of-cardio-metabolic-diseases-in-indigenous-populations-an-international-delphi-study
#12
Lee Stoner, Anna G Matheson, Lane G Perry, Michelle A Williams, Alexandra McManus, Maureen Holdaway, Lyn Dimer, Jennie R Joe, Andrew Maiorana
The disparity in life expectancy between Indigenous and non-Indigenous populations, including within high-income countries, is driven by a heightened risk of cardio-metabolic diseases. The current study recruited independent panels of experts in Indigenous cardio-metabolic health from Australia, New Zealand and the United States, in order to establish local consensus opinion and initiate dialogue on appropriate prevention strategies. Therefore, a three-round Delphi process was used to consolidate and compare the opinions of 60 experts, 20 from each country...
January 2, 2017: Preventive Medicine
https://www.readbyqxmd.com/read/28056851/quality-of-life-in-patients-on-chronic-dialysis-in-south-africa-a-comparative-mixed-methods-study
#13
Elliot K Tannor, Elize Archer, Kenneth Kapembwa, Susan C van Schalkwyk, M Razeen Davids
BACKGROUND: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). METHODS: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis...
January 5, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28053509/involvement-of-the-end-user-exploration-of-older-people-s-needs-and-preferences-for-a-wearable-fall-detection-device-a-qualitative-descriptive-study
#14
Friederike Js Thilo, Selina Bilger, Ruud Jg Halfens, Jos Mga Schols, Sabine Hahn
PURPOSE: To explore the needs and preferences of community-dwelling older people, by involving them in the device design and mock-up development stage of a fall detection device, consisting of a body-worn sensor linked to a smartphone application. PATIENTS AND METHODS: A total of 22 community-dwelling persons 75 years of age and older were involved in the development of a fall detection device. Three semistructured focus group interviews were conducted. The interview data were analyzed using qualitative descriptive analysis with deductive coding...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28041869/-palliative-care-after-neonatal-intensive-care-contributions-of-leonetti-law-and-remaining-challenges
#15
P Kuhn, L Dillenseger, N Cojean, B Escande, C Zores, D Astruc
The 2005 enactment of the "Patients' rights and end-of-life care" act, known as the Leonetti law, has been accompanied by practical changes in the processes of withdrawal and withholding of active life-sustaining treatments. This law has also promoted the implementation of palliative care in perinatal medicine to avoid unreasonable therapeutic interventions and to preserve the dying patient's quality of life and human dignity. Recently, a new law has been voted by the French National Assembly and new reflections on the ethical aspects of the end of life in neonatal medicine should resume again within the French Society of Neonatology in the working group on ethical issues in neonatology...
December 29, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28036065/design-of-a-mobile-low-cost-sensor-network-using-urban-buses-for-real-time-ubiquitous-noise-monitoring
#16
Rosa Ma Alsina-Pagès, Unai Hernandez-Jayo, Francesc Alías, Ignacio Angulo
One of the main priorities of smart cities is improving the quality of life of their inhabitants. Traffic noise is one of the pollutant sources that causes a negative impact on the quality of life of citizens, which is gaining attention among authorities. The European Commission has promoted the Environmental Noise Directive 2002/49/EC (END) to inform citizens and to prevent the harmful effects of noise exposure. The measure of acoustic levels using noise maps is a strategic issue in the END action plan. Noise maps are typically calculated by computing the average noise during one year and updated every five years...
December 29, 2016: Sensors
https://www.readbyqxmd.com/read/28031256/organ-donation-after-medical-assistance-in-dying-or-cessation-of-life-sustaining-treatment-requested-by-conscious-patients-the-canadian-context
#17
Julie Allard, Marie-Chantal Fortin
In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death...
December 28, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28028266/-case-study-a-successful-cooperation-of-clinic-pharmacist-and-pharmacies-in-home-palliative-care-with-pca-pump
#18
Michiyo Kawana, Haruko Yuge, Hirokazu Sakurai, Minoru Hatsuta, Yuko Osuga, Masayoshi Hirohara, Kazuki Kushida
To make a good end at home and provide good palliative care for patients with cancer are urgent issues in Setagaya ward, as shown by certain statistics. Medical opioids are greatly needed for palliative care; as patient controlled analgesia(PCA) develops, it can lead to decisions by patients and their families to receive end-of-life care at home because the patient can choose to receive the same advanced palliative care received at the hospital. With in-home palliative care, given the rapid change in the medical condition of the patient and the sentiment of the family, the role of pharmacists is to quickly and reliably supply the pharmaceuticals and medical equipment that doctors need...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28024551/end-of-life-issues-in-cardiac-critical-care-the-option-of-organ-donation
#19
REVIEW
Karim Serri, Pierre Marsolais
Despite important advances in the care of postcardiac arrest patients, severe brain injury remains one of the major causes of death in the cardiac intensive care unit. Neurological prognostication after cardiac arrest has evolved significantly since the introduction of therapeutic hypothermia. It now relies on a multimodal approach and a minimal observation period of 72 hours is usually advocated. However, when brain injury is severe and the prognosis considered dismal, patients become eligible for organ donation...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28011502/objective-predictive-score-as-a-feasible-biomarker-for-short-term-survival-in-terminaliy-ill-patients-with-cancer
#20
Yoshinaga Okugawa, Yumiko Shirai, Hiroko Nodono, Fukumi Matsutani, Mari Itoh, Asahi Hishida, Yuki Morimoto, Ryutaro Nishikawa, Takeshi Yokoe, Koji Tanaka, Hisashi Urata, Yuji Toiyama, Toshimitsu Araki, Yasuhiro Inoue, Motoyoshi Tanaka, Masato Kusunoki, Chikao Miki
BACKGROUND: In palliative care, prediction of life expectancy is one of the most crucial issues for patients, family and medical staff, in order to provide appropriate end-of-life care. The aim of this study was to formulate a new objective score to predict life expectancy within 1 week for terminally ill patients with cancer. PATIENTS AND METHODS: Medical records were obtained from 187 terminally-ill patients with cancer who were admitted for palliative care. The biomarkers for a potential 'Objective Predictive Score' were assessed...
January 2017: Anticancer Research
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