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https://www.readbyqxmd.com/read/28643812/-conscience-clause-in-end-of-life-care
#1
Ludovica De Panfilis, Daniela Cattaneo, Luisanna Cola, Maddalena Gasparini, Corinna Porteri, Daniela Tarquini, Alessandro Tiezzi, Simone Veronese, Silvia Zullo, Eugenio Pucci
The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento"...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28641378/staff-perceptions-of-key-factors-guiding-nursing-home-search-and-selection-within-the-veterans-health-administration
#2
Edward Alan Miller, Stefanie Gidmark, Emily Gadbois, James L Rudolph, Orna Intrator
Background and Objectives: Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA)...
June 21, 2017: Gerontologist
https://www.readbyqxmd.com/read/28640487/a-qualitative-study-exploring-the-difficulties-influencing-decision-making-at-the-end-of-life-for-people-with-dementia
#3
Kethakie Lamahewa, Rammya Mathew, Steve Iliffe, Jane Wilcock, Jill Manthorpe, Elizabeth L Sampson, Nathan Davies
BACKGROUND: Dementia is a progressive neurodegenerative condition characterized by declining functional and cognitive abilities. The quality of end of life care for people with dementia in the UK can be poor. Several difficult decisions may arise at the end of life, relating to the care of the person with dementia, for example management of comorbidities. OBJECTIVE: To explore difficulties in decision making for practitioners and family carers at the end of life for people with dementia...
June 22, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28638855/end-of-life-care-and-do-not-resuscitate-orders-how-much-does-age-influence-decision-making-a-systematic-review-and-meta-analysis
#4
REVIEW
Ifor Cook, Aimee L Kirkup, Lauren J Langham, Muminah A Malik, Gabriella Marlow, Ian Sammy
With population aging, "do not resuscitate" (DNAR) decisions, pertaining to the appropriateness of attempting resuscitation following a cardiac arrest, are becoming commoner. It is unclear from the literature whether using age to make these decisions represents "ageism." We undertook a systematic review of the literature using CINAHL, Medline, and the Cochrane database to investigate the relationship between age and DNAR. All 10 studies fulfilling our inclusion criteria found that "do not attempt resuscitation" orders were more prevalent in older patients; eight demonstrated that this was independent of other mediating factors such as illness severity and likely outcome...
January 2017: Gerontology & Geriatric Medicine
https://www.readbyqxmd.com/read/28638606/palliative-care-for-patients-with-end-stage-renal-disease-approach-to-treatment-that-aims-to-improve-quality-of-life-and-relieve-suffering-for-patients-and-families-with-chronic-illnesses
#5
Amy Rak, Rupesh Raina, Theodore T Suh, Vinod Krishnappa, Jessica Darusz, Charles W Sidoti, Mona Gupta
Providing end-of-life care to patients suffering from chronic kidney disease (CKD) and/or end-stage renal disease often presents ethical challenges to families and health care providers. However, as the conditions these patients present with are multifaceted in nature, so should be the approach when determining prognosis and treatment strategies for this patient population. Having an interdisciplinary palliative team in place to address any concerns that may arise during conversations related to end-of-life care encourages effective communication between the patient, the family and the medical team...
February 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28636455/the-role-of-the-healthcare-chaplain-a-literature-review
#6
Fiona Timmins, Sílvia Caldeira, Maryanne Murphy, Nicolas Pujol, Greg Sheaf, Elizabeth Weathers, Jacqueline Whelan, Bernadette Flanagan
Healthcare chaplains operate in many healthcare sites internationally and yet their contribution is not always clearly understood by medical and healthcare staff. This review aims to explore the chaplains' role in healthcare, with a view to informing best practice in future healthcare chaplaincy. Overall the extent of the provision and staffing of chaplaincy service internationally is unclear. From this review, several key spiritual and pastoral roles in healthcare emerge including a potential contribution to ethical decision making at the end of life...
June 21, 2017: Journal of Health Care Chaplaincy
https://www.readbyqxmd.com/read/28636405/conventional-polysomnography-is-not-necessary-for-the-management-of-most-patients-with-suspected-obstructive-sleep-apnea
#7
Jaime Corral, Maria-Ángeles Sánchez-Quiroga, Carmen Carmona-Bernal, Ángeles Sánchez-Armengol, Alicia Sánchez-de-la-Torre, Joaquín Durán-Cantolla, Carlos J Egea, Neus Salord, Carmen Monasterio, Joaquín Terán, M Luz Alonso-Alvarez, Jesús Muñoz-Méndez, Eva M Arias, Marta Cabello, Josep M Montserrat, Mónica De la Peña, José C Serrano, Ferran Barbe, Juan F Masa
RATIONALE: Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic obstructive sleep apnea patients, but its effectiveness has not been evaluated across a broad clinical spectrum. OBJECTIVE: To compare the long-term effectiveness (6 months) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate to high sleep apnea suspicion (most patients requiring a sleep study)...
June 21, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28636108/understanding-the-influences-and-impact-of-patient-clinician-communication-in-cancer-care
#8
Jennifer Elston Lafata, Laura A Shay, Jodi M Winship
BACKGROUND: Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood. OBJECTIVE: We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built. DESIGN: We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use...
June 21, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28631809/anabolic-steroids-for-treating-pressure-ulcers
#9
REVIEW
Cho Naing, Maxine A Whittaker
BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers...
June 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28619775/retrospective-cohort-study-of-all-deaths-among-infants-born-between-22-and-27-completed-weeks-of-gestation-in-switzerland-over-a-3-year-period
#10
T M Berger, M A Steurer, H U Bucher, J C Fauchère, M Adams, R E Pfister, R Baumann-Hölzle, D Bassler
OBJECTIVES: The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period. DESIGN: Population-based, retrospective cohort study. SETTING: All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland. PATIENTS: ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28618897/shared-decision-making-about-palliative-chemotherapy-a-qualitative-observation-of-talk-about-patients-preferences
#11
Inge Henselmans, Hanneke Wm Van Laarhoven, Jane Van der Vloodt, Hanneke Cjm De Haes, Ellen Ma Smets
BACKGROUND: Particularly at the end of life, treatment decisions should be shared and incorporate patients' preferences. This study examines elaboration and preference construction. AIM: To examine the values, appraisals and preferences that patients express, as well as the oncologists' communicative behaviour that facilitates these expressions in consultations on palliative chemotherapy. DESIGN: Verbatim transcripts of audio-recorded consultations ( n = 60) were analysed in MAXqda10 software...
July 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28618896/managing-risk-during-care-transitions-when-approaching-end-of-life-a-qualitative-study-of-patients-and-health-care-professionals-decision-making
#12
Maureen A Coombs, Roses Parker, Kay de Vries
BACKGROUND: Increasing importance is being placed on the coordination of services at the end of life. AIM: To describe decision-making processes that influence transitions in care when approaching the end of life. DESIGN: Qualitative study using field observations and longitudinal semi-structured interviews. SETTING/PARTICIPANTS: Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand...
July 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28614074/a-patient-not-alone
#13
Lauren Sydney Flicker
This case analysis examines questions that arise when an ethically appropriate recommendation initially appears to be in conflict with the legally appropriate recommendation. The case involves a dying, incapacitated octogenarian who had friends who were willing to share her values, but not to make decisions on her behalf. These circumstances put the patient in the unique position of being legally considered a "patient alone," but who was ethically like a patient with surrogates-distinctions that are crucial when making end-of-life decisions under the New York Family Health Care Decisions Act...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28609264/supporting-muslim-patients-during-advanced-illness
#14
REVIEW
Nathan A Boucher, Ejaz A Siddiqui, Harold G Koenig
Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28604116/the-cognitive-decline-in-older-patients-with-end-stage-renal-disease-cope-study-rationale-and-design
#15
Noeleen Berkhout-Byrne, Marije H Kallenberg, André Gaasbeek, Ton J Rabelink, Sebastiaan Hammer, Mark A van Buchem, Matthias J van Osch, Lucia J M Kroft, Henk Boom, Simon P Mooijaart, Marjolijn van Buren
BACKGROUND: Older patients with end stage renal disease (ESRD) are at increased risk for cognitive decline, but detailed studies of the magnitude of cognitive decline on dialysis or comprehensive conservative management (CCM) are lacking and the underlying pathophysiological mechanisms have poorly been studied. OBJECTIVE: To describe the rationale and design of the COPE study. Study objectives are firstly to examine the severity of cognitive impairment in older patients reaching ESRD before dialysis and the rate of decline after dialysis or CCM initiation...
June 10, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28603515/factors-influencing-decision-making-for-carotid-endarterectomy-versus-stenting-in-the-very-elderly
#16
REVIEW
Sung Hyuk Heo, Cheryl D Bushnell
As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28601143/psychiatric-and-palliative-care-in-the-intensive-care-unit
#17
REVIEW
Stephanie M Harman
Palliative care is specialized medical care focused on patients with serious illness and their families. In the intensive care unit (ICU), palliative care encompasses core skills to support patients and their families throughout their ICU course and post-ICU stays. Psychiatric symptoms are common among patients approaching the end of life and require particular attention in the setting of sedating medications, typically used when patients require ventilators and other life-sustaining treatments. For patients with preexisting severe mental illness who have a concurrent serious medical illness, a palliative psychiatric approach can address complex symptom management and support ethical and value-based shared decision making...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28592468/improving-health-care-provider-communication-in-end-of-life-decision-making
#18
Tracey Wilson, Cathy Haut, Bimbola Akintade
Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28590407/family-communication-about-end-of-life-decisions-and-the-enactment-of-the-decision-maker-role
#19
April R Trees, Jennifer E Ohs, Meghan C Murray
End-of-life (EOL) decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior...
June 7, 2017: Behavioral Sciences
https://www.readbyqxmd.com/read/28587503/sense-of-responsibility-in-icu-end-of-life-decision-making-relatives-experiences
#20
Ranveig Lind
BACKGROUND: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation...
January 1, 2017: Nursing Ethics
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