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End-of-life issues

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https://www.readbyqxmd.com/read/28927667/development-and-validation-of-a-tool-to-evaluate-the-evolution-of-clinical-reasoning-in-trauma-using-virtual-patients
#1
David Fleiszer, Michael L Hoover, Nancy Posel, Tarek Razek, Simon Bergman
CONTEXT: Undergraduate medical students at a large academic trauma center are required to manage a series of online virtual trauma patients as a mandatory exercise during their surgical rotation. PURPOSE: Clinical reasoning during undergraduate medical education can be difficult to assess. The purpose of the study was to determine whether we could use components of the students' virtual patient management to measure changes in their clinical reasoning over the course of the clerkship year...
September 16, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28919728/chronic-obstructive-pulmonary-disease-with-mild-airflow-limitation-current-knowledge-and-proposal-for-future-research-a-consensus-document-from-six-scientific-societies
#2
REVIEW
Andrea Rossi, Bojana Butorac-Petanjek, Marco Chilosi, Borja G Cosío, Matjaz Flezar, Nikolaos Koulouris, José Marin, Neven Miculinic, Guido Polese, Miroslav Samaržija, Sabina Skrgat, Theodoros Vassilakopoulos, Andrea Vukić-Dugac, Spyridon Zakynthinos, Marc Miravitlles
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28918445/pre-emptive-intestinal-transplant-the-surgeon-s-point-of-view
#3
REVIEW
Augusto Lauro, Ignazio R Marino, Kishore R Iyer
Pre-emptive transplantation is a well-established practice for certain types of end-organ failure such as in the use of kidney transplantation. For irreversible intestinal failure, total parenteral nutrition (TPN) remains the gold standard, due to the suboptimal long-term results of intestinal transplantation. As such, the only role for pre-emptive transplantation, if at all, will be for patients identified to be at high risk of complications and mortality while on definitive long-term TPN. In these patients, the timing of early listing and transplantation could become life-saving, taking into account that mortality on the waiting list is still the highest for intestinal candidates...
September 16, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28916293/is-there-ever-a-role-for-the-unilateral-do-not-attempt-resuscitation-order-in-pediatric-care
#4
Jonathan M Marron, Emma Jones, Joanne Wolfe
Care for children as they near the end of life is difficult and very complex. More difficult still are the decisions regarding what interventions are and are not indicated during these trying times. Occasionally, families of children who are nearing the end of life disagree with the assessment of the medical team regarding these interventions. In rare cases, the medical team can be moved to enact a do not attempt resuscitation (DNAR) order against the wishes of the patient's parents. This manuscript presents one such illustrative case and discusses the ethical issues relevant to such challenging clinical scenarios...
September 12, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28915078/pediatric-specific-end-of-life-care-quality-measures-an-unmet-need-of-a-vulnerable-population
#5
Emily E Johnston, Abby R Rosenberg, Arif H Kamal
We must ensure that the 20,000 US children (age 0 to 19 years) who die as a result of serious illness annually receive high-quality end-of-life care. Ensuring high-quality end-of-life care requires recognition that pediatric end-of-life care is conceptually and operationally different than that for adults. For example, in-hospital adult death is considered an outcome to be avoided, whereas many pediatric families may prefer hospital death. Because pediatric deaths are comparatively rare, not all centers offer pediatric-focused palliative care and hospice services...
September 15, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28914076/integrative-review-of-the-literature-on-hispanics-and-hospice
#6
Margaret L Rising, Dena S Hassouneh, Kristin F Lutz, Chris S Lee, Pat Berry
The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, "hospicio," has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28912616/decision-making-in-neonatal-end-of-life-scenarios-in-low-income-settings-1
#7
James McTavish
The challenge of decision making in end-of-life scenarios is exacerbated when the patient is a newborn and in a low-income setting. The principle of proportionate care is a helpful guide but needs to be applied. The complex interplay of benefit, burden, and cost of various treatments all need to be considered. In patients with severe neonatal encephalopathy, prognosis can be hard to determine, and a team approach to decision making can help. In low-income settings, or where there are limited resources, the ideal care needs to be incarnated in the real context...
August 2017: Linacre Quarterly
https://www.readbyqxmd.com/read/28901283/a-systematic-review-of-religious-beliefs-about-major-end-of-life-issues-in-the-five-major-world-religions
#8
Rajshekhar Chakraborty, Areej R El-Jawahri, Mark R Litzow, Karen L Syrjala, Aric D Parnes, Shahrukh K Hashmi
OBJECTIVE: The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). METHOD: This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus...
October 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28899266/graduate-students-reflections-on-elder-and-end-of-life-care-for-prisoners
#9
Steven L Baumann, Vidette Todaro-Franceschi
The focus of this report was graduate nursing students' reflections on elder and end-of-life care for prisoners. The personal reflections of 21 graduate nursing students who attended a presentation by Susan J. Loeb on October 26, 2016 were included in this report. The title of the presentation was "Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community." The student essays were synthesized to construct a summary essay, from which four themes were identified: aging in prison, dying in prison, ethical and professional issues in the elder and end-of-life care of prisoners, and ethical and professional issues in research involving elderly and end-of-life care of prisoners...
July 2017: Nursing Science Quarterly
https://www.readbyqxmd.com/read/28891705/-why-would-doctors-from-debrecen-go-abroad-results-of-a-questionnaire
#10
Zoltán Szekanecz, Zoltán Tóth, Attila Hamar, Levente Lánczi
INTRODUCTION: Numerous beliefs have arisen in relation to the emigration of doctors. First of all, in most cases emigration has been attributed to, almost exclusively, low salaries. There are a number of non-financial issues that could possibly be more easily addressed. METHOD: In order to get closer to these issues, we sent out a 37-item questionnaire to doctors, who originally graduated from the University of Debrecen. Altogether 82 of them sent back the questionnaire...
September 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28887931/extracorporeal-membrane-oxygenation-management-techniques-to-liberate-from-extracorporeal-membrane-oxygenation-and-manage-post-intensive-care-unit-issues
#11
REVIEW
Joseph B Zwischenberger, Harrison T Pitcher
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique when patients require pulmonary and/or cardiac support for days to weeks for recovery, bridge to decision, or transplantation. Due to complications associated with ECMO, it is best to stay on ECMO as little time as necessary. Foremost is weaning from ECMO, but the post-ECMO period recapitulates the entire field of critical care. Identified issues include (1) potential for systemic inflammatory response syndrome post-decannulation; (2) post-ECMO complications, such as deep vein thrombosis, wounds, renal failure, and stroke; (3) delirium; (4) posttraumatic stress disorder; (5) rehabilitation; and (6) end of life...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28877556/patient-identified-impact-of-symptoms-in-spinal-and-bulbar-muscular-atrophy
#12
Robert D Guber, Angela D Kokkinis, Alice B Schindler, Roxanna M Bendixen, Chad R Heatwole, Kenneth H Fischbeck, Christopher Grunseich
INTRODUCTION: The effects of spinal bulbar muscular atrophy (SBMA) on quality of life (QoL) are not well understood. This study describes symptoms from the patient's perspective, and the impact these symptoms have on QoL. METHODS: We conducted open-ended interviews with 21 adult males with genetically confirmed SBMA. Using a qualitative framework technique, interviews were coded and analyzed to identify symptoms and resulting themes. RESULTS: From these interviews, 729 quotations were extracted...
September 6, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28874926/craniosacral-therapy-and-visceral-manipulation-a-new-treatment-intervention-for-concussion-recovery
#13
Gail Wetzler, Melinda Roland, Sally Fryer-Dietz, Dee Dettmann-Ahern
Background: Military service members and veterans face health issues related to traumatic brain injury (TBI), especially during combat, use of heavy equipment, and exposures to environmental hazards and explosives. There were 400,000 TBIs reported in deployed U.S. troops in 2012. Athletes are also subject to TBI. Studies have indicated that some manual therapies could be helpful for treating patients who have post-concussive syndrome. Objective: This case series report describes the effects of CranioSacral Therapy (CST), Visceral Manipulation (VM), and Neural Manipulation (NM) modalities for treating patients who have post-concussion syndrome...
August 1, 2017: Medical Acupuncture
https://www.readbyqxmd.com/read/28872031/palliative-care-and-management-of-troublesome-symptoms-for-people-with-chronic-obstructive-pulmonary-disease
#14
REVIEW
Matthew Maddocks, Natasha Lovell, Sara Booth, William D-C Man, Irene J Higginson
People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care...
September 2, 2017: Lancet
https://www.readbyqxmd.com/read/28871833/facing-death-in-medical-training-a-view-from-students-in-mexico
#15
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/28870189/can-digital-stories-go-where-palliative-care-research-has-never-gone-before-a-descriptive-qualitative-study-exploring-the-application-of-an-emerging-public-health-research-method-in-an-indigenous-palliative-care-context
#16
Lisa Williams, Merryn Gott, Tess Moeke-Maxwell, Stella Black, Shuchi Kothari, Sarina Pearson, Tessa Morgan, Matua Rawiri Wharemate, Whaea Whio Hansen
BACKGROUND: The World Health Organization (WHO) has called for global approaches to palliative care development. Yet it is questionable whether one-size-fits-all solutions can accommodate international disparities in palliative care need. More flexible research methods are called for in order to understand diverse priorities at local levels. This is especially imperative for Indigenous populations and other groups underrepresented in the palliative care evidence-base. Digital storytelling (DST) offers the potential to be one such method...
September 4, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28868842/effect-of-marital-relationship-enrichment-program-on-marital-satisfaction-marital-intimacy-and-sexual-satisfaction-of-infertile-couples
#17
Seyedeh Zahra Masoumi, Somayeh Khani, Farideh Kazemi, Fatemeh Kalhori, Reyhaneh Ebrahimi, Ghodratollah Roshanaei
Background: Infertile couples only think of having children during their sexual intercourse, and their constant concern about this issue increases their stress level. Psychosocial and social stress leads to decreased life satisfaction, increased marital problems, and reduced sexual confidence. This study aims to determine the effect of enrichment program on marital and sexual satisfaction as well as marital intimacy among infertile couples. MATERIALS AND METHODS: This randomized controlled clinical trial was conducted on 50 infertile couples in 2013 in Hamedan...
October 2017: International Journal of Fertility & Sterility
https://www.readbyqxmd.com/read/28866906/end-of-life-care-for-advanced-dementia-patients-in-residential-care-home-a-hong-kong-perspective
#18
James K H Luk, Felix H W Chan
Dementia will become more common as the population ages. Advanced dementia should be considered as a terminal illnesses and end-of-life (EOL) care is very much needed for this disease group. Currently, the EOL services provided to this vulnerable group in Hong Kong, especially those living in residential care homes, is limited. The usual practice of residential care homes is to send older residents with advanced dementia to acute hospitals when they are sick, irrespective of their wish, premorbid status, diagnoses and prognosis...
August 28, 2017: Annals of Palliative Medicine
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
#19
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/28863219/discussing-advance-care-planning-and-directives-in-the-general-population
#20
Pascal J de Caprariis, Bronwyn Rucker, Claudia Lyon
The concept of end-of-life planning, along with medical and legal issues, has been discussed and has evolved over several years. The 1990 Patient Self-Determination Act and individual states' Department of Health Advance Directive forms helped overcome past problems. Patients with terminal and chronic illness are now able to have their wishes recognized for their future care. Any healthy individual's decision during an advance care planning (ACP) discussion can be adversely affected by various factors; however, multiple barriers-religion, culture, education, and family dynamics-can influence the process...
September 2017: Southern Medical Journal
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