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Advance care directives

Dennis DiGiorgi, John L Cerf, Daniel S Bowerman
Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications...
2018: Chiropractic & Manual Therapies
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
Michael R Kolber, Shelley Ross
BACKGROUND AND OBJECTIVES: In Canada, few family physicians (FPs) perform endoscopy. Conflicting evidence exists on the quality of endoscopy performed by Canadian FPs, which may be explained by differing skillsets of these endoscopists. The objective of this study was to perform the first exploration of the practice, skills, and knowledge of Canadian FP endoscopists. METHODS: A cross-sectional survey, including direct knowledge test, was used. RESULTS: Twenty Canadian FP endoscopists completed the survey...
March 2018: Family Medicine
Hannah Padda, Amy Niedbalski, Erin Tate, Sharon L Deem
Zoological institutions play an important role in promoting the goals of the One Health movement. We launched the Institute for Conservation Medicine (ICM) at the Saint Louis Zoo in 2011 to advance the goals of One Health. In 2016, we distributed a survey to Zoo members to evaluate member awareness and understanding of One Health and to provide direction for future communication and actions from the ICM. We hypothesized that Zoo members would be aware of One Health and care about infectious disease issues. Survey results showed Zoo members primarily cared about chronic, non-infectious diseases and their associated economic costs, with participants ranking their top three health issues of concern for humans as nutrition/obesity/diet (49%), costs of health care (48%), and cancer (37%)...
2018: Frontiers in Veterinary Science
Utpal Bhalala, Praveen Khilnani
Pediatric critical care services in India have grown with leaps and bounds. There has been a growing need of physicians specially trained in pediatric critical care medicine (PCCM) in India. Physicians returning to India after their formal training in PCCM abroad have partly supported this growing need. Development of formal PCCM training programs in India has been a huge step toward supporting the growing clinical needs. This article focuses on advances in pediatric critical care training in India and its future directions...
2018: Frontiers in Pediatrics
Matthew R Sydes, Melissa R Spears, Malcolm D Mason, Noel W Clarke, David P Dearnaley, Johann S de Bono, Gert Attard, Simon Chowdhury, Bill Cross, Silke Gillessen, Zaf Malik, Rob Jones, Chris Parker, Alastair W S Ritchie, J Martin Russell, Robin Millman, David Matheson, Claire Amos, Clare Gilson, Alison Birtle, Susannah Brock, Lisa Capaldi, Prabir Chakraborti, Ananya Choudhury, Linda Evans, Daniel Ford, Joanna Gale, Stephanie Gibbs, Duncan Gilbert, Robert Hughes, Duncan McLaren, Jason Lester, Ashok Nikapota, Joe O'Sullivan, Omi Parikh, Clive Peedell, Andrew Protheroe, Sarah M Rudman, Richard Shaffer, Denise Sheehan, Matthew Simms, Narayanan Srihari, Räto Strebel, Santhanam Sundar, Shaun Tolan, David Tsang, Mohini Varughese, John Wagstaff, Mahesh K B Parmar, Nicholas D James
Background: Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in STAMPEDE: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC+AAP vs SOC+DocP. Method: Recruitment to SOC+DocP and SOC+AAP overlapped Nov-2011─Mar-2013...
February 26, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
William Bortcosh, Ashkon Shaahinfar, Sakina Sojar, Jean E Klig
PURPOSE OF REVIEW: The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS: POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration...
March 9, 2018: Current Opinion in Pediatrics
Shuichi Hagiwara, Minoru Kaneko, Makoto Aoki, Masato Murata, Yumi Ichikawa, Jun Nakajima, Yuta Isshiki, Yusuke Sawada, Jun'ichi Tamura, Kiyohiro Oshima
Aim Almost no Japanese elderly patients have an advance directive (AD). Our aim was to determine whether or not the wish to receive intensive care in elderly patients with respiratory tract infection could be predicted from the prehospital data. Methods In this retrospective study, we reviewed patients ≥ 65 years of age with respiratory tract infection who had been transferred to our hospital by ambulance between September 2014 and August 2016. The patients were divided into two groups according to whether or not they wished to receive intensive treatment...
March 9, 2018: Internal Medicine
Catherine A Pembroke, Joanne Alfieri, Alain Biron, Carolyn Freeman, Tarek Hijal
PURPOSE: Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. METHODS AND MATERIALS: A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology...
March 2018: Practical Radiation Oncology
Amanda Gehrke, Sukhyung Steve Lee, Karrie Hilton, Barbara Ganster, Rebecca Trupp, Corinne McCullough, Elizabeth Mott, Michael Feuerstein
PURPOSE: Despite advancements in care, cancer survivors continue to report unmet needs following active cancer treatment. The Cancer Survivor Profile-Breast Cancer (CSPro-BC) application (app) was developed to help address these needs, using breast cancer survivors (BCS) as a pilot group. This paper describes the app development, BCS and nurse perceptions of the app, and changes made based on this feedback. METHODS: The CSPro-BC app was developed for use on an iPad and includes (1) administration of a 15-20-min survey assessing 18 needs, (2) generation of a profile of needs, relative to a reference group of BCS (median 2 years post-treatment), and (3) provision of problem-specific online resources...
March 9, 2018: Journal of Cancer Survivorship: Research and Practice
Gina Bravo, Modou Sene, Marcel Arcand
OBJECTIVES: To investigate which of two sources of information about an older adult's wishes-choices made in an advance directive or proxy's opinion-provides better insight into the older adult's preferences measured in hypothetical clinical situations involving decisional incapacity. METHODS: Secondary analyses of data collected from 157 community-dwelling, decisionally competent adults aged 70 years and over who attended a group information session on advance directives with their proxy...
March 9, 2018: Journal of Medical Ethics
Belén Ortiz-Gonçalves, Bernardo Perea-Pérez, Elena Labajo González, Elena Albarrán Juan, Andrés Santiago-Sáez
OBJECTIVE: To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. METHOD: The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. RESULTS: Five clusters stand out...
March 6, 2018: Gaceta Sanitaria
Giuseppina Caiazzo, Michele Fratello, Federica Di Nardo, Francesca Trojsi, Gioacchino Tedeschi, Fabrizio Esposito
PURPOSE: Advances in computational network analysis have enabled the characterization of topological properties of human brain networks (connectomics) from high angular resolution diffusion imaging (HARDI) MRI structural measurements. In this study, the effect of changing the diffusion weighting (b value) and sampling (number of gradient directions) was investigated in ten healthy volunteers, with specific focus on graph theoretical network metrics used to characterize the human connectome...
March 8, 2018: Neuroradiology
G Hawa, Linda Sonnleitner, A Missbichler, A Prinz, G Bauer, C Mauracher
Although Enzyme Linked Immuno Sorbent Assay (ELISA) technology is approaching it's 45th year of existence since first described in 1971, it is still the main diagnostic tool in clinical research and routine diagnostics. However, despite its broad usage it suffers from some drawbacks, limiting its use especially in more advanced assay formats like multiplexing platforms, point of care devices or protein arrays. Those limitations result from the need for an enzyme label, a soluble enzyme substrate, washing steps (multiplexing, point care, arrays) and in some cases also insufficient sensitivity, because the majority of circulating proteins and thus potential biomarkers may be found in lowor sub-picomolar concentrations...
March 5, 2018: Analytical Biochemistry
Shuji Ota, Terunobu Haruyama, Masashi Ishihara, Maika Natsume, Yoko Fukasawa, Takahiko Sakamoto, Shigeru Tanzawa, Ryo Usui, Takeshi Honda, Yasuko Ichikawa, Kiyotaka Watanabe, Yuko Sasajima, Nobuhiko Seki
The patient was a 66-year-old woman. An induration of approximately 15 mm in size that accompanied redness was palpable in the umbilical fossa. She did not respond to 1-month antibiotic treatment provided by the previous physician. For this reason, a biopsy of the site was performed with the possibility of neoplastic disease in mind, resulting in the detection of adenocarcinoma. Subsequent detailed whole-body examination revealed advanced gastric cancer and peritoneal dissemination, and the induration in the umbilical fossa was diagnosed as a direct infiltration from the peritoneal dissemination...
January 2018: Case Reports in Oncology
S Olafsson, T Tyrfingsson, V Runarsdottir, O M Bergmann, I Hansdottir, E S Björnsson, B Johannsson, B Sigurdardottir, R H Fridriksdottir, A Löve, M Hellard, T J Löve, T Gudnason, M Heimisdottir, M Gottfredsson
A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018...
March 7, 2018: Journal of Internal Medicine
Prabhpreet Singh, Amit Noheria
Invasive electrophysiology (EP) mapping and catheter ablation has increasingly become the standard of care for many cardiac arrhythmias like supraventricular tachycardias, atrial fibrillation, premature ventricular complexes (PVC), and monomorphic ventricular tachycardia. In this review, we discuss the recent progress made in the mapping and ablation of ventricular fibrillation (VF). Ventricular activation during VF is apparently disorganized, making mapping and interpretation difficult. Prolonged mapping during VF would require mechanical circulatory support as VF causes complete hemodynamic collapse...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Mohanraj Karunanithi, Qing Zhang
Australian population aged over 65 years is 14% (3.3 million) and this expected to increase to 21% by 2053 (8.3 million), of which 1.9% to 4.2% is attributed to Australians over 85 years. With increase in ageing, there is high prevalence in long-term health conditions and more likely multiple visits to the doctors or the hospitals, particularly when one's functional condition declines. This adds burden to the already stretched health system such as the overcrowding of emergency departments in hospitals. This is partly due to many ageing patients with high care needs occupying significant number of hospital beds because they are waiting for entry to the limited placements in residential care...
2018: Studies in Health Technology and Informatics
Ayman W El-Hattab, Mohammed Almannai, V Reid Sutton
Newborn screening programs aim to achieve presymptomatic diagnosis of treatable disorders allowing for early initiation of medical care to prevent or reduce significant morbidity and mortality. Many of the conditions included in the newborn screening panels are inborn errors of metabolism; however, screening for endocrine, hematologic, immunologic, and cardiovascular diseases, and hearing loss is also included in many panels. Newborn screening tests are not diagnostic and therefore diagnostic testing is needed to confirm or exclude the suspected diagnosis...
April 2018: Pediatric Clinics of North America
David Gibbes Miller, Rebecca Dresser, Scott Y H Kim
Authorising euthanasia and assisted suicide with advance euthanasia directives (AEDs) is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer's disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law was enacted...
March 3, 2018: Journal of Medical Ethics
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