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https://www.readbyqxmd.com/read/28324205/levels-of-intervention-how-are-they-used-in-quebec-hospitals
#1
Marjolaine Frenette, Jocelyne Saint-Arnaud, Karim Serri
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered...
March 21, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28322634/end-of-life-decision-support-in-the-icu
#2
Grant Pignatiello, Ronald L Hickman, Breanna Hetland
Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies...
November 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28320024/-therapeutic-decisions-concerning-severe-neurological-diseases-and-at-the-end-of-life
#3
Christoph Burkhard Lücking
Modern medicine increasingly enables survival of life-threatening diseases. On the other side, however, especially in Neurology, the questions have to be addressed how intensive the initial treatment should be and how to deal with residual states when severe functional or cognitive deficits are expected. In these cases, it is not only important to decide which medical measures are appropriate for the patient, but also whether, given the prognosis, the patient would agree with the suggested measures. This article first describes the basis for each medical action, i...
March 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28315547/how-can-i-change-my-patients-treatment-decision-making-by-becoming-a-nurse-scientist-%C3%A2
#4
Tamryn F Gray
"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28314153/sewage-sludge-disposal-strategies-for-sustainable-development
#5
Małgorzata Kacprzak, Ewa Neczaj, Krzysztof Fijałkowski, Anna Grobelak, Anna Grosser, Małgorzata Worwag, Agnieszka Rorat, Helge Brattebo, Åsgeir Almås, Bal Ram Singh
The main objective of the present review is to compare the existing sewage sludge management solutions in terms of their environmental sustainability. The most commonly used strategies, that include treatment and disposal has been favored within the present state-of-art, considering existing legislation (at European and national level), characterization, ecotoxicology, waste management and actual routs used currently in particular European countries. Selected decision making tools, namely End-of-waste criteria and Life Cycle Assessment has been proposed in order to appropriately assess the possible environmental, economic and technical evaluation of different systems...
March 14, 2017: Environmental Research
https://www.readbyqxmd.com/read/28303282/-advance-directives-in-clinical-practice-living-will-healthcare-power-of-attorney-and-care-directive
#6
J Hack, B Buecking, C L Lopez, S Ruchholtz, C A Kühne
In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e...
March 16, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28301702/space-for-the-prisoner-s-point-of-view
#7
Laura Haupt
The lead article in this issue discusses a potentially free metaphorical space-that of decision-making-within the confines, tangible and intangible, of life in jail or prison. By interviewing prisoner-participants from six clinical studies, Paul Christopher and colleagues sought to find out how these men and women would answer open-ended questions about their decision to enroll in the research. What the interviewers heard was that none saw themselves as having been inappropriately pressured to do so. In fact, a significant percentage of the prisoners described being dissuaded from participating in the studies...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28296280/prevention-of-renal-failure-in-chinese-patients-with-newly-diagnosed-type-2-diabetes-a-cost-effectiveness-analysis
#8
REVIEW
Bin Wu, Suhua Zhang, Houwen Lin, Shan Mou
AIMS: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease (ESRD) in China. The current study is to assess the cost effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes (T2DM) from the Chinese health care perspective. METHODS: A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed T2DM might receive treatment according to one of the following three strategies: "do nothing" strategy (control strategy), treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) (universal strategy), or screening for microalbuminuria followed by ACEI/ARB treatment (screening strategy)...
March 10, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28294479/understanding-advance-care-planning-within-the-south-asian-community
#9
Patricia D Biondo, Rashika Kalia, Rooh-Afza Khan, Nadia Asghar, Cyrene Banerjee, Debbie Boulton, Nancy Marlett, Svetlana Shklarov, Jessica E Simon
BACKGROUND: Advance care planning (ACP) is a process of reflection on and communication of a person's future health-care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community. OBJECTIVE: To explore perspectives of South Asian community members towards ACP...
March 10, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28283409/topics-in-practice-management-integrating-advance-care-planning-into-practice
#10
REVIEW
Laura E Dingfield, Joshua B Kayser
Advanced respiratory diseases progress over time and often lead to death. As their condition worsens, patients may lose medical decision making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences, or appointment of a health care power of attorney (HCPOA)...
March 7, 2017: Chest
https://www.readbyqxmd.com/read/28278611/specific-words-and-experience-matter-to-surrogates-when-making-end-of-life-decisions
#11
Dawn E Fairlie
This grant funded preliminary study investigated the relationship between end-of-life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults aged 50 and older. Participants were randomized into two groups; each received a survey packet that varied only in the use of the words "Do Not Resuscitate (DNR)" and "Allow Natural Death (AND)." The Decisional Conflict Scale (DCS) was administered and demographic data were collected. No difference was found in the total DCS scores based on the AND and DNR versions...
February 17, 2017: Health Communication
https://www.readbyqxmd.com/read/28277859/impact-of-a-multivariate-serum-based-proteomic-test-on-physician-treatment-recommendations-for-advanced-non-small-cell-lung-cancer
#12
Wallace L Akerley, Alix M Arnaud, Bibas Reddy, Ray D Page
OBJECTIVE: The VeriStrat * test (VS) is intended to help guide treatment decisions for patients with advanced NSCLC without an EGFR-sensitizing mutation, classifying patients into two categories. Patients classified as VSGood have a favorable prognosis and significant clinical response to EGFR-Tyrosine Kinase Inhibitors (TKI). Patients classified as VSPoor has a less favorable prognosis and exhibit no significant response to EGFR-TKIs. The objective of this paper is to assess the real-world impact of VS test results on physicians' treatment recommendations including referrals for best-supportive-care (BSC)...
March 3, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28277773/rapid-response-systems-supporting-end-of-life-care-time-for-a-new-approach
#13
Jillian Hartin, Judy Walker
Rapid response systems have been implemented worldwide to support management of deteriorating patients outwith critical care units, and are increasingly required to support end of life care. These challenges require a new approach to supporting staff involved in do not attempt cardiopulmonary resuscitation decisions.
March 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28273761/teaching-medical-students-about-the-conversation
#14
Hillary D Lum, Joanna Dukes, Skotti Church, Jean Abbott, Jean M Youngwerth
BACKGROUND: Advance care planning (ACP) promotes care consistent with patient wishes. Medical education should teach how to initiate value-based ACP conversations. OBJECTIVE: To develop and evaluate an ACP educational session to teach medical students a value-based ACP process and to encourage students to take personal ACP action steps. DESIGN: Groups of third-year medical students participated in a 75-minute session using personal reflection and discussion framed by The Conversation Starter Kit...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28273002/agency-behind-bars-advance-care-planning-with-aging-and-dying-offenders
#15
Sara Sanders, Meredith Stensland, Kim Juraco
Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's Agentic perspective, we examined 20 aging/dying offenders' EOL preferences and ACP. Findings include six themes: Decisions in the shadow of the past, What works best for me, Feeling blessed, What is really going on, Can anyone be trusted, and Turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process...
March 8, 2017: Death Studies
https://www.readbyqxmd.com/read/28271120/code-status-reconciliation-to-improve-identification-and-documentation-of-code-status-in-electronic-health-records
#16
Viral G Jain, Peter J Greco, David C Kaelber
BACKGROUND: Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues...
March 8, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28264097/the-catch-22-of-neuroimaging-disorders-of-consciousness-and-end-of-life-decisions
#17
Emanuel Cabral, Judy Illes
No abstract text is available yet for this article.
March 6, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28259490/what-do-patients-expect-from-total-knee-arthroplasty-a-delphi-consensus-study-on-patient-treatment-goals
#18
Toni Lange, Jochen Schmitt, Christian Kopkow, Elisabeth Rataj, Klaus-Peter Günther, Jörg Lützner
BACKGROUND: Although total knee arthroplasty (TKA) is among the most frequent orthopedic procedures for end-stage knee osteoarthritis (OA), systematically developed patient treatment goals for this elective intervention are missing. This constitutes a relevant barrier toward patient-centered healthcare. METHODS: A Delphi consensus study was conducted. Patients who were candidates for TKA were recruited through 11 outpatient orthopedic surgeons, 4 physiotherapists, and a patient organization in Germany...
February 7, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28249013/societal-perspective-on-access-to-publicly-subsidised-medicines-a-cross-sectional-survey-of-3080-adults-in-australia
#19
Lesley Chim, Glenn Salkeld, Patrick Kelly, Wendy Lipworth, Dyfrig A Hughes, Martin R Stockler
BACKGROUND: Around the world government agencies responsible for the selection and reimbursement of prescribed medicines and other health technologies are considering how best to bring community preferences into their decision making. In particular, community views about the distribution or equity of funding across the population. These official committees and agencies often have access to the best available and latest evidence on clinical effectiveness, safety and cost from large clinical trials and population-based studies...
2017: PloS One
https://www.readbyqxmd.com/read/28244362/life-and-death-decisions
#20
Layla Haidrani
What is your job? Dementia nurse at The Hospice of St Francis in Berkhamsted, Hertfordshire. I was appointed to help improve end of life care for people with dementia.
February 28, 2017: Nursing Older People
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