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https://www.readbyqxmd.com/read/28230644/expanding-the-donor-pool-through-intensive-care-to-facilitate-organ-donation-results-of-a-spanish-multicenter-study
#1
Beatriz Domínguez-Gil, Elisabeth Coll, José Elizalde, Jaime E Herrero, Teresa Pont, Brígida Quindós, Bella Marcelo, María A Bodí, Adolfo Martínez, Agustín Nebra, Francisco Guerrero, José M Manciño, Juan Galán, Miguel Lebrón, Eduardo Miñambres, Rafael Matesanz
BACKGROUND: Intensive Care to facilitate Organ Donation (ICOD) may help to increase the donor pool. We describe the Spanish experience with ICOD. METHODS: ACCORD-Spain consisted of an audit of the donation pathway from patients dead as a result of a devastating brain injury (possible donors) in 68 hospitals during 11/1/2014-4/30/2015. We focused on possible donors whose family was interviewed to discuss organ donation once intensive care with a therapeutic purpose was deemed futile and brain death (BD) was a likely outcome...
February 23, 2017: Transplantation
https://www.readbyqxmd.com/read/28224879/-palliative-sedation-because-it-s-what-the-patient-wants-pronouncement-of-disciplinary-court-cause-of-great-confusion
#2
A C Hendriks, B Keizer
The Medical Disciplinary Court of The Hague recently imposed an official warning on two physicians who did not yield to the pressure exerted by a 102-year-old patient and her family to start palliative sedation. This decision not only restricts the directing role of physicians with respect to the end-of-life phase, but is also inconsistent with the guideline from the Royal Dutch Medical Association (KNMG) on palliative sedation.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28221673/breast-cancer-prevention-strategies-in-lobular-carcinoma-in-situ-a-decision-analysis
#3
Stephanie M Wong, Natasha K Stout, Rinaa S Punglia, Ipshita Prakash, Yasuaki Sagara, Mehra Golshan
BACKGROUND: Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS. METHODS: A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies...
February 21, 2017: Cancer
https://www.readbyqxmd.com/read/28216869/do-not-resuscitate-order-the-experiences-of-iranian-cardiopulmonary-resuscitation-team-members
#4
Abdolghader Assarroudi, Fatemeh Heshmati Nabavi, Abbas Ebadi, Habibollah Esmaily
BACKGROUND: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. METHODS: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. RESULTS: Three categories and six subcategories emerged: "The dilemma between revival and suffering" with the subcategories of "revival likelihood" and "death as a cause for comfort;" "conflicting situation" with the subcategories of "latent decision" and "ambivalent order;" and "low-quality CPR" with the subcategories of "team member demotivation" and "disrupting CPR performance...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28216856/feasibility-and-acceptability-of-implementing-the-integrated-care-plan-for-the-dying-in-the-indian-setting-survey-of-perspectives-of-indian-palliative-care-providers
#5
Naveen Salins, Jeremy Johnson, Stanley Macaden
INTRODUCTION: Capacity to provide end-of-life care in India is scored as 0.6/100, and very few people in India have access to palliative and end-of-life care. Lack of end-of-life care provision in India has led to a significant number of people receiving inappropriate medical treatment at the end of life, with no access to pain and symptom control and high treatment costs. The International Collaborative for the Best Care for the Dying Person is an initiative that offers the opportunity to apply international evidence on the key factors required to provide best care for the dying in the Indian context...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28214237/knowledge-attitudes-and-preferences-of-advance-decisions-end-of-life-care-and-place-of-care-and-death-in-hong-kong-a%C3%A2-population-based-telephone-survey-of-1067-adults
#6
Roger Yat-Nork Chung, Eliza Lai-Yi Wong, Nicole Kiang, Patsy Yuen-Kwan Chau, Janice Y C Lau, Samuel Yeung-Shan Wong, Eng-Kiong Yeoh, Jean W Woo
OBJECTIVES: According to the 2015 Quality of Death Index published by the Intelligence Unit of the Economist, Hong Kong is ranked 22nd in terms of quality of palliative care in the world, behind many other major developed countries in Asia, including Taiwan, Singapore, Japan, and South Korea. The objectives of the present study were to describe the knowledge, attitude, and preferences of the general Hong Kong adult population across different age groups regarding end-of-life (EOL) care decisions, place of care and death, as well as advance directive (AD)...
February 14, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28214236/are-hospital-ed-transfers-less-likely-among-nursing-home-residents-with-do-not-hospitalize-orders
#7
Taeko Nakashima, Yuchi Young, Wan-Hsiang Hsu
OBJECTIVES: This study aims to examine whether an advance directive "Do Not Hospitalize" (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined. DESIGN: Cross-sectional study. SETTING/SUBJECTS: New York State (NYS) nursing home residents (n = 43,024). MEASUREMENTS AND ANALYSIS: The Minimum Data Set 2.0 was used to address the study aims...
February 14, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28212642/beyond-cultural-stereotyping-views-on-end-of-life-decision-making-among-religious-and-secular-persons-in-the-usa-germany-and-israel
#8
Mark Schweda, Silke Schicktanz, Aviad Raz, Anita Silvers
BACKGROUND: End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping...
February 17, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28211000/the-implementation-and-evaluation-of-a-communication-skills-training-program-for-oncology-nurses
#9
Smita C Banerjee, Ruth Manna, Nessa Coyle, Stacey Penn, Tess E Gallegos, Talia Zaider, Carol A Krueger, Philip A Bialer, Carma L Bylund, Patricia A Parker
Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families...
February 16, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28210847/ethical-considerations-in-the-long-term-ventricular-assist-device-patient
#10
REVIEW
Amanda Cai, Howard J Eisen
PURPOSE OF REVIEW: As the heart failure population continues to age, the need for definitive therapies such as ventricular assist devices (VADs) to extend life and alleviate suffering from end-stage disease directly increases. The goal of this article is to examine the ethical principles of autonomy, beneficence, non-maleficence, and justice within the context of long-term VAD patients. RECENT FINDINGS: Survival rates in VAD-implanted patients have improved in parallel with modernization of device design and surgical technique, reaching that of cardiac transplantation at 1 year post-procedure...
February 16, 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28210521/the-right-to-die-in-chronic-disorders-of-consciousness-can-we-avoid-the-slippery-slope-argument
#11
REVIEW
Rocco Salvatore Calabrò, Antonino Naro, Rosaria De Luca, Margherita Russo, Lory Caccamo, Alfredo Manuli, Alessia Bramanti, Placido Bramanti
Managing individuals with chronic disorders of consciousness raises ethical questions about the appropriateness of maintaining life-sustaining treatments and end-of-life decisions for those who are unable to make decisions for themselves. For many years, the positions fostering the "sanctity" of human life (i.e., life is inviolable in any case) have led to maintaining life-sustaining treatments (including artificial nutrition and hydration) in patients with disorders of consciousness, allowing them to live for as long as possible...
November 2016: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/28206733/end-of-life-decisions-in-34-slovene-intensive-care-units-a-nationwide-prospective-clinical-study
#12
Miha Orazem, Urh Groselj, Manca Stojan, Neza Majdic, Gaj Vidmar, Stefan Grosek
BACKGROUND: To determine how end-of-life decisions (EOLD) on limitations of life- sustaining treatment (LST) are made in three different types of intensive care units (ICUs) in Slovenia. METHODS: A national multicenter prospective study among 31 adult and three pediatric/neonatal ICUs (PICUs). The questionnaire form on EOLD was designed to assess the clinical practice. Data were collected between January 1, 2013, and March 31, 2013. For statistical analysis we used IBM® SPSS® Statistics 20 software package...
February 15, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28203120/international-lessons-in-new-methods-for-grading-and-integrating-cost-effectiveness-evidence-into-clinical-practice-guidelines
#13
REVIEW
Kathryn M Antioch, Michael F Drummond, Louis W Niessen, Hindrik Vondeling
Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor...
2017: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/28198722/triad-viii-nationwide-multicenter-evaluation-to-determine-whether-patient-video-testimonials-can-safely-help-ensure-appropriate-critical-versus-end-of-life-care
#14
Ferdinando L Mirarchi, Timothy E Cooney, Arvind Venkat, David Wang, Thaddeus M Pope, Abra L Fant, Stanley A Terman, Kevin M Klauer, Monica Williams-Murphy, Michael A Gisondi, Brian Clemency, Ankur A Doshi, Mari Siegel, Mary S Kraemer, Kate Aberger, Stephanie Harman, Neera Ahuja, Jestin N Carlson, Melody L Milliron, Kristopher K Hart, Chelsey D Gilbertson, Jason W Wilson, Larissa Mueller, Lori Brown, Bradley D Gordon
OBJECTIVE: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. METHODS: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine...
February 14, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28195841/multiple-perspectives-of-symptoms-and-suffering-at-end-of-life-in-the-nicu
#15
Emily L Shultz, Mary Switala, Adrien M Winning, Madelaine C Keim, Amy E Baughcum, Cynthia A Gerhardt, Christine A Fortney
BACKGROUND: Despite technological advances in the neonatal intensive care unit, not all infants survive. Limited research has focused on infants' symptoms and suffering at end of life (EOL) from multiple perspectives. PURPOSE: To compare retrospective parent report and electronic medical record (EMR) documentation of symptoms and to examine associations with parent perceptions of infants suffering at EOL. METHODS/SEARCH STRATEGY: Bereaved parents of 40 infants (40 mothers and 27 fathers) retrospectively reported on their perceptions of infant symptoms and suffering during the last week of life...
February 13, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28192224/qualitative-study-on-the-perceptions-of-terminally-ill-cancer-patients-and-their-family-members-regarding-end-of-life-experiences-focusing-on-palliative-sedation
#16
Young Eun, In-Wha Hong, Eduardo Bruera, Jung Hun Kang
CONTEXT: Patients with terminal cancer experience refractory symptoms in the last days of life. Although palliative sedation (PS) is recommended for patients suffering unbearable symptoms with imminent death, it requires clear communication between physicians and patients/caregivers. Understanding the demands and perceptions of patients and caregivers in the end-of-life phase are needed for effective communication. OBJECTIVE: To explore patient experiences regarding end-of-life status and PS...
February 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28187812/family-discussions-on-life-sustaining-interventions-in-neurocritical-care
#17
M M Adil, D Larriviere
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28186376/end-of-life-decisions-for-extremely-preterm-infants-a-matter-of-language-gender-and-education
#18
EDITORIAL
Christoph Bührer
No abstract text is available yet for this article.
March 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28185893/united-states-clergy-religious-values-and-relationships-to-end-of-life-discussions-and-care
#19
Michael J Balboni, Adam Sullivan, Andrea C Enzinger, Patrick T Smith, Christine Mitchell, John R Peteet, James Tulsky, Tyler VanderWeele, Tracy A Balboni
CONTEXT: While clergy interact with approximately half of U.S. patients facing end-of-life medical decisions, little is known about clergy-congregant interactions or clergy influence on end-of-life decisions. OBJECTIVE: To conduct a nationally representative survey of clergy beliefs and practices. METHODS: A mailed survey to a nationally representative sample of clergy completed in March 2015 with 1005 of 1665 responding (60% response rate)...
February 6, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28177638/parasitic-reactions-in-nano-sized-silicon-anodes-for-lithium-ion-batteries
#20
Han Gao, Lisong Xiao, Ingo Plümel, Gui-Liang Xu, Yang Ren, Xiaobing Zuo, Yuzi Liu, Christof Schulz, Hartmut Wiggers, Khalil Amine, Zonghai Chen
When designing nano-Si electrodes for lithium-ion batteries, the detrimental effect of the c-Li15Si4 phase formed upon full lithiation is often a concern. In this study, Si nanoparticles with controlled particle sizes and morphology were synthesized and parasitic reactions of the metastable c-Li15Si4 phase with the non-aqueous electrolyte was investigated. The use of smaller Si nanoparticles (~ 60 nm) and the addition of fluoroethylene carbonate additive played decisive roles in the parasitic reactions such that the c-Li15Si4 phase could disappear at the end of lithiation...
February 8, 2017: Nano Letters
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