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Rejection of Care

Bettina von Dessauer, Carmen Benavente, Emilia Monje, Jazmina Bongain, Nadia Ordenes
OBJECTIVE: Describe the frequency and characteristics of PICU patients who undergo a process of withholding or withdrawing life-sustaining treatment (LTSV), between 2004 y 2014. PATIENTS AND METHOD: A retrospective, observational descriptive study, using two documents for quality assessment in the PICU of Hospital Roberto del Río: 1) daily individual patient tracking log and 2) daily record of quality indicators, including LTSV, both updated daily at the morning visit...
December 2017: Revista Chilena de Pediatría
Julio Rosenstock, Vlado Perkovic, John H Alexander, Mark E Cooper, Nikolaus Marx, Michael J Pencina, Robert D Toto, Christoph Wanner, Bernard Zinman, David Baanstra, Egon Pfarr, Michaela Mattheus, Uli C Broedl, Hans-Juergen Woerle, Jyothis T George, Maximilian von Eynatten, Darren K McGuire
BACKGROUND: Cardiovascular (CV) outcome trials in type 2 diabetes (T2D) have underrepresented patients with chronic kidney disease (CKD), leading to uncertainty regarding their kidney efficacy and safety. The CARMELINA® trial aims to evaluate the effects of linagliptin, a DPP-4 inhibitor, on both CV and kidney outcomes in a study population enriched for cardio-renal risk. METHODS: CARMELINA® is a randomized, double-blind, placebo-controlled clinical trial conducted in 27 countries in T2D patients at high risk of CV and/or kidney events...
March 14, 2018: Cardiovascular Diabetology
Amy O'Brien, Julie McCormack, Kimberley J Hoiles, Hunna J Watson, Rebecca A Anderson, Phillipa Hay, Sarah J Egan
OBJECTIVE: There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. METHOD: A modified Delphi technique was used to develop consensus-based opinions. Participants (N = 74) were recruited for three panels: clinicians (n = 24), carers (n = 31), and patients (n = 19), who endorsed three rounds of statements online...
March 14, 2018: International Journal of Eating Disorders
Kate H Thomas, Justin T McDaniel, David L Albright, Kari L Fletcher, Harold G Koenig
Suicide rates among military veterans exceed those found in the general population. While the exact reasons for these high rates are unknown, contributing factors may include the military's perceived rejection of patient identities, creating barriers to mental health care within the clinical sector and a mandate for prevention programs. Spiritual fitness has emerged over the last decade as an important concept in human performance optimization and is included among holistic approaches to developing and maintaining mentally fit fighting forces...
March 13, 2018: Journal of Religion and Health
Sandesh Parajuli, Didier A Mandelbrot, Brenda Muth, Maha Mohamed, Neetika Garg, Fahad Aziz, Robert R Redfield, Weixiong Zhong, Brad C Astor, Arjang Djamali
Background: There is limited information on treatment strategies and monitoring strategies for late antibody-mediated rejection (ABMR) after kidney transplantation. Methods: In this observational and nonrandomized study, we compared 78 patients diagnosed with late ABMR (>3 months after transplant) who were treated with standard of care steroids/IVIG (n = 38) ± rituximab (n = 40) at our center between March 1, 2013 and December 31, 2016. All patients had follow-up biopsy and donor-specific antibodies (DSA) monitoring within 3 to 12 weeks...
December 2017: Transplantation Direct
Cheryl Lynn Wolverton, Sue Lasiter, Joanne R Duffy, Michael T Weaver, Anna M McDaniel
Objectives: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses' perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. Methods: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing...
2018: SAGE Open Medicine
Deniz Demet, Nilgün Aksoy, Nihal Kiraz
Kidney transplant is the leading treatment method for patients with recent renal failure in terms of quality of life, cost, and survival. After transplant, rejection, infection, cardiovascular diseases, malignancies, immunosuppressive therapy failure, and psychologic problems may occur. Posttransplant nursing care is as important as pretransplant nursing care in terms of enhancing quality of life, preventing complications, and providing necessary changes to treatment. In this report, we presented ways to increase quality of care after transplant and outlined standardized nursing care to reduce work and time loads by ensuring integrative and systematic approaches of nurses...
March 2018: Experimental and Clinical Transplantation
Jae A Puckett, Peter Cleary, Kinton Rossman, Michael E Newcomb, Brian Mustanski
Gender-affirming care, including hormone therapy, "top" (e.g., chest reconstruction surgery) and "bottom" (e.g., vaginoplasty, phalloplasty, metoidioplasty, etc.) surgeries, and puberty blockers, is an efficacious treatment of gender dysphoria for transgender and gender nonconforming (TGNC) individuals. However, many TGNC people encounter significant barriers in accessing gender-affirming care, which we detail via results from on online study. Participants included 256 TGNC individuals (78...
March 2018: Sexuality Research & Social Policy
Pablo M Gabay, Mónica Fernández Bruno
The rehabilitation of severely mentally-ill patients and their return to the community are related to historical progress. Their potential of achieving these goals is higher or lower depending on the presence of more or less stigma attached to their condition. Watts and Bennett have divided psychiatric rehabilitation into three phases: Phase 1: Very little was done because there was not much to be done. Patients were rejected and received mistreatment. Phase 2: Their vulnerability was admitted and protection was given to the disabled; services were provided by charity and voluntary religious institutions; there was no clear distinction between illness and poverty...
September 2017: Vertex: Revista Argentina de Psiquiatriá
Toshifumi Yamaguchi, Ken Kato, Kengo Nagashima, Satoru Iwasa, Yoshitaka Honma, Atsuo Takashima, Tetsuya Hamaguchi, Yoshinori Ito, Jun Itami, Narikazu Boku, Kazuhide Higuchi
BACKGROUND: While the standard treatment for stage II-III (non-T4) esophageal squamous cell carcinoma (ESCC) is neoadjuvant therapy followed by esophagectomy, definitive chemoradiation therapy (dCRT) is an option to treat ESCC patients who reject or may not tolerate surgical treatment. Second primary malignancy (SPM) is a problem for long-term survivors after achieving complete response (CR) by dCRT. METHODS: The source of the subjects in this study was the patients with stage II/III (excluding T4 disease) ESCC (UICC6th) who underwent dCRT from 2000 to 2011 at the National Cancer Center Hospital, Japan...
March 8, 2018: International Journal of Clinical Oncology
Ivana Pentz, Sandra Nakić Radoš
OBJECTIVE: The goal of the study was to examine differences between adolescents and young women with functional hypothalamic amenorrhea (FHA) and control groups in personality traits, eating attitudes and behaviours, and perception of parental behaviour. BACKGROUND: The FHA is stress-induced anovulation, both related to metabolic challenges, such as excessive exercise and malnutrition, and psychogenic challenges, such as perfectionism and poor coping strategies...
April 2017: Journal of Reproductive and Infant Psychology
Salman Khan, Timothy Sullivan, Mohsin Ali, Dallas Dunn, Gopi Patel, Shirish Huprikar
BACKGROUND: Liver transplant recipients (LTR) who are seropositive for cytomegalovirus (CMV) (R+) are at intermediate-risk for CMV disease. A preventive strategy following transplant is considered standard of care. Current guidelines recommend high-dose valganciclovir (VGCV) (900 mg/day adjusted for renal function) for prophylaxis given limited data on the efficacy and safety of low-dose VGCV (450 mg/day adjusted for renal function). We describe our experience using low-dose VGCV prophylaxis for R+ LTR at our institution...
March 3, 2018: Liver Transplantation
James N Fleming, Frank Treiber, John McGillicuddy, Mulugeta Gebregziabher, David J Taber
BACKGROUND: Medication errors, adverse drug events, and nonadherence are the predominant causes of graft loss in kidney transplant recipients and lead to increased healthcare utilization. Research has demonstrated that clinical pharmacists have the unique education and training to identify these events early and develop strategies to mitigate or prevent downstream sequelae. In addition, studies utilizing mHealth interventions have demonstrated success in improving the control of chronic conditions that lead to kidney transplant deterioration...
March 2, 2018: JMIR Research Protocols
Anne I Dipchand
Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing...
January 2018: Annals of Cardiothoracic Surgery
Syed-Saif Abbas Rizvi, Jessica G Y Luc, Jae Hwan Choi, Kevin Phan, Ester Moncho Escrivà, Sinal Patel, H Todd Massey, Vakhtang Tchantchaleishvili
Background: Long-term efficacy of heart retransplantation (RTx) for end-stage cardiac allograft failure remains unclear given the limited worldwide experience and is an important question to elucidate given the shortage of donor organs. The aim of this systematic review was to examine the outcomes of RTx in patients with cardiac allograft failure. Methods: Electronic search was performed to identify all studies in the English literature assessing RTx for cardiac allograft failure...
January 2018: Annals of Cardiothoracic Surgery
Branislav Kollar, Bohdan Pomahac
Hundred years ago, Sir Harold Gillies laid a foundation to the modern plastic surgery trying to reconstruct facial defects of severely disfigured soldiers of World War I. Some years later, Joseph Murray experimented with rejection of skin grafts aimed for treatment of burned patients who sustained their injuries on battlefields of World War II. In 1954, the acquired expertise and intensive research allowed him to perform the first successful kidney transplantation in the world at Peter Bent Brigham Hospital in Boston...
February 25, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Ian A Thomas, Jeffrey J Gaynor, Tameka Joseph, Nestor De La Cruz-Munoz, Junichiro Sageshima, Warren Kupin, Linda J Chen, Gaetano Ciancio, George W Burke, Adela D Mattiazzi, David Roth, Giselle Guerra
Body mass index(BMI)>35-40kg/m2 is often a contraindication, while Roux-en-Y gastric bypass(RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese end-stage-renal-disease patients having RYGB before kidney transplantation between July,2009-June,2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI>36kg/m2 at transplantation were used as historical controls...
February 28, 2018: Clinical Transplantation
Richard P Kluft
Freud's rejection of hypnosis gave rise to a rift between clinical hypnosis and psychoanalysis that has endured for over a century. A review of Freud's rationales (Kluft, 2018a/this issue) demonstrates that while some stemmed from what he considered advances, others appear strongly influenced by his promoting the superiority of his "psycho-analysis" at the expense of hypnosis. Mainstream psychoanalysis continues to endorse the perpetuation of rationales Freud asserted nearly a century ago, and an oral lore of related supportive statements...
April 2018: American Journal of Clinical Hypnosis
Cory E Goldstein, Charles Weijer, Jamie C Brehaut, Dean A Fergusson, Jeremy M Grimshaw, Austin R Horn, Monica Taljaard
BACKGROUND: Pragmatic randomized controlled trials (RCTs) are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. METHODS: We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis...
February 27, 2018: BMC Medical Ethics
Haitham W Tuffaha, Paul A Scuffham
In 2010, the Australian Government introduced the managed entry scheme (MES) to improve patient access to subsidised drugs on the Pharmaceutical Benefits Scheme and enhance the quality of evidence provided to decision makers. The aim of this paper was to critically review the Australian MES experience. We performed a comprehensive review of publicly available Pharmaceutical Benefits Advisory Committee online documents from January 2010 to July 2017. Relevant information on each MES agreement was systematically extracted, including its rationale, the conditions that guided its implementation and its policy outcomes...
February 24, 2018: PharmacoEconomics
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