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end of life decision making

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https://www.readbyqxmd.com/read/29440801/a-retrospective-study-of-end-of-life-care-decisions-in-the-critically-ill-in-a-surgical-intensive-care-unit
#1
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29440799/is-every-life-worth-saving-does-religion-and-religious-beliefs-influence-paramedic-s-end-of-life-decision-making-a-prospective-questionnaire-based-investigation
#2
Alexander Leibold, Christoph L Lassen, Nicole Lindenberg, Bernhard M Graf, Christoph Hr Wiese
Background: Paramedics, arriving on emergency cases first, have to make end-of-life decisions almost on a daily basis. Faith shapes attitudes toward the meaning and worth of life itself and therefore influences decision-making. Objective: The objective of this study was to detect whether or not religious and spiritual beliefs influence paramedics in their workday life concerning end-of-life decisions, and whether it is legally possible for them to act according to their conscience...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29439650/a-model-to-predict-disease-progression-in-patients-with-autosomal-dominant-polycystic-kidney-disease-adpkd-the-adpkd-outcomes-model
#3
Phil McEwan, Hayley Bennett Wilton, Albert C M Ong, Bjarne Ørskov, Richard Sandford, Francesco Scolari, Maria-Cristina V Cabrera, Gerd Walz, Karl O'Reilly, Paul Robinson
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the leading inheritable cause of end-stage renal disease (ESRD); however, the natural course of disease progression is heterogeneous between patients. This study aimed to develop a natural history model of ADPKD that predicted progression rates and long-term outcomes in patients with differing baseline characteristics. METHODS: The ADPKD Outcomes Model (ADPKD-OM) was developed using available patient-level data from the placebo arm of the Tolvaptan Efficacy and Safety in Management of ADPKD and its Outcomes Study (TEMPO 3:4; ClinicalTrials...
February 13, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29436432/passing-the-baton-of-trust
#4
Catherine Millington-Sanders
Proactive, shared decision making between key professionals and sensitive communication with patients, and those important to them, can never be overestimated. Projected annual deaths in England and Wales are set to rise, highlighting the increasing need for high quality palliative and end-of-life care. The Royal College of General Practitioners and Marie Curie have worked in partnership to develop the Daffodil Standards, an evidenced-based, structured approach for practices using quality improvement methodology to help improve care for patients at an advanced stage of serious illness or approaching end of life...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29432705/lay-patient-navigators-perspectives-of-barriers-facilitators-and-training-needs-in-initiating-advance-care-planning-conversations-with-older-patients-with-cancer
#5
Soumya J Niranjan, Chao-Hui S Huang, J Nicholas Dionne-Odom, Karina I Halilova, Maria Pisu, Patricia Drentea, Elizabeth A Kvale, Kerri S Bevis, Thomas W Butler, Edward E Partridge, Gabrielle B Rocque
CONTEXT: Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29428002/physician-perceptions-regarding-antimicrobial-use-in-end-of-life-care
#6
Christopher E Gaw, Keith W Hamilton, Jeffrey S Gerber, Julia E Szymczak
BACKGROUND The decision to utilize antimicrobials in end-of-life situations is complex. Understanding the reasons why physicians prescribe antimicrobials in this patient population is important for informing the design of antimicrobial stewardship interventions. METHODS A 51-item survey containing both closed and open-ended questions on end-of-life antimicrobial use was administered to physicians affiliated with the University of Pennsylvania and Children's Hospital of Philadelphia from January through April 2017...
February 12, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29426965/decisional-control-preferences-in-the-hispanic-population-in-the-bronx
#7
Jhosselini Cardenas, Pamela Infante, Abel Infante, Elizabeth Chuang, Peter Selwyn
Hispanic Americans are among the fastest growing minority groups in the USA, and understanding their preferences for medical decision-making and information sharing is imperative to provide high quality end of life care. Studies exploring these decision control preferences (DCPs) are limited and found inconsistent results. (1) To measure DCPs of Hispanic patients in the Bronx. (2) To measure disclosure of information preferences of Hispanic patients in the Bronx. This is a cross-sectional survey. One hundred nineteen cancer patients who self-identified as Hispanic and were waiting at the oncology clinic at Montefiore Medical Center Cancer Center...
February 9, 2018: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
https://www.readbyqxmd.com/read/29425521/identifiable-risk-factors-and-miscalculations-during-listing-for-pediatric-heart-transplantation
#8
REVIEW
Hugo R Martinez, Samuel Wittekind, Roosevelt Bryant, James S Tweddell, Clifford Chin
The objective of this study is to describe identifiable risk factors, complications, and pitfalls while listing pediatric patients for heart transplantation, which is the standard of care for end-stage heart disease in children. Since the introduction of cyclosporine in the 1980s, the management in pediatric heart transplantation has shown consistent improvement, mainly because of technological advances and the integration of multidisciplinary teams in the field. However, the complexity of this patient population makes medical providers vulnerable to complications as a result of undesirable mistakes...
March 2018: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/29421457/political-economy-of-hope-as-a-cultural-facet-of-biomedicalization-a-qualitative-examination-of-constraints-to-hospice-utilization-among-u-s-end-stage-cancer-patients
#9
Emily Hammad Mrig, Karen Lutfey Spencer
A growing body of social science literature is devoted to describing processes of biomedicalization. The issue of biomedicalization is especially relevant for individuals suffering from end-stage cancer and hoping that aggressive end-of-life interventions, which are riddled with uncertainty around quantity or quality of life, will produce a 'cure'. To examine hospice underutilization among end-stage cancer patients, we apply the anthropological concept 'political economy of hope,' which describes how personal and collective 'hope' is associated with the political and economic structures that produce biomedicalization processes...
January 27, 2018: Social Science & Medicine
https://www.readbyqxmd.com/read/29421166/defining-the-scope-of-prognosis-primary-care-clinicians-perspectives-on-predicting-the-future-health-of-older-adults
#10
John M Thomas, Terri R Fried
CONTEXT: Studies examining the attitudes of clinicians towards prognostication for older adults have focused on life expectancy prediction. Little is known about whether clinicians approach prognostication in other ways. OBJECTIVES: To describe how clinicians approach prognostication for older adults, defined broadly as making projections about patients' future health METHODS: In five focus groups, thirty primary care clinicians from community-based, academic-affiliated, and Veterans Affairs primary care practices were given open-ended questions about how they make projections about their patients' future health, and how this informs the approach to care...
February 5, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29417291/management-and-survival-analysis-of-elderly-patients-with-a-cancer-in-the-digestive-system-who-refused-to-receive-anticancer-treatments
#11
Jun Wan, Shiping Xu, Yinqiao Wu, Benyan Wu, Dezhong Joshua Liao, Ningzhi Xu, Gangshi Wang
Treatment and management of cancers in elderly patients require some special considerations. A better understanding of how cancers progress in those elderly patients who have not received any anticancer treatments could better help us in treating these patients and in making end-of-life decisions. Over the past years, we had encountered 57 elderly patients, aged 75 to 94 years (87.6 on average), with a cancer in the digestive system, who refused to accept anticancer treatment but who did receive the best available supportive and palliative care...
February 7, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29413727/addressing-spirituality-during-critical-illness-a-review-of-current-literature
#12
REVIEW
Barbara S Gordon, Maggie Keogh, Zachary Davidson, Stephen Griffiths, Vanshdeep Sharma, Deborah Marin, Stephan A Mayer, Neha S Dangayach
OBJECTIVES: The purpose of this review is to provide an overview of research on spirituality and religiosity in the intensive care setting that has been published since the 2004-2005 American College of Critical Care Medicine (ACCM) Clinical Practice Guidelines for the Support of Family in the Patient-Centered Intensive Care Unit with an emphasis on its application beyond palliative and end-of-life care. MATERIALS AND METHODS: ACCM 2004-2005 guidelines emphasized the importance of spiritual and religious support in the form of four specific recommendations: [1] assessment and incorporation of spiritual needs in ICU care plan; [2] spiritual care training for doctors and nurses; [3] physician review of interdisciplinary spiritual need assessments; and [4] honoring the requests of patients to pray with them...
January 31, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29409171/comparing-30-day-all-cause-readmission-rates-between-tibiotalar-fusion-and-total-ankle-replacement
#13
Robert K Merrill, Rocco M Ferrandino, Ryan Hoffman, Anthony Ndu, Gene W Shaffer
BACKGROUND: End-stage ankle arthritis is a debilitating condition that negatively impacts patient quality of life. Tibiotalar fusion and total ankle replacement are treatment options for managing ankle arthritis. Few studies have examined short term readmission rates of these two procedures. The objective of this study was compare all-cause 30-day readmission rates between patients undergoing tibiotalar fusion vs. total ankle replacement. METHODS: This study queried the Nationwide Readmission Database (NRD) from 2013-2014 and used international classification of disease, 9th revision (ICD-9) procedure codes to identify all patients who underwent a tibiotalar fusion or a total ankle replacement...
January 12, 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29398351/assessing-the-decision-making-capacity-of-terminally-ill-patients-with-cancer
#14
Elissa Kolva, Barry Rosenfeld, Rebecca Saracino
OBJECTIVE: Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients...
December 27, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29397521/end-of-life-care-of-children-with-diffuse-intrinsic-pontine-glioma
#15
Fyeza Hasan, Kevin Weingarten, Adam Rapoport, Eric Bouffet, Ute Bartels
The end-of-life management of children with diffuse intrinsic pontine glioma (DIPG) is challenging. Families cope with debilitating symptoms and make complex decisions regarding their child's care. However, there is little evidence guiding palliative care provision for these children. Our objective was to describe the dying trajectory of children with DIPG, their symptoms, the care they require and the end-of-life decisions made for them. This retrospective cohort study analyzed the end-of-life care of 41 consecutive patients with DIPG who died between January 2001 and June 2010...
February 3, 2018: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29393763/conversation-analysis-of-veterinarians-proposals-for-long-term-dietary-change-in-companion-animal-practice-in-ontario-canada
#16
Clare MacMartin, Hannah C Wheat, Jason B Coe, Cindy L Adams
Nutritional changes recommended by veterinarians to clients can have a major role in animal-patient health. Although there is literature on best practices that can inform veterinary communication training, little is known specifically about how veterinarians communicate their recommendations to clients in real-life interactions. This study used the qualitative research method of conversation analysis to investigate the form and content of veterinarian-initiated proposals for long-term dietary change in canine and feline patients to further inform veterinary communication training...
February 2, 2018: Journal of Veterinary Medical Education
https://www.readbyqxmd.com/read/29389725/end-of-life-communication-nurses-cocreating-the-closing-composition-with-patients-and-families
#17
Mary J Isaacson, Mary E Minton
Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter...
January 2018: ANS. Advances in Nursing Science
https://www.readbyqxmd.com/read/29388129/linking-science-and-policy-to-support-the-implementation-of-the-minamata-convention-on-mercury
#18
Henrik Selin, Susan Egan Keane, Shuxiao Wang, Noelle E Selin, Kenneth Davis, Dominique Bally
The Minamata Convention on Mercury, with its objective to protect human health and the environment from the dangers of mercury (Hg), entered into force in 2017. The Convention outlines a life-cycle approach to the production, use, emissions, releases, handling, and disposal of Hg. As it moves into the implementation phase, scientific work and information are critically needed to support decision-making and management. This paper synthesizes existing knowledge and examines three areas in which researchers across the natural sciences, engineering, and social sciences can mobilize and disseminate knowledge in support of Hg abatement and the realization of the Convention's objective: (1) uses, emissions, and releases; (2) support, awareness raising, and education; and (3) impacts and effectiveness...
January 31, 2018: Ambio
https://www.readbyqxmd.com/read/29386983/is-healthcare-providers-value-neutrality-depending-on-how-controversial-a-medical-intervention-is-analysis-of-10-more-or-less-controversial-interventions
#19
Niels Lynöe, Joar Björk, Niklas Juth
Background: Swedish healthcare providers are supposed to be value-neutral when making clinical decisions. Recent conducted studies among Swedish physicians have indicated that the proportion of those whose personal values influence decision-making (the value-influenced) vary depending on the framing and the nature of the issue. Objective: To examine whether the proportions of value-influenced and value-neutral participants vary depending on the extent to which the intervention is considered controversial...
September 2017: Clinical Ethics
https://www.readbyqxmd.com/read/29381234/balancing-early-access-with-uncertainties-in-evidence-for-drugs-authorized-by-prospective-case-series-systematic-review-of-reimbursement-decisions
#20
Susanna M Wallerstedt, Martin Henriksson
AIMS: To review clinical and cost-effectiveness evidence underlying reimbursement decisions relating to drugs whose authorization mainly is based on evidence from prospective case series. METHODS: A systematic review of all new drugs evaluated in 2011-2016 within a health care profession-driven resource prioritization process, with a market approval based on prospective case series, and a reimbursement decision by the Swedish Dental and Pharmaceutical Benefits Board (TLV)...
January 30, 2018: British Journal of Clinical Pharmacology
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