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End of life issues

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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/29321079/the-enactment-stage-of-end-of-life-decision-making-for-children
#2
Jane Elizabeth Sullivan, Lynn Heather Gillam, Paul Terence Monagle
OBJECTIVES: Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process...
January 11, 2018: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29317084/-reversal-of-neuromuscular-block-with-sugammadex-in-five-heart-transplant-pediatric-recipients
#3
Ricardo Vieira Carlos, Marcelo Luis Abramides Torres, Hans Donald de Boer
Heart transplantation is a frequent procedure in the treatment of end-stage cardiac dysfunction. Therefore, these patient populations will also be more frequent exposed to other more common surgical procedures after their transplantation. Anesthesiologist should be aware in their assessment of these patients, especially regarding some specific issues related to patients with a history of heart transplantation, like reversal of neuromuscular block. Several reports described that cholinesterase inhibitors drugs, like neostigmine, may produce a dose-dependent life-threatening bradycardia in heart transplant recipients while other publication described the safe use of neostigmine...
January 6, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29302603/what-are-the-ethical-dimensions-in-the-profession-of-intensive-care-specialist
#4
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Jean-Pierre Eraldi, François Bougerol, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
Two essential components of the profession of a medical doctor are the constant review of the patient's therapeutic project, and collaboration between healthcare professionals. The profession of intensive care unit (ICU) physician goes further in terms of responsibility, vis-à-vis the intensive treatments dispensed to the patients, and the physician's responsibilities towards the patient's family and the caregiving team, also bearing in mind that ICU care is costly in terms of human and financial resources...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29302599/what-are-the-ethical-aspects-surrounding-the-collegial-decisional-process-in-limiting-and-withdrawing-treatment-in-intensive-care
#5
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of expressing themselves...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29301585/a-randomised-pragmatic-trial-of-corticosteroid-optimization-in-severe-asthma-using-a-composite-biomarker-algorithm-to-adjust-corticosteroid-dose-versus-standard-care-study-protocol-for-a-randomised-trial
#6
Catherine E Hanratty, John G Matthews, Joseph R Arron, David F Choy, Ian D Pavord, P Bradding, Christopher E Brightling, Rekha Chaudhuri, Douglas C Cowan, Ratko Djukanovic, Nicola Gallagher, Stephen J Fowler, Tim C Hardman, Tim Harrison, Cécile T Holweg, Peter H Howarth, James Lordan, Adel H Mansur, Andrew Menzies-Gow, Sofia Mosesova, Robert M Niven, Douglas S Robinson, Dominick E Shaw, Samantha Walker, Ashley Woodcock, Liam G Heaney
BACKGROUND: Patients with difficult-to-control asthma consume 50-60% of healthcare costs attributed to asthma and cost approximately five-times more than patients with mild stable disease. Recent evidence demonstrates that not all patients with asthma have a typical type 2 (T2)-driven eosinophilic inflammation. These asthmatics have been called 'T2-low asthma' and have a minimal response to corticosteroid therapy. Adjustment of corticosteroid treatment using sputum eosinophil counts from induced sputum has demonstrated reduced severe exacerbation rates and optimized corticosteroid dose...
January 4, 2018: Trials
https://www.readbyqxmd.com/read/29301524/what-does-complex-mean-in-palliative-care-triangulating-qualitative-findings-from-3-settings
#7
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/29301481/public-awareness-of-palliative-care-in-sweden
#8
Caroline Westerlund, Carol Tishelman, Inger Benkel, Carl Johan Fürst, Ulla Molander, Birgit H Rasmussen, Sylvia Sauter, Olav Lindqvist
OBJECTIVE: The aim of this study was to investigate the awareness of palliative care (PC) in a general Swedish population. DESIGN: We developed an e-survey based on a similar study conducted in Northern Ireland, consisting of 10 questions. Closed questions were primarily analyzed using descriptive statistics. Open questions were subject to inductive qualitative analysis. SUBJECTS: The study utilized a population sample of 7684 persons aged 18-66, of which 2020 responded, stratified by gender, age and region...
January 1, 2018: Scandinavian Journal of Public Health
https://www.readbyqxmd.com/read/29300970/patients-knowledge-and-attitudes-regarding-living-with-implantable-electronic-devices-results-of-a-multicentre-multinational-patient-survey-conducted-by-the-european-heart-rhythm-association
#9
Kristina Hermann Haugaa, Tatjana S Potpara, Serge Boveda, Jean-Calude Deharo, Jian Chen, Dan Dobreanu, Stefano Fumagalli, Radoslaw Lenarczyk, Antonio Hernandez Madrid, Torben Bjerregaard Larsen, Elena Sciarrafia, Milos Taborsky, Roland Richard Tilz, Paolo Pieragnoli, Andrzej Przybylski, Nikolaos Dagres
The purpose of this patient survey was to analyse the knowledge, experiences, and attitudes regarding cardiac implantable electronic devices (CIED) in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization devices. Of the 1644 patients with CIEDs from seven European countries, 88% were over 50 years of age. Most patients (90%) knew what device they were implanted with and felt sufficiently informed about the indications for therapy. As many as 42% of patients needed additional information on the battery replacement and limitations in physical activity...
December 28, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29290454/-teacher-sick-leave-prevalence-duration-reasons-and-covariates
#10
M-N Vercambre-Jacquot, F Gilbert, N Billaudeau
BACKGROUND: Absences from work have considerable social and economic impact. In the education sector, the phenomenon is particularly worrying since teacher sick leave has an impact on the overall performance of the education system. Yet, available data are scarce. METHODS: In April-June 2013, 2653 teachers responded to a population-based postal survey on their quality of life (enquête Qualité de vie des enseignants, MGEN Foundation/Ministry of education, response rate 53 %)...
December 28, 2017: Revue D'épidémiologie et de Santé Publique
https://www.readbyqxmd.com/read/29288180/identifying-and-understanding-the-health-and-social-care-needs-of-older-adults-with-multiple-chronic-conditions-and-their-caregivers-a-protocol-for-a-scoping-review
#11
Elana Commisso, Katherine S McGilton, Ana Patricia Ayala, Melissa K Andrew, Howard Bergman, Line Beaudet, Veronique Dubé, Mikaela Gray, Lori Hale, Margaret Keatings, Emily Gard Marshall, Janet McElhaney, Debra Morgan, Edna Parrott, Jenny Ploeg, Tara Sampalli, Douglas Stephens, Isabelle Vedel, Jennifer Walker, Walter P Wodchis, Martine T E Puts
INTRODUCTION: People are living longer; however, they are not necessarily experiencing good health and well-being as they age. Many older adults live with multiple chronic conditions (MCC), and complex health issues, which adversely affect their day-to-day functioning and overall quality of life. As a result, they frequently rely on the support of friend and/or family caregivers. Caregivers of older adults with MCC often face challenges to their own well-being and also require support...
December 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/29286266/the-2017-seventh-world-congress-of-pediatric-cardiology-cardiac-surgery-week-in-review-adults-with-chd
#12
Jolien W Roos-Hesselink, Daniel Tobler, Carole Warnes
For the first time in 2017 adults with CHD was included in the World Congress of Pediatric Cardiology & Cardiac Surgery. With growing numbers and more complex patients reaching adulthood, there is a growing need for more attention to this subspecialty. Although survival is excellent and now over 90% of patients reach adulthood, many have residual problems and complications. Heart failure and arrhythmias are most commonly encountered. Life-expectancy is nearly normal for mild lesions, but remains reduced in moderate-complex lesions and re-interventions are often needed...
December 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/29279456/exploring-attractiveness-of-the-basic-sciences-for-female-physicians
#13
Yuka Yamazaki, Shinji Fukushima, Yuki Kozono, Takanori Uka, Eiji Marui
In Japan, traditional gender roles of women, especially the role of motherhood, may cause early career resignations in female physicians and a shortage of female researchers. Besides this gender issue, a general physician shortage is affecting basic science fields. Our previous study suggested that female physicians could be good candidates for the basic sciences because such work offers good work-life balance. However, the attractiveness for female physicians of working in the basic sciences, including work-life balance, is not known...
2018: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/29276766/challenges-to-ethically-managing-parkinson-disease-an-interview-study-of-patient-perspectives
#14
Shelagh T Shaw, Pirashanthie Vivekananda-Schmidt
This study investigated the current ethical issues in relation to recognizing and managing Parkinson disease (PD) from the patient's perspective. Methods: Twelve patients living with PD who were from the medical school's Patients as Educators program were recruited. Semistructured interviews were conducted to record patient experiences in order to identify potential ethical issues in relation to recognizing and managing PD. Thematic analysis was applied to the interview transcripts. Results: Four key themes emerged from the interviews...
December 2017: Journal of Patient Experience
https://www.readbyqxmd.com/read/29259647/efficacy-and-safety-of-compound-kushen-injection-on-patients-with-advanced-colon-cancer-a-meta-analysis-of-randomized-controlled-trials
#15
REVIEW
Lixiu Yu, Ying Zhou, Yu Yang, Furong Lu, Yeqin Fan
Objective: The efficacy and safety of Compound Kushen Injection (CKI) on advanced colon cancer remain controversial. We undertook a systematic meta-analysis of randomized controlled clinical studies on this issue. Methods: A comprehensive literature search was conducted by searching the following electronic databases: PubMed, Cochrane, Chinese Biological Medical disc, Chinese National Knowledge Infrastructure, and Wan-Fang Database in China by the end of January 31, 2017, without language restriction...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/29251606/issues-in-access-to-end-of-life-care-in-low-resource-areas
#16
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/29247307/attitudes-towards-end-of-life-issues-in-intensive-care-unit-among-italian-anesthesiologists-a-nation-wide-survey
#17
Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Sebastiano Mercadante
BACKGROUND: The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). METHODS: Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. RESULTS: Eight hundred and five persons responded to the full list of questions...
December 15, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29247229/salford-lung-study-in-chronic-obstructive-pulmonary-disease-sls-copd-follow-up-interviews-on-patient-centred-outcomes
#18
Lynda Doward, Henrik Svedsater, Diane Whalley, Rebecca Crawford, David Leather, James Lay-Flurrie, Nick Bosanquet
This study investigated patient perceptions, experiences and management of COPD throughout the SLS COPD study. Follow-up interviews were conducted with 400 patients who completed SLS COPD; a mixed-methods approach was used to collect quantitative and qualitative information. Structured interviews using closed-ended questions were conducted with 360 patients, detailing aspects of background/lifestyle information and COPD. Extended interviews containing open-ended questions on perceptions of COPD and quality of life (QoL) in addition to the closed-ended questions were completed by 40 further patients...
December 15, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/29242811/patients-with-dementia-are-easily-distracted
#19
R C Hamdy, A Kinser, A Depelteau, T Kendall-Wilson, J V Lewis, K Whalen
Mild cognitive impairment (MCI) is the middle ground between normal, age-appropriate memory impairment, and dementia. Whereas patients with MCI are able to cope with the memory deficit, those with dementia are not: Their memory impairment and other cognitive deficits are of sufficient magnitude to interfere with the patients' ability to cope independently with daily activities. In both MCI and dementia, there is evidence of declining cognitive functions from a previously higher level of functioning. In both the conditions, there is also an evidence of dysfunction in one or more cognitive domains...
January 2017: Gerontology & Geriatric Medicine
https://www.readbyqxmd.com/read/29242031/prognosis-and-predictors-of-mortality-in-critically-ill-elderly-patients
#20
A Suarez-de-la-Rica, C Castro-Arias, J Latorre, F Gilsanz, E Maseda
OBJECTIVES: to evaluate mortality of patients≥80 years admitted to the Surgical Intensive Care Unit (SICU), global hospital mortality and factors related to it. MATERIAL AND METHODS: observational retrospective study of patients≥80 years admitted to SICU between June 2012 and June 2015. RESULTS: a total of 299 patients were included, 54 of them died in the SICU (18.1%) and 80 patients (26.8%) died during their hospital stay. SICU mortality was independently related to age (OR=1...
December 11, 2017: Revista Española de Anestesiología y Reanimación
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