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Advance care directives

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https://www.readbyqxmd.com/read/27935971/costs-of-care-of-hiv-infected-children-initiating-lopinavir-ritonavir-based-antiretroviral-therapy-before-the-age-of-two-in-cote-d-ivoire
#1
Sophie Desmonde, Divine Avit, Junie Petit, Madeleine Amorissani Folquet, Francois Tanoh Eboua, Clarisse Amani Bosse, Evelyne Dainguy, Véronique Mea, Marguerite Timite-Konan, Sylvie Ngbeché, Andrea Ciaranello, Valeriane Leroy
OBJECTIVES: To access the costs of care for Ivoirian children before and after initiating LPV/r-based antiretroviral therapy (ART) before the age of two. METHODS: We assessed the direct costs of care for all HIV-infected children over the first 12 months on LPV/r-based ART initiated <2 years of age in Abidjan. We recorded all drug prescriptions, ART and cotrimoxazole prophylaxis delivery, medical analyses/examinations and hospital admissions. We compared these costs to those accrued in the month prior to ART initiation...
2016: PloS One
https://www.readbyqxmd.com/read/27932341/older-patient-considering-treatment-for-advanced-renal-disease-protocol-for-a-scoping-review-of-the-information-available-for-shared-decision-making
#2
Rajesh Raj, Kiran D K Ahuja, Mai Frandsen, Matthew Jose
INTRODUCTION: Older adults constitute the largest group of patients on dialysis in most parts of the world. Management of advanced renal disease in the older adult is complex; treatment outcomes and prognosis can be markedly different from younger patients. Clinical teams caring for such patients are often called on to provide information regarding prognosis and outcomes with treatment-particularly, the comparison between having dialysis treatment versus not having dialysis. These discussions can be difficult for clinicians because they have to contend with incomplete or nascent data regarding prognosis and outcomes in this age group...
December 8, 2016: BMJ Open
https://www.readbyqxmd.com/read/27930644/immunotherapy-for-the-treatment-of-breast-cancer-checkpoint-blockade-cancer-vaccines-and-future-directions-in-combination-immunotherapy
#3
Heather L McArthur, David B Page
Immunotherapy encompasses both vaccines that direct immune responses to tumor-associated antigens, and checkpoint blocking antibodies that inhibit immune system suppression by targeting key pathways mediated by cytotoxic T-lymphocyte-associated antigen 4, programmed death 1 (PD-1), and programmed death ligand 1 (PD-L1). Both of these approaches currently are being explored as potential strategies for the treatment of breast cancer. Recent studies suggest that immunotherapy is poised to change the therapeutic landscape for some breast cancers...
November 2016: Clinical Advances in Hematology & Oncology: H&O
https://www.readbyqxmd.com/read/27929325/social-competence-in-pediatric-burn-survivors-a-systematic-review
#4
Margo M Szabo, Kaitlyn A Ferris, Lauryn Urso, Ariel M Aballay, Christina L Duncan
OBJECTIVE: Youth sustaining burn injuries during childhood have dramatically increased survival rates due to improvements in medical treatment and multidisciplinary approaches to burn critical care and recovery. Despite positive advancements in burn treatment, youth sustaining such injuries may experience social deficits. Thus, this systematic review without meta-analysis investigation contributes to the growing literature on this topic by comparing social competence of pediatric burn survivors to youth without burns, and examining potential correlates of social competence among children and adolescents who have sustained burn injuries...
December 8, 2016: Rehabilitation Psychology
https://www.readbyqxmd.com/read/27927063/inflammation-and-beyond-new-directions-and-emerging-drugs-for-treating-atherosclerosis
#5
Marie-Jeanne Bertrand, Jean-Claude Tardif
Cardiovascular (CV) atherosclerotic disease remains the leading cause of morbidity and mortality worldwide, despite the advances in contemporary therapies. Inflammation is an important process in atherosclerosis, leading to plaque rupture and acute coronary syndrome. Although statin therapy has substantially reduced CV events in primary and secondary prevention, many treated patients will have recurrent adverse CV events despite the standard of care. Thus, drug development aiming to target inflammatory pathways seems a promising avenue for novel therapies in atherosclerosis...
December 7, 2016: Expert Opinion on Emerging Drugs
https://www.readbyqxmd.com/read/27926542/measuring-quality-of-life-in-advanced-heart-failure
#6
Jane MacIver, Kirsten Wentlandt, Heather J Ross
PURPOSE OF REVIEW: Patients with Stage D heart failure can benefit from palliative care consultation to help them manage unpleasant symptoms and improve quality of life. Although guidelines describe how to manage symptoms, very little direction is provided on how to evaluate the effectiveness of those interventions. RECENT FINDINGS: Numerous studies have used the measurement of symptoms, emotional distress, functional capacity and quality of life to evaluate the effectiveness of interventions in heart failure...
December 6, 2016: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/27925077/challenges-to-implementation-of-advance-directives-of-will-in-hospital-practice
#7
Silvana Bastos Cogo, Valéria Lerch Lunardi, Alberto Manuel Quintana, Nara Marilene Oliveira Girardon-Perlini, Rosemary Silva da Silveira
Objective: to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. Method: qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. Results: the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication...
November 2016: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/27924978/astaxanthin-in-cardiovascular-health-and-disease-mechanisms-of-action-therapeutic-merits-and-knowledge-gaps
#8
REVIEW
Francesco Visioli, Christian Artaria
Cardiovascular disease is the main contributor to morbidity and mortality worldwide. Based on its unique chemical features, the xanthophyll carotenoid astaxanthin is being proposed as a suitable preventive and therapeutic agent in cardiovascular disease. This review focuses on recent advances in astaxanthin research relevant to cardiovascular health and disease, i.e. its direct antioxidant, indirect antioxidant, anti-inflammatory, anti-hypertensive, anti-diabetic, renoprotective, lipid-lowering and anti-atherosclerotic activities in vitro and in vivo...
December 7, 2016: Food & Function
https://www.readbyqxmd.com/read/27924357/caring-at-home-until-death-enabled-determination
#9
Carole A Robinson, Joan L Bottorff, Erin McFee, Laura J Bissell, Gillian Fyles
PURPOSE: The importance of family caregivers in providing palliative care at home and in supporting a home death is well supported. Gaining a better understanding of what enables palliative family caregivers to continue caring at home for their family members until death is critical to providing direction for more effective support. The purpose of the study was to describe the experiences of bereaved family caregivers whose terminally ill family members with advanced cancer were successful in achieving a desired home death...
December 6, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/27920707/a-case-report-demonstrating-the-potential-clinical-relevance-of-liquid-tumor-biopsies-in-lung-cancer
#10
Revathi Suppiah, Bruce Gershenhorn, Maurie Markman
A 50-year-old male with advanced non-small-cell lung cancer was unable to have standard-of-care molecular testing performed at diagnosis as a result of inadequacy of the available tissue. A subsequently performed commercial liquid tumor biopsy (Foundation ACT(®)) revealed an epidermal growth factor receptor exon 19 deletion, but due to the progression of the tumor and rapid deterioration in the patient's performance status, a meaningful attempt at therapy directed to this recognized therapeutic target was not possible...
September 2016: Case Reports in Oncology
https://www.readbyqxmd.com/read/27918852/anomaly-detection-outperforms-logistic-regression-in-predicting-outcomes-in-trauma-patients
#11
Zachary D W Dezman, Chen Gao, Shiming Yang, Peter Hu, Li Yao, Hsiao-Chi Li, Chein-I Chang, Colin Mackenzie
OBJECTIVE: Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. METHODS: We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center)...
December 5, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27918399/the-evolution-of-the-new-provider-team-driving-cultural-change-through-data
#12
Trish Anen, Debra McElroy
Nursing executives are continually challenged to address a rapidly evolving health care system. Every aspect of care delivery is being scrutinized, yet the constant requirement remains assurance of high-quality, highly reliable care that is cost-effective and easily accessible. The nursing workforce remains visible in traditional roles as well as in new and innovative capacities, whereas nurse executives experience expanded realms of focus and responsibility. As health systems continue to adapt to the changing environment, the ability to leverage the role and scope of the advanced practice registered nurse (APRN) as a health care provider is emerging as an essential business and care strategy...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27915265/the-ethics-of-unilateral-implantable-cardioverter-defibrillators-and-cardiac-resynchronization-therapy-with-defibrillator-deactivation-patient-perspectives
#13
Margaret Daeschler, Ralph J Verdino, James N Kirkpatrick
AIMS: Decisions about deactivation of implantable cardioverter defibrillators (ICDs) are complicated. Unilateral do-not-resuscitate (DNR) orders (against patient/family wishes) have been ethically justified in cases of medical futility. Unilateral deactivation of ICDs may be seen as a logical extension of a unilateral DNR order. However, the ethical implications of unilateral ICD deactivation have not been explored. METHODS AND RESULTS: Sixty patients who had an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were interviewed at a quaternary medical centre outpatient electrophysiology practice...
December 2, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27910697/sensitivity-of-magnetic-field-line-pitch-angle-measurements-to-sawtooth-events-in-tokamaks
#14
J Ko
The sensitivity of the pitch angle profiles measured by the motional Stark effect (MSE) diagnostic to the evolution of the safety factor, q, profiles during the tokamak sawtooth events has been investigated for Korea Superconducting Tokamak Advanced Research (KSTAR). An analytic relation between the tokamak pitch angle, γ, and q estimates that Δγ ∼ 0.1° is required for detecting Δq ∼ 0.05 near the magnetic axis (not at the magnetic axis, though). The pitch angle becomes less sensitive to the same Δq for the middle and outer regions of the plasma (Δγ ∼ 0...
November 2016: Review of Scientific Instruments
https://www.readbyqxmd.com/read/27909934/current-achievements-and-future-perspectives-of-metronomic-chemotherapy
#15
REVIEW
Adriana Romiti, Rosa Falcone, Michela Roberto, Paolo Marchetti
In recent years, many anticancer drugs have been tested at metronomic dosages for a variety of tumours. Mechanisms of action attributed to metronomic chemotherapy (MCT) include antiangiogenesis, immunomodulation, direct inhibition of tumour growth, effect on tumour initiating cells and the modulation of clonal evolution. An active clinical research, aimed at testing MCT in several cancers, has been conducted over the past 15 years. However, because the majority of available results come from earlier phase II studies, mainly performed in the area of breast cancer (BC), it is clear that there are areas still to be investigated...
December 1, 2016: Investigational New Drugs
https://www.readbyqxmd.com/read/27908942/the-need-for-an-effective-process-to-resolve-conflicts-over-medical-futility-a-case-study-and-analysis
#16
Jocelyn A Olmstead, Michael D Dahnke
The issue of medical futility requires a well-defined process in which both sides of the dispute can be heard and a resolution reached in a fair and ethical manner. Procedural approaches to medical futility cases provide all parties involved with a process-driven framework for resolving these disputes. Medical paternalism or the belief in the absolute rightness of the medical model will not serve to resolve these disputes. Although medical futility is first determined by medicine, in order for the determination to meet legal criteria, it must be subject to review...
December 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27907962/critical-care-of-traumatic-cervical-spinal-cord-injuries-preventing-secondary-injury
#17
Gary Schwartzbauer, Deborah Stein
The incidence of traumatic spinal cord injury (SCI) has not changed much over the years due to an aging population suffering falls, yet advances have been made in quality of life and survival time. In addition to initial medical and surgical stabilization, modern intensive care unit (ICU) care throughout the critical early period following SCI is essential to avoid continued secondary injury to the spinal cord. Cervical SCI patients are particularly prone and sensitive to periods of cardiovascular instability and respiratory failure directly resulting from their injuries...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27903834/saliva-diagnostics-current-views-and-directions
#18
Karolina Elżbieta Kaczor-Urbanowicz, Carmen Martin Carreras-Presas, Katri Aro, Michael Tu, Franklin Garcia-Godoy, David Tw Wong
In this review, we provide an update on the current and future applications of saliva for diagnostic purposes. There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a "mirror of the body," can reflect the physiological and pathological state of the body. Therefore, it serves as a diagnostic and monitoring tool in many fields of science such as medicine, dentistry, and pharmacotherapy. Introduced in 2008, the term "Salivaomics" aimed to highlight the rapid development of knowledge about various "omics" constituents of saliva, including: proteome, transcriptome, micro-RNA, metabolome, and microbiome...
November 29, 2016: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/27903057/spatial-analysis-and-prediction-of-the-flow-of-patients-to-public-health-centres-in-a-middle-sized-spanish-city
#19
Isabel Ramos, Juan J Cubillas, Francisco R Feito, Tomas Ureña
Human and medical resources in the Spanish primary health care centres are usually planned and managed on the basis of the average number of patients in previous years. However, sudden increases in patient demand leading to delays and slip-ups can occur at any time without warning. This paper describes a predictive model capable of calculating patient demand in advance using geospatial data, whose values depend directly on weather variables and location of the health centre people are assigned to. The results obtained here show that outcomes differ from one centre to another depending on variations in the variables measured...
November 21, 2016: Geospatial Health
https://www.readbyqxmd.com/read/27900726/survey-on-german-palliative-care-specialists-experiences-with-advance-directives
#20
Julia Zenz, Michael Zenz
INTRODUCTION: Advance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals' views on advance directives (AD). METHODS: A questionnaire was handed out to attendants of a palliative care symposium. RESULTS: Complete answers were obtained from 126 physicians and 276 nurses...
November 29, 2016: Pain and Therapy
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