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https://www.readbyqxmd.com/read/28324205/levels-of-intervention-how-are-they-used-in-quebec-hospitals
#1
Marjolaine Frenette, Jocelyne Saint-Arnaud, Karim Serri
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered...
March 21, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28315547/how-can-i-change-my-patients-treatment-decision-making-by-becoming-a-nurse-scientist-%C3%A2
#2
Tamryn F Gray
"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28314153/sewage-sludge-disposal-strategies-for-sustainable-development
#3
Małgorzata Kacprzak, Ewa Neczaj, Krzysztof Fijałkowski, Anna Grobelak, Anna Grosser, Małgorzata Worwag, Agnieszka Rorat, Helge Brattebo, Åsgeir Almås, Bal Ram Singh
The main objective of the present review is to compare the existing sewage sludge management solutions in terms of their environmental sustainability. The most commonly used strategies, that include treatment and disposal has been favored within the present state-of-art, considering existing legislation (at European and national level), characterization, ecotoxicology, waste management and actual routs used currently in particular European countries. Selected decision making tools, namely End-of-waste criteria and Life Cycle Assessment has been proposed in order to appropriately assess the possible environmental, economic and technical evaluation of different systems...
March 14, 2017: Environmental Research
https://www.readbyqxmd.com/read/28303282/-advance-directives-in-clinical-practice-living-will-healthcare-power-of-attorney-and-care-directive
#4
J Hack, B Buecking, C L Lopez, S Ruchholtz, C A Kühne
In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e...
March 16, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28301702/space-for-the-prisoner-s-point-of-view
#5
Laura Haupt
The lead article in this issue discusses a potentially free metaphorical space-that of decision-making-within the confines, tangible and intangible, of life in jail or prison. By interviewing prisoner-participants from six clinical studies, Paul Christopher and colleagues sought to find out how these men and women would answer open-ended questions about their decision to enroll in the research. What the interviewers heard was that none saw themselves as having been inappropriately pressured to do so. In fact, a significant percentage of the prisoners described being dissuaded from participating in the studies...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28294479/understanding-advance-care-planning-within-the-south-asian-community
#6
Patricia D Biondo, Rashika Kalia, Rooh-Afza Khan, Nadia Asghar, Cyrene Banerjee, Debbie Boulton, Nancy Marlett, Svetlana Shklarov, Jessica E Simon
BACKGROUND: Advance care planning (ACP) is a process of reflection on and communication of a person's future health-care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community. OBJECTIVE: To explore perspectives of South Asian community members towards ACP...
March 10, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28283409/topics-in-practice-management-integrating-advance-care-planning-into-practice
#7
REVIEW
Laura E Dingfield, Joshua B Kayser
Advanced respiratory diseases progress over time and often lead to death. As their condition worsens, patients may lose medical decision making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences, or appointment of a health care power of attorney (HCPOA)...
March 7, 2017: Chest
https://www.readbyqxmd.com/read/28278611/specific-words-and-experience-matter-to-surrogates-when-making-end-of-life-decisions
#8
Dawn E Fairlie
This grant funded preliminary study investigated the relationship between end-of-life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults aged 50 and older. Participants were randomized into two groups; each received a survey packet that varied only in the use of the words "Do Not Resuscitate (DNR)" and "Allow Natural Death (AND)." The Decisional Conflict Scale (DCS) was administered and demographic data were collected. No difference was found in the total DCS scores based on the AND and DNR versions...
February 17, 2017: Health Communication
https://www.readbyqxmd.com/read/28277859/impact-of-a-multivariate-serum-based-proteomic-test-on-physician-treatment-recommendations-for-advanced-non-small-cell-lung-cancer
#9
Wallace L Akerley, Alix M Arnaud, Bibas Reddy, Ray D Page
OBJECTIVE: The VeriStrat * test (VS) is intended to help guide treatment decisions for patients with advanced NSCLC without an EGFR-sensitizing mutation, classifying patients into two categories. Patients classified as VSGood have a favorable prognosis and significant clinical response to EGFR-Tyrosine Kinase Inhibitors (TKI). Patients classified as VSPoor has a less favorable prognosis and exhibit no significant response to EGFR-TKIs. The objective of this paper is to assess the real-world impact of VS test results on physicians' treatment recommendations including referrals for best-supportive-care (BSC)...
March 3, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28273002/agency-behind-bars-advance-care-planning-with-aging-and-dying-offenders
#10
Sara Sanders, Meredith Stensland, Kim Juraco
Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's Agentic perspective, we examined 20 aging/dying offenders' EOL preferences and ACP. Findings include six themes: Decisions in the shadow of the past, What works best for me, Feeling blessed, What is really going on, Can anyone be trusted, and Turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process...
March 8, 2017: Death Studies
https://www.readbyqxmd.com/read/28259490/what-do-patients-expect-from-total-knee-arthroplasty-a-delphi-consensus-study-on-patient-treatment-goals
#11
Toni Lange, Jochen Schmitt, Christian Kopkow, Elisabeth Rataj, Klaus-Peter Günther, Jörg Lützner
BACKGROUND: Although total knee arthroplasty (TKA) is among the most frequent orthopedic procedures for end-stage knee osteoarthritis (OA), systematically developed patient treatment goals for this elective intervention are missing. This constitutes a relevant barrier toward patient-centered healthcare. METHODS: A Delphi consensus study was conducted. Patients who were candidates for TKA were recruited through 11 outpatient orthopedic surgeons, 4 physiotherapists, and a patient organization in Germany...
February 7, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28249013/societal-perspective-on-access-to-publicly-subsidised-medicines-a-cross-sectional-survey-of-3080-adults-in-australia
#12
Lesley Chim, Glenn Salkeld, Patrick Kelly, Wendy Lipworth, Dyfrig A Hughes, Martin R Stockler
BACKGROUND: Around the world government agencies responsible for the selection and reimbursement of prescribed medicines and other health technologies are considering how best to bring community preferences into their decision making. In particular, community views about the distribution or equity of funding across the population. These official committees and agencies often have access to the best available and latest evidence on clinical effectiveness, safety and cost from large clinical trials and population-based studies...
2017: PloS One
https://www.readbyqxmd.com/read/28243134/home-hemodialysis-a-comprehensive-review-of-patient-centered-and-economic-considerations
#13
REVIEW
Rachael C Walker, Kirsten Howard, Rachael L Morton
Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients' lifestyle...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28242134/system-level-barriers-and-facilitators-for-foregoing-or-withdrawing-dialysis-a-qualitative-study-of-nephrologists-in%C3%A2-the%C3%A2-united-states-and-england
#14
Vanessa Grubbs, Delphine S Tuot, Neil R Powe, Donal O'Donoghue, Catherine A Chesla
BACKGROUND: Despite a growing body of literature suggesting that dialysis does not confer morbidity or mortality benefits for all patients with chronic kidney failure, the initiation and continuation of dialysis therapy in patients with poor prognosis is commonplace. Our goal was to elicit nephrologists' perspectives on factors that affect decision making regarding end-stage renal disease. STUDY DESIGN: Semistructured, individual, qualitative interviews. METHODOLOGY: Participants were purposively sampled based on age, race, sex, geographic location, and practice type...
February 24, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28237287/single-antiplatelet-therapy-in-patients-with-contraindication-to-dual-antiplatelet-therapy-after-transcatheter-aortic-valve-implantation
#15
Antonio Mangieri, Richard J Jabbour, Claudio Montalto, Matteo Pagnesi, Damiano Regazzoli, Marco B Ancona, Francesco Giannini, Akihito Tanaka, Letizia Bertoldi, Fabrizio Monaco, Eustachio Agricola, Manuela Giglio, Roberto Mattioli, Luca Ferri, Matteo Montorfano, Alaide Chieffo, Ottavio Alfieri, Antonio Colombo, Azeem Latib
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28235727/acceptable-regret-model-in-the-end-of-life-setting-patients-require-high-level-of-certainty-before-forgoing-management-recommendations
#16
Athanasios Tsalatsanis, Iztok Hozo, Benjamin Djulbegovic
BACKGROUND: The acceptable regret model postulates that under some circumstances decision-makers may tolerate wrong decisions. The purpose of this work is to empirically evaluate the acceptable regret model of decision-making in the end-of-life care setting, where terminally ill patients consider seeking curative treatment versus accepting hospice/palliative care. METHODS: We conducted interviews with 48 terminally ill patients to assess their preferences about end-of-life treatment choices...
February 21, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28216869/do-not-resuscitate-order-the-experiences-of-iranian-cardiopulmonary-resuscitation-team-members
#17
Abdolghader Assarroudi, Fatemeh Heshmati Nabavi, Abbas Ebadi, Habibollah Esmaily
BACKGROUND: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. METHODS: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. RESULTS: Three categories and six subcategories emerged: "The dilemma between revival and suffering" with the subcategories of "revival likelihood" and "death as a cause for comfort;" "conflicting situation" with the subcategories of "latent decision" and "ambivalent order;" and "low-quality CPR" with the subcategories of "team member demotivation" and "disrupting CPR performance...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28216856/feasibility-and-acceptability-of-implementing-the-integrated-care-plan-for-the-dying-in-the-indian-setting-survey-of-perspectives-of-indian-palliative-care-providers
#18
Naveen Salins, Jeremy Johnson, Stanley Macaden
INTRODUCTION: Capacity to provide end-of-life care in India is scored as 0.6/100, and very few people in India have access to palliative and end-of-life care. Lack of end-of-life care provision in India has led to a significant number of people receiving inappropriate medical treatment at the end of life, with no access to pain and symptom control and high treatment costs. The International Collaborative for the Best Care for the Dying Person is an initiative that offers the opportunity to apply international evidence on the key factors required to provide best care for the dying in the Indian context...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28214237/knowledge-attitudes-and-preferences-of-advance-decisions-end-of-life-care-and-place-of-care-and-death-in-hong-kong-a%C3%A2-population-based-telephone-survey-of-1067-adults
#19
Roger Yat-Nork Chung, Eliza Lai-Yi Wong, Nicole Kiang, Patsy Yuen-Kwan Chau, Janice Y C Lau, Samuel Yeung-Shan Wong, Eng-Kiong Yeoh, Jean W Woo
OBJECTIVES: According to the 2015 Quality of Death Index published by the Intelligence Unit of the Economist, Hong Kong is ranked 22nd in terms of quality of palliative care in the world, behind many other major developed countries in Asia, including Taiwan, Singapore, Japan, and South Korea. The objectives of the present study were to describe the knowledge, attitude, and preferences of the general Hong Kong adult population across different age groups regarding end-of-life (EOL) care decisions, place of care and death, as well as advance directive (AD)...
February 14, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28212642/beyond-cultural-stereotyping-views-on-end-of-life-decision-making-among-religious-and-secular-persons-in-the-usa-germany-and-israel
#20
Mark Schweda, Silke Schicktanz, Aviad Raz, Anita Silvers
BACKGROUND: End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping...
February 17, 2017: BMC Medical Ethics
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