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end of life decisions

Katsiaryna Laryionava, Katja Mehlis, Elena Bierwirth, Friederike Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C Winkler
BACKGROUND: Many patients with advanced cancer receive chemotherapy close to death and are referred too late to palliative or hospice care, and therefore die under therapy or in intensive care units. Oncologists still have difficulties in involving patients appropriately in decisions about limiting tumor-specific or life-prolonging treatment. OBJECTIVE: The aim of this Ethics Policy for Advanced Care Planning and Limiting Treatment Study is to develop an ethical guideline for end-of-life decisions and to evaluate the impact of this guideline on clinical practice regarding the following target goals: reduction of decisional conflicts, improvement of documentation transparency and traceability, reduction of distress of the caregiver team, and better knowledge and consideration of patients' preferences...
June 15, 2018: JMIR Research Protocols
Elisa Ballardini, Pietro Marino, Elisa Maietti, Gianni Astolfi, Amanda J Neville
Agenesis and hypoplasia of the corpus callosum (ACC and HCC) are heterogeneous group with a large variation in published prevalence based on few population based studies. The aim of this work is to describe prevalence, associated factors and other malformations present in cases with either agenesis or hypoplasia of the corpus callosum, using a population-based database of all malformations diagnosed in Emilia-Romagna, Italy, (the Emilia-Romagna Registry on Congenital Malformations, IMER). This registry links and integrates hospital discharge records, birth certificates with cases reported by referral clinicians to identify all structural malformations diagnosed within one year of life regarding live birth, fetal death or termination of pregnancy due to fetal malformations (TOPFA)...
June 11, 2018: European Journal of Medical Genetics
Jae Yoon Park, Chi-Yeon Lim, Gloria Puurveen, Do Yeun Kim, Jae Hang Lee, Han Ho Do, Kyung Soo Kim, Kyung Don Yoo, Hyo Jin Kim, Yunmi Kim, Sung Joon Shin
Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded "accept the special interventions" on the reference form...
January 1, 2018: Omega
Lisa Caulley, Muriel R Gillick, Lisa S Lehmann
New England Journal of Medicine, Volume 378, Issue 24, Page 2339-2341, June 2018.
June 14, 2018: New England Journal of Medicine
Sarah Hoare, Michael P Kelly, Larissa Prothero, Stephen Barclay
BACKGROUND: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. AIM: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. DESIGN: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically...
June 1, 2018: Palliative Medicine
Laurence Jee Peng Leong, Gregory Brian Crawford
BACKGROUND: With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. METHODS: A retrospective case-note review of hospital records was conducted in Adelaide, Australia...
June 9, 2018: BMC Palliative Care
Maria Karagiannidou, Raphael Wittenberg, Filipa Isabel Trigo Landeiro, A-La Park, Andra Fry, Martin Knapp, Alastair M Gray, Antje Tockhorn-Heidenreich, Amparo Yovanna Castro Sanchez, Isaac Ghinai, Ron Handels, Pascal Lecomte, Jane Wolstenholme
INTRODUCTION: Dementia is one of the greatest health challenges the world will face in the coming decades, as it is one of the principal causes of disability and dependency among older people. Economic modelling is used widely across many health conditions to inform decisions on health and social care policy and practice. The aim of this literature review is to systematically identify, review and critically evaluate existing health economics models in dementia. We included the full spectrum of dementia, including Alzheimer's disease (AD), from preclinical stages through to severe dementia and end of life...
June 8, 2018: BMJ Open
Erin Colleen Johansson, Susanne Hartz, Sandeep Himatlal Kiri, Gayathri Kumar, Axel Svedbom
AIMS: Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK...
June 6, 2018: Journal of Medical Economics
Paolo Vercellini, Agnese Donati, Federica Ottolini, Annalisa Frassineti, Jessica Fiorini, Vanessa Nebuloni, Maria Pina Frattaruolo, Anna Roberto, Paola Mosconi, Edgardo Somigliana
OBJECTIVE: To assess the proportion of patients with symptomatic endometriosis satisfied with their medical treatment 12 months after enrollment in a stepped-care management protocol. DESIGN: Prospective, single-arm, self-controlled study. SETTING: Academic department. PATIENT(S): A cohort of 157 consecutive patients referred or self-referred to our center for symptomatic endometriosis. INTERVENTIONS(S): Systematic detailed information process on medical and surgical treatment followed by a shared decision to start a stepped-care protocol including three subsequent medical therapy steps (oral contraception [OC]; 2...
June 2, 2018: Fertility and Sterility
Elizabeth L Godfrey, Michael L Kueht, Abbas Rana, Samir Awad
BACKGROUND: The new Model for End-Stage Liver Disease includes serum sodium (MELD-Na). To evaluate its predictive power in non-transplant surgery, we analyzed emergency surgery outcomes of cirrhotic patients, hypothesizing that negative outcomes could be associated with discrete MELD-Na score thresholds. METHODS: Retrospective chart review was conducted of patients with cirrhosis undergoing emergency surgery at our institution from 2001 to 2013 (n = 85). Risk thresholds and predictors of peri-operative outcomes were identified using univariate and multivariate regression...
May 22, 2018: American Journal of Surgery
Nevena Markovic, Marcus Povitz, Joanne Smith, David Leasa, Christen Shoesmith, Teneille E Gofton
BACKGROUND: Non-invasive ventilation (NIV) improves quality of life and survival in patients with amyotrophic lateral sclerosis (ALS) and respiratory symptoms. Little is known about the patterns of NIV use over time and the impact of NIV on end-of-life decision-making in ALS. OBJECTIVE: This study assessed the pattern of NIV use over the course of the disease and the timing of end-of-life discussions in people living with ALS. METHOD: A retrospective single-center cohort study was performed at London Health Sciences Centre...
June 6, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Felicity Moon, Fiona McDermott, David Kissane
BACKGROUND: Patients with dementia may receive suboptimal end-of-life care in hospital settings reflecting broader debate around the palliative status of dementia syndromes. OBJECTIVES: To synthesize literature describing the quality of end-of-life care for patients with dementia dying in hospital. METHODS: An integrative review assessed the quality of 26 articles concerning medical, nursing, and psychosocial care of patients with dementia dying in hospital settings...
January 1, 2018: American Journal of Hospice & Palliative Care
Mi-Kyung Song, Sandra E Ward, Kenneth Hepburn, Sudeshna Paul, Raj C Shah, Darby J Morhardt
People in the early stages of Alzheimer's disease and related dementias (ADRD) are encouraged to engage in advance care planning (ACP) while they are still competent to appoint a surrogate decision maker and meaningfully participate in ACP discussions with the surrogate. In this NIH Stage I behavioral intervention development trial, we will adapt and test an efficacious ACP intervention, SPIRIT (Sharing Patient's Illness Representation to Increase Trust), with people with mild dementia and their surrogates to promote open, honest discussions while such discussions about end-of-life care are possible...
June 2, 2018: Contemporary Clinical Trials
M M Muñoz-Sánchez, C Calderon, P Jimenez-Fonseca, M C Soriano-Rodríguez, C Jara, T García-García, C Beato, J Rogado, B Castelo, R Hernández, M Mangas-Izquierdo, A Carmona-Bayonas
PURPOSE: Despite the burgeoning geriatric population with cancer and the importance of understanding how age may be related to mental adjustment and quality of life so far, differences in coping strategies and psychological harm between the elderly and adults are hardly being taken into account to modify the approach to this population. The aim of this prospective study is to describe the differences in psychological characteristics between older and adult cancer patients and examine dissimilarities in their psychological evolution during adjuvant chemotherapy...
June 4, 2018: Clinical & Translational Oncology
Griphin Baxter Chirambo, Victoria E Hardy, Ciara Heavin, Yvonne O'Connor, John O'Donoghue, Nikolaos Mastellos, Tammy Tran, Jenny Hsieh, Joseph Tsung-Shu Wu, Sven Carlsson, Bo Andersson, Adamson S Muula, Matthew Thompson
Background: Improved availability of mobile phones in low- and middle-income countries (LMICs) offer an opportunity to improve delivery of Community Case Management (CCM). Despite enthusiasm for introducing mHealth into healthcare across LMICs, end-user attitudes towards mHealth solutions for CCM are limited. We aimed to explore Health Surveillance Assistants' (HSAs) perceptions of the Supporting LIFE electronic CCM Application (SL eCCM App) and their experiences incorporating it as part of their clinical practice...
March 2018: Malawi Medical Journal: the Journal of Medical Association of Malawi
Victoria Siegrist, Ceylan Eken, Christian H Nickel, Rui Mata, Ralph Hertwig, Roland Bingisser
Background: End-of-life decisions (EOLD) represent potentially highly consequential decisions often made in acute situations, such as "do not attempt resuscitation" (DNAR) choices at emergency presentation. Aim: We investigated DNAR decisions in an emergency department (ED) to assess prevalence, associated patient characteristics, potential medical and economic consequences, and estimate contributions of patients and physicians to DNAR decisions. Design: Single-centre retrospective observation, including ED patients with subsequent hospitalisation between 2012 and 2016...
May 30, 2018: QJM: Monthly Journal of the Association of Physicians
Maya L Chan, John A Spertus, Yuanyuan Tang, Monique Anderson Starks, Paul S Chan
BACKGROUND: Despite the high incidence of in-hospital cardiac arrest (IHCA) in US hospitals, the prognosis and end-of-life decision-making patterns of a patient with a recurrent IHCA are unknown. METHODS: Within Get-With-The-Guidelines-Resuscitation, we identified 192,250 patients from 711 hospitals with an IHCA from 2000 to 2015. Patients were categorized as having no recurrent IHCA (only 1 event), recurrent IHCA (≥2 IHCAs), and recurrent out-of-hospital cardiac arrest (OHCA), defined as an IHCA after an OHCA...
May 9, 2018: American Heart Journal
David Hausner, Nanor Kevork, Ashley Pope, Breffni Hannon, John Bryson, Jenny Lau, Gary Rodin, Lisa W Le, Camilla Zimmermann
PURPOSE: Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients' discharge disposition on an APCU in a cancer center. METHODS: We evaluated demographic, administrative, and clinical data for all patients admitted to the APCU in 2015...
May 30, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Manuel R G Carrapato, Teresa Andrade, Teresa Caldeira
Small preterms often have low blood pressure readings in the first few days of life. However, what is hypotension in preterms? Should there be an aggressive approach to its management? What are the immediate and long-term side effects of powerful medications? Alternatively, could be accepted a low blood pressure instead? Our data show that, despite extremely low gestational age (ELGA) / extremely low birth weight (ELBW) neonates, almost half of these tiny babies have neither low mean arterial pressure (MAP) readings nor clinical signs of impaired perfusion...
May 30, 2018: Journal of Maternal-fetal & Neonatal Medicine
Regina Kwon, Larry A Allen, Laura D Scherer, Jocelyn S Thompson, Madiha F Abdel-Maksoud, Colleen K McIlvennan, Daniel D Matlock
BACKGROUND: Unrestrained use of expensive, high-risk interventions runs counter to the idea of a limited medical commons. OBJECTIVE: To examine the effect of displaying the total first-year cost of implanting a left ventricular assist device (LVAD) on a hypothetical treatment decision and whether this effect differs when choosing for oneself versus for another person. DESIGN: We conducted an online survey in February 2016. The survey described the clinical course of end-stage heart failure and the risks and benefits of an LVAD...
July 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
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