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https://www.readbyqxmd.com/read/29045355/complexity-of-chronic-conditions-impact-on-end-of-life-expense-trajectories-of-medicare-decedents
#1
Suzanne S Sullivan, Junxin Li, Yow-Wu Bill Wu, Sharon Hewner
OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling...
October 17, 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/29042081/peritoneal-dialysis-is-associated-with-better-cognitive-function-than-hemodialysis-over-a-one-year-course
#2
Denise Neumann, Wilfried Mau, Andreas Wienke, Matthias Girndt
Impaired cognitive functioning in patients with end-stage renal disease may reduce their capabilities to adhere to complex medical or dietary regimens and to fully participate in medical decisions. With decreasing renal function, cognitive abilities are likely to decline, with cognitive dysfunction improving after initiation of dialysis and even being generally reversible after successful renal transplantation. However, little is known about cognitive changes particularly regarding different treatment modalities...
October 14, 2017: Kidney International
https://www.readbyqxmd.com/read/29040427/what-is-the-end-of-life-period-trajectories-and-characterization-based-on-primary-caregiver-reports
#3
Jiska Cohen-Mansfield, Rinat Cohen, Michal Skornick-Bouchbinder, Shai Brill
BACKGROUND: As the population lives longer, end of life (EOL) is emerging as a distinct life phase, about which there is still limited understanding. Characterizing this important period is vital for clarifying issues regarding trajectory and decline at EOL and for health service planning on an institutional, communal, and societal level. In this paper we aim to characterize the EOL period, examining the duration and number of EOL stages, as well as the functional, attitudinal and emotional trajectories...
October 12, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29040344/dilemmas-for-guardians-of-advanced-dementia-patients-regarding-tube-feeding
#4
Efrat Gil, Maayan Agmon, Ayal Hirsch, Miriam Ziv, Anna Zisberg
Background: advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure...
October 13, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29038186/incidence-duration-and-cost-of-futile-treatment-in-end-of-life-hospital-admissions-to-three-australian-public-sector-tertiary-hospitals-a-retrospective-multicentre-cohort-study
#5
Hannah E Carter, Sarah Winch, Adrian G Barnett, Malcolm Parker, Cindy Gallois, Lindy Willmott, Ben P White, Mary Anne Patton, Letitia Burridge, Gayle Salkield, Eliana Close, Leonie Callaway, Nicholas Graves
OBJECTIVES: To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions. DESIGN: Retrospective multicentre cohort study involving a clinical audit of hospital admissions. SETTING: Three Australian public-sector tertiary hospitals. PARTICIPANTS: Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012. MAIN OUTCOME MEASURES: Incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment...
October 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29034348/selection-of-patients-with-hepatocellular-cancer-a-difficult-balancing-between-equity-utility-and-benefit
#6
REVIEW
Alessandro Vitale, Quirino Lai
Although liver transplantation (LT) represents the gold-standard strategy for hepatocellular cancer (HCC), its use is circumscribed by several factors like donor shortage, perioperative complications, or competition with other candidates without HCC. Moreover, different alternative approaches like resection or loco-regional therapies may be attempted in selected cases. The best option for the treatment of an HCC patient is a complex decision, involving several ethical principles including: equity (horizontal equity and vertical equity or urgency), and utility...
2017: Translational Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29032732/a-personalized-week-to-week-updating-algorithm-to-improve-continuous-glucose-monitoring-performance
#7
Stamatina Zavitsanou, Joon Bok Lee, Jordan E Pinsker, Mei Mei Church, Francis J Doyle, Eyal Dassau
BACKGROUND: Continuous glucose monitoring (CGM) systems are increasingly becoming essential components in type 1 diabetes mellitus (T1DM) management. Current CGM technology requires frequent calibration to ensure accurate sensor performance. The accuracy of these systems is of great importance since medical decisions are made based on monitored glucose values and trends. METHODS: In this work, we introduce a calibration strategy that is augmented with a weekly updating feature...
October 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29030806/palliative-care-in-the-management-of-patients-with-advanced-heart-failure
#8
Susan E Lowey
Globally, there are 18-million individuals living with heart failure, a disease that is responsible for 12-15 million office visits and 6.5 million inpatient hospitalizations each year. As HF becomes advanced or end-stage, patients often live in a cycle of frequent transitions between care settings, and with unmet needs, including distress from inadequately managed symptoms. Prognostication in patients with heart failure can be challenging due to the unpredictable exacerbating-remitting illness trajectory that is associated with this progressive disease...
October 14, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29028421/medical-student-reflections-on-geriatrics-moral-distress-empathy-ethics-and-end-of-life
#9
Mary E Camp, Haekyung Jeon-Slaughter, Anne E Johnson, John Z Sadler
INTRODUCTION: Medical students' early clinical encounters may influence their perceptions of geriatrics. This study examines reflective essays written by 3rd year medical students on required clinical rotations. METHODS: Using content analysis, the authors analyzed the essays' thematic content. The authors then used chi-square analysis to compare themes with geriatric patients (age 60+) to themes with other age groups. RESULTS: 120 out of 802 essays described a geriatric patient...
October 13, 2017: Gerontology & Geriatrics Education
https://www.readbyqxmd.com/read/29026418/heterozygosity-analysis-of-polycystic-kidney-disease-1-gene-microsatellite-markers-for-linkage-analysis-of-autosomal-dominant-polycystic-kidney-disease-type-1-in-the-iranian-population
#10
Razieh Fatehi, Sharifeh Khosravi, Maryam Abedi, Rasoul Salehi, Yousof Gheisari
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage renal disease. Although imaging techniques are a means of accurate diagnosis when the cysts appear in the third or fourth decades of the patient's life, they are of little value for early diagnosis. Genetic tests are required for preimplantation genetic diagnosis, decision-making for kidney donation to an affected relative. Although mutation of the polycystic kidney disease (PKD1) gene is solely responsible for the most cases of ADPKD, direct genetic testing is limited by the large size of this gene and the presence of many mutations without hot spots...
2017: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/29024808/critical-care-nurses-experiences-of-withdrawal-of-treatment-a-systematic-review-of-qualitative-evidence
#11
REVIEW
Brandi Vanderspank-Wright, Nikolaos Efstathiou, Amanda D Vandyk
BACKGROUND: Death and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit. OBJECTIVE: To synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment...
September 28, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/29022068/esophagectomy-for-end-stage-achalasia-systematic-review-and-meta-analysis
#12
REVIEW
Alberto Aiolfi, Emanuele Asti, Gianluca Bonitta, Luigi Bonavina
BACKGROUND: Indications for surgery and clinical outcomes of esophagectomy in the management of end-stage achalasia are not clearly defined. The aim of this systematic review and meta-analysis was to provide evidence-based information to help in the decision-making and in the choice of surgical technique. METHODS: An extensive literature search was conducted to identify all reports on esophagectomy for end-stage achalasia patients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy" and "esophageal resection" with "AND" and "OR...
October 11, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29020932/difficult-conversations-australian-indigenous-patients-views-on-kidney-transplantation
#13
Jeannie Devitt, Kate Anderson, Joan Cunningham, Cilla Preece, Paul Snelling, Alan Cass
BACKGROUND: Indigenous Australians suffer a disproportionate burden of end stage kidney disease (ESKD) but are significantly less likely to receive a transplant. This study explores Indigenous ESKD patients' views on transplantation as a treatment option. METHODS: The Improving Access to Kidney Transplants (IMPAKT) research program investigated barriers to kidney transplantation for Indigenous Australians. An interview study, conducted in 2005-2006, elicited illness experience narratives from 146 Indigenous patients, including views on transplant...
October 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29020864/end-of-life-care-a-qualitative-study-comparing-the-views-of-people-with-dementia-and-family-carers
#14
Marie Poole, Claire Bamford, Emma McLellan, Richard P Lee, Catherine Exley, Julian C Hughes, Karen Harrison-Dening, Louise Robinson
BACKGROUND: In recent years, UK policy has increasingly recognised the importance of end-of-life care in dementia. While professional consensus on optimal palliative care in dementia has been reported, little is known about the perspectives of people with dementia and family carers. AIM: To compare the views of people with dementia and family carers of people with dementia (current and recently bereaved) on optimal end-of-life care. DESIGN: Qualitative interviews (32) and a focus group were conducted...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29020854/shared-decision-making-at-the-end-of-life-a-focus-group-study-exploring-the-perceptions-and-experiences-of-multi-disciplinary-healthcare-professionals-working-in-the-home-setting
#15
Paula Brogan, Felicity Hasson, Sonja McIlfatrick
BACKGROUND: Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. AIM: To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. DESIGN: Qualitative design using focus groups, transcribed verbatim and analysed thematically...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28993286/spirit-trial-a-phase-iii-pragmatic-trial-of-an-advance-care-planning-intervention-in-esrd
#16
Mi-Kyung Song, Mark L Unruh, Amita Manatunga, Laura C Plantinga, Janice Lea, Manisha Jhamb, Abhijit V Kshirsagar, Sandra E Ward
Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates...
October 6, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28993227/adverse-glycaemic-effects-of-cancer-therapy-indications-for-a-rational-approach-to-cancer-patients-with-diabetes
#17
REVIEW
Marco Gallo, Giovanna Muscogiuri, Francesco Felicetti, Antongiulio Faggiano, Francesco Trimarchi, Emanuela Arvat, Riccardo Vigneri, Annamaria Colao
Diabetes and cancer are common, chronic, and potentially fatal diseases that frequently co-exist. Observational studies have reported an increased risk of cancer in patients with diabetes. Furthermore, many patients with cancer already have diabetes, or develop hyperglycemia as a consequence of the tumor or of cancer therapies, and coexisting diabetes confers a greater risk of mortality for many malignancies. Managing oncologic patients with diabetes is often complicated, since the co-existence of diabetes and cancer poses several complex clinical questions: what level of glycemic control to achieve, which therapy to use, how to deal with glucocorticoid therapies and artificial nutrition, how diabetes complications can affect cancer management, which drug-drug interactions should be taken into account, or even how to manage diabetes at the end of life...
October 6, 2017: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/28993099/recognising-older-frail-patients-near-the-end-of-life-what-next
#18
Magnolia Cardona-Morrell, Ebony Lewis, Sanjay Suman, Cilla Haywood, Marcella Williams, Audrey-Anne Brousseau, Sally Greenaway, Ken Hillman, Elsa Dent
Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may be controlled and can be slowed down and its precursor -pre-frailty- can be treated with multidisciplinary intervention. The aim of this narrative review is to provide an overview of the different ways of measuring frailty in community settings, hospital, emergency, general practice and residential aged care; suggest occupational groups who can assess frailty in various services; discuss the feasibility of comprehensive geriatric assessments; and summarise current evidence of its management guidelines...
October 6, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28991602/nurses-experiences-of-end-of-life-care-in-long-term-care-hospitals-in-japan-balancing-improving-the-quality-of-life-and-sustaining-the-lives-of-patients-dying-at-hospitals
#19
Ryo Odachi, Tomoko Tamaki, Mikiko Ito, Taketoshi Okita, Yuri Kitamura, Tomotaka Sobue
PURPOSE: In Japan, about 80% of deaths occur in hospitals, especially long-term care beds. The purpose of this study was to clarify the nursing practices used for such older patients at the end-of-life stage in long-termcare wards via the modified grounded theory approach (M-GTA). METHODS: Data were obtained through semi-structured interviews of nineteen nurses working in cooperating long-term care wards, acute care wards, or hospice services (to allow for constant comparison between these types of wards) in western Japan in 2014...
September 2017: Asian Nursing Research
https://www.readbyqxmd.com/read/28990634/understanding-end-of-life-decision-making-terminology-among-african-american-older-adults
#20
Karen O Moss, Nancy L Deutsch, Patricia J Hollen, Virginia G Rovnyak, Ishan C Williams, Karen M Rose
The purpose of the current study was to examine understanding of end-of-life (EOL) decision-making terminology among family caregivers of African American older adults with dementia. This qualitative descriptive study was part of a larger mixed-methods study from which a subset of caregivers (n = 18) completed interviews. Data were analyzed using descriptive statistics and content analyses guided by methods of qualitative analysis. Caregiver interpretation of EOL decision-making terminology varied between associations before and/or after death...
October 6, 2017: Journal of Gerontological Nursing
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