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https://www.readbyqxmd.com/read/28634768/futile-treatment-a-review
#1
Lenko Šarić, Ivana Prkić, Marko Jukić
The main goal of intensive care medicine is helping patients survive acute threats to their lives, while preserving and restoring life quality. Because of medical advancements, it is now possible to sustain life to an extent that would previously have been difficult to imagine. However, the goals of medicine are not to preserve organ function or physiological activity but to treat and improve the health of a person as a whole. When dealing with medical futilities, physicians and other members of the care team should be aware of some ethical principles...
June 20, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28634767/including-people-with-dementia-in-research-an-analysis-of-australian-ethical-and-legal-rules-and-recommendations-for-reform
#2
Nola M Ries, Katie A Thompson, Michael Lowe
Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules...
June 20, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28633915/patient-centered-care-in-obstructive-sleep-apnea-a%C3%A2-vision%C3%A2-for%C3%A2-the%C3%A2-future
#3
REVIEW
Janet Hilbert, Henry K Yaggi
Obstructive sleep apnea is a common condition, with multiple potential neurocognitive, cardiovascular, and metabolic consequences. Efficacious treatment is available, but patient engagement is typically required for treatment to be effective. Patients with sleep apnea are phenotypically diverse and have individual needs, preferences, and values that impact treatment decisions. There has been a shift in obstructive sleep apnea management from diagnosis to chronic care management. Making treatment decisions that incorporate an individual patient's values and preferences and are personalized for that patient's biology has the potential to improve patient outcomes...
February 24, 2017: Sleep Medicine Reviews
https://www.readbyqxmd.com/read/28633023/the-insular-cortex
#4
Nadine Gogolla
Whether you see the person you are in love with, try to listen to your own heartbeat, suffer from a headache, or crave for a chocolate cookie, one part of your brain is sure to increase its activity strongly: the insular cortex. The insular cortex, or 'insula' for short, is part of the cerebral cortex. J.C. Reil, a German neurologist, first named this brain structure in the early 19(th) century. Subsequent research findings have implicated the insula in an overwhelming variety of functions ranging from sensory processing to representing feelings and emotions, autonomical and motor control, risk prediction and decision-making, bodily- and self-awareness, and complex social functions like empathy...
June 19, 2017: Current Biology: CB
https://www.readbyqxmd.com/read/28630319/chimpanzees-return-favors-at-a-personal-cost
#5
Martin Schmelz, Sebastian Grueneisen, Alihan Kabalak, Jürgen Jost, Michael Tomasello
Humans regularly provide others with resources at a personal cost to themselves. Chimpanzees engage in some cooperative behaviors in the wild as well, but their motivational underpinnings are unclear. In three experiments, chimpanzees (Pan troglodytes) always chose between an option delivering food both to themselves and a partner and one delivering food only to themselves. In one condition, a conspecific partner had just previously taken a personal risk to make this choice available. In another condition, no assistance from the partner preceded the subject's decision...
June 19, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/28629423/understanding-consumer-and-clinician-preferences-and-decision-making-for-rehabilitation-following-arthroplasty-in-the-private-sector
#6
Mark A Buhagiar, Justine M Naylor, Grahame Simpson, Ian A Harris, Friedbert Kohler
BACKGROUND: To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. METHODS: Mixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014-2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway...
June 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28628782/incorporation-of-a-health-economic-modelling-tool-into-public-health-commissioning-evidence-use-in-a-politicised-context
#7
Tom Sanders, Amy Grove, Sarah Salway, Susan Hampshaw, Elizabeth Goyder
This paper explores how commissioners working in an English local government authority (LA) viewed a health economic decision tool for planning services in relation to diabetes. We conducted 15 interviews and 2 focus groups between July 2015 and February 2016, with commissioners (including public health managers, data analysts and council members). Two overlapping themes were identified explaining the obstacles and enablers of using such a tool in commissioning: a) evidence cultures, and b) system interdependency...
June 12, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28628391/interest-and-attitudes-of-patients-with-advanced-cancer-with-regard-to-secondary-germline-findings-from-tumor-genomic-profiling
#8
Jada G Hamilton, Elyse Shuk, Margaux C Genoff, Vivian M Rodríguez, Jennifer L Hay, Kenneth Offit, Mark E Robson
PURPOSE: Tumor genomic profiling (TGP) can reveal secondary findings about inherited disease risks in a patient with cancer. Little is known about how patients with advanced cancer, currently the primary users of TGP, perceive the benefits and harms of secondary germline findings. METHODS: We conducted semistructured interviews with 40 patients with advanced breast, bladder, colorectal, or lung cancer who had TGP. Qualitative interview data were evaluated by using a thematic content analysis approach...
June 19, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28624395/statin-trials-cardiovascular-events-and%C3%A2-coronary-artery-calcification-implications-for-a-trial-based-approach-to-statin-therapy-in%C3%A2-mesa
#9
Martin Bødtker Mortensen, Erling Falk, Dong Li, Khurram Nasir, Michael J Blaha, Veit Sandfort, Carlos Jose Rodriguez, Pamela Ouyang, Matthew Budoff
OBJECTIVES: This study sought to determine whether coronary artery calcium (CAC) could be used to optimize statin allocation among individuals for whom trial-based evidence supports efficacy of statin therapy. BACKGROUND: Recently, allocation of statins was proposed for primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on proven efficacy from randomized controlled trials (RCTs) of statin therapy, a so-called trial-based approach. METHODS: The study used data from MESA (Multi-Ethnic Study of Atherosclerosis) with 5,600 men and women, 45 to 84 years of age, and free of clinical ASCVD, lipid-lowering therapy, or missing information for risk factors at baseline examination...
June 9, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28624364/decision-making-in-swiss-home-like-childbirth-a-grounded-theory-study
#10
Yvonne Meyer, Franziska Frank, Franziska Schläppy Muntwyler, Valerie Fleming, Jessica Pehlke-Milde
BACKGROUND: Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. AIM: To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions...
June 14, 2017: Women and Birth: Journal of the Australian College of Midwives
https://www.readbyqxmd.com/read/28622841/do-online-prognostication-tools-represent-a-valid-alternative-to-genomic-profiling-in-the-context-of-adjuvant-treatment-of-early-breast-cancer-a-systematic-review-of-the-literature
#11
REVIEW
Hiba El Hage Chehade, Umar Wazir, Kinan Mokbel, Abdul Kasem, Kefah Mokbel
INTRODUCTION: Decision-making regarding adjuvant chemotherapy has been based on clinical and pathological features. However, such decisions are seldom consistent. Web-based predictive models have been developed using data from cancer registries to help determine the need for adjuvant therapy. More recently, with the recognition of the heterogenous nature of breast cancer, genomic assays have been developed to aid in the therapeutic decision-making. METHODS: We have carried out a comprehensive literature review regarding online prognostication tools and genomic assays to assess whether online tools could be used as valid alternatives to genomic profiling in decision-making regarding adjuvant therapy in early breast cancer...
June 3, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622019/patient-perceptions-of-illness-identity-in-cancer-clinical-trial-decision-making
#12
Angela L Palmer-Wackerly, Phokeng M Dailey, Jessica L Krok-Schoen, Nancy D Rhodes, Janice L Krieger
When patients are diagnosed with cancer, they begin to negotiate their illness identity in relation to their past and future selves, their relationships, and their group memberships. Thus, how patients view their cancer in relation to their other identities may affect how and why they make particular decisions about treatment options. Using the Communication Theory of Identity (CTI), the current study explores: (1) how and why illness identity is framed across identity layers in relation to one particular cancer treatment: participation in a cancer clinical trial (CT); and (2) how and why patients experience identity conflicts while making their treatment decisions...
June 16, 2017: Health Communication
https://www.readbyqxmd.com/read/28619524/molecular-determinants-of-radiosensitivity-in-normal-and-tumor-tissue-a-bioinformatic-approach
#13
Athanasia Pavlopoulou, Pantelis Bagos, Vasiliki Koutsandrea, Alexandros G Georgakilas
Although radiation therapy is a treatment of choice for cancer, a high percentage of patients develop adverse effects in normal tissue following radiotherapy, mainly, due to genetic factors. Notably, although it is established that a lower dose of ionizing radiation can minimize the tumor cell population in radiosensitive cancer patients, the sensitivity of tumor cells to radiation has not gained enough attention. In this mini-review, the molecular pathways/mechanisms and the related molecules involved in clinically relevant radiotoxicity, as well as normal and tumor cell radiosensitivity, were investigated for various types of cancers employing bioinformatics approaches...
June 12, 2017: Cancer Letters
https://www.readbyqxmd.com/read/28619024/communication-with-young-people-in-paediatric-and-adult-endocrine-consultations-an-intervention-development-and-feasibility-study
#14
J Downing, H Gleeson, P E Clayton, J R E Davis, P Dimitri, J Wales, B Young, P Callery
BACKGROUND: Communication is complex in endocrine care, particularly during transition from paediatric to adult services. The aims of this study were to examine the feasibility of interventions to support young people to interact with clinicians. METHODS: Development and evaluation of a complex intervention in 2 phases: Pre-intervention observational study; Intervention feasibility study. Purposive sample of recordings of 62 consultations with 58 young people aged 11-25 years with long-term endocrine conditions in two paediatric and two adult endocrine clinics...
June 15, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28618958/current-and-future-biomarkers-for-pancreatic-adenocarcinoma
#15
Sven H Loosen, Ulf P Neumann, Christian Trautwein, Christoph Roderburg, Tom Luedde
Although pancreatic cancer is only the twelfth most common type of cancer in the world, it features a very unfavorable prognosis. The mortality rate almost equals the incidence rate, corroborating the very poor prognosis of pancreatic cancer. The 5-year survival rate for all stages of pancreatic ductal adenocarcinoma is only 7%. Surgical resection represents the only potentially curative treatment option for pancreatic ductal adenocarcinoma patients but is often not feasible due to the advanced stage of the disease upon diagnosis...
June 2017: Tumour Biology: the Journal of the International Society for Oncodevelopmental Biology and Medicine
https://www.readbyqxmd.com/read/28618897/shared-decision-making-about-palliative-chemotherapy-a-qualitative-observation-of-talk-about-patients-preferences
#16
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/28618054/ethics-intimacy-and-sexuality-in-aged-care
#17
Catherine Cook, Vanessa Schouten, Mark Henrickson, Sandra Mcdonald
AIM: To analyse the accounts of staff, family and residents in order to advance ethical insights into intimacy and sexuality in residential care. BACKGROUND: Discourses of ageing readily construct people in residential aged care as post-sexual, vulnerable and at risk of sexual exploitation and therefore expressions of intimacy and sexuality may be responded to as deviant and inherently risky. Staff may manage decision-making tacitly, without recourse to policies and education...
June 15, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28618008/needs-and-challenges-of-home-visitors-conducting-perinatal-depression-screening
#18
Jennifer J Doering, Kristyn Maletta, Audrey Laszewski, Christina L Wichman, Jennifer Hammel
This article describes the needs and challenges faced by home visitors, supervisors, and clients when conducting perinatal depression screening. Home visitors (n = 11), supervisors (n = 5), and clients (n = 9) representing rural and urban practice settings in Wisconsin were recruited into three separate focus groups. Themes were identified from the transcribed audio-recorded interviews using content analysis. Results indicate that a trusting relationship was leveraged to facilitate depression screening and referral...
June 15, 2017: Infant Mental Health Journal
https://www.readbyqxmd.com/read/28617426/prenatal-non-treatment-decisions-in-extreme-prematurity-evaluation-of-decisional-conflict-and-regret-among-parents
#19
R Geurtzen, J Draaisma, R Hermens, H Scheepers, M Woiski, A van Heijst, M Hogeveen
OBJECTIVE: To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics. STUDY DESIGN: A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24(+0/7)-24(+6/7) weeks gestational age in 2010-2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28617166/challenges-in-providing-timely-physiotherapy-and-opportunities-to-influence-outcomes-for-potential-lung-donors
#20
Cassandra Raios, Jenny L Keating, Nicola Stitt, Helen I Opdam, Elizabeth H Skinner
CONTEXT: There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor. OBJECTIVE: To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effects on donor lung suitability for procurement. DESIGN: Retrospective audit. SETTING: Australian tertiary hospital...
June 2017: Progress in Transplantation
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