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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/28320024/-therapeutic-decisions-concerning-severe-neurological-diseases-and-at-the-end-of-life
#2
Christoph Burkhard Lücking
Modern medicine increasingly enables survival of life-threatening diseases. On the other side, however, especially in Neurology, the questions have to be addressed how intensive the initial treatment should be and how to deal with residual states when severe functional or cognitive deficits are expected. In these cases, it is not only important to decide which medical measures are appropriate for the patient, but also whether, given the prognosis, the patient would agree with the suggested measures. This article first describes the basis for each medical action, i...
March 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28318209/end-of-life-care-managing-common-symptoms
#3
Ross H Albert
Physicians should be proficient at managing symptoms as patients progress through the dying process. When possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than to treat an acute symptom. As swallowing function diminishes, medications are typically administered sublingually, transdermally, or via rectal suppository. Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. Delirium and agitation may be caused by reversible etiologies, which should be identified and treated when feasible...
March 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28317617/companion-animal-owner-perceptions-knowledge-and-beliefs-regarding-pain-management-in-end-of-life-care
#4
Roschelle Heuberger, Michael Petty, Janice Huntingford
The senior companion animal is the fastest growing segment of the pet population. End-of-life care, quality of life, and pain management (PM) are extremely important to pet owners. Research into PM and end-of-life care is essential due to lack of information on owner knowledge, attitudes, and beliefs. A survey was developed to gather information from owners. Surveys were developed using expert focus groups, and participants were recruited through social media. Survey validation employed emergent themes and grounded theory...
December 2016: Topics in Companion Animal Medicine
https://www.readbyqxmd.com/read/28317138/impact-of-providing-psychiatry-specialty-pharmacist-intervention-on-reducing-drug-related-problems-among-children-with-autism-spectrum-disorder-related-to-disruptive-behavioural-symptoms-a-prospective-randomized-open-label-study
#5
R Wongpakaran, T Suansanae, T Tan-Khum, C Kraivichian, R Ongarjsakulman, C Suthisisang
WHAT IS KNOWN AND OBJECTIVES: Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours...
March 20, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28315547/how-can-i-change-my-patients-treatment-decision-making-by-becoming-a-nurse-scientist-%C3%A2
#6
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/28315478/improving-palliative-care-trough-teamwork-impactt-in-nursing-homes-study-design-and-baseline-findings
#7
Helena Temkin-Greener, Susan Ladwig, Zhiqiu Ye, Sally A Norton, Dana B Mukamel
BACKGROUND: The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life...
March 14, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28314840/end-of-life-care-matters-palliative-cancer-care-results-in-better-care-and-lower-costs
#8
Shalini Dalal, Eduardo Bruera
No abstract text is available yet for this article.
March 17, 2017: Oncologist
https://www.readbyqxmd.com/read/28306661/referring-patients-to-hospice-or-palliative-care
#9
Kathleen Broglio, Anne Walsh
NPs care for patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, cancer, and dementia. As the disease progresses or patients age, disease-related symptoms may become increasingly burdensome, and these patients may benefit from hospice or palliative care. NPs can guide individuals in this process to optimize care and support at the end of life.
April 16, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28304263/battling-a-tangled-web-the-lived-experience-of-nurses-providing-end-of-life-care-on-an-acute-medical-unit
#10
Irene Oliveira, Frances Fothergill-Bourbonnais, Christine McPherson, Brandi Vanderspank-Wright
Meeting the heath care needs of patients at the end of life is becoming more complex. In Canada, most patients with life-limiting illness will die in hospitals, many on medical units. Yet, few studies have qualitatively investigated end-of-life care (EOLC) in this context, or from the perspectives of nurses providing EOLC. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology guided the method and analysis...
November 1, 2016: Research and Theory for Nursing Practice
https://www.readbyqxmd.com/read/28303481/morphea-and-eosinophilic-fasciitis-an-update
#11
REVIEW
Jorre S Mertens, Marieke M B Seyger, Rogier M Thurlings, Timothy R D J Radstake, Elke M G J de Jong
Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated...
March 16, 2017: American Journal of Clinical Dermatology
https://www.readbyqxmd.com/read/28303282/-advance-directives-in-clinical-practice-living-will-healthcare-power-of-attorney-and-care-directive
#12
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/28302739/changing-landscape-of-congenital-heart-disease
#13
Berto J Bouma, Barbara J M Mulder
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28301700/implementing-california-s-law-on-assisted-dying
#14
Ruchika Mishra
On October 5, 2015, Governor Jerry Brown approved bill ABX2 15, the End of Life Option Act, making California the fifth state in the country to allow physician-assisted dying. The law was modeled after Oregon's 1997 Death with Dignity Act. When the legislative special session ended on March 10, 2016, California health care providers had only ninety days to respond to the state mandate before the law would take effect, on June 9, 2016. Experience with the law so far suggests several challenges with implementation...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28300964/effects-of-a-12-hour-shift-on-mood-states-and-sleepiness-of-neonatal-intensive-care-unit-nurses
#15
Tadeu Sartini Ferreira, Clarice Zinato Moreira, James Guo, Franco Noce
OBJECTIVE: To assess the effect of a 12-hour shift on mood states and sleepiness at the beginning and end of the shift. METHOD: Quantitative, cross-sectional and descriptive study.It was conducted with 70 neonatal intensive care unit nurses. The Brunel Mood Scale (BRUMS), Karolinska Sleepiness Scale (KSS), and a socio-demographic profile questionnaire were administered. RESULTS: When the KSS and BRUMS scores were compared at the beginning of the shift associations were found with previous sleep quality (p ≤ 0...
March 9, 2017: Revista da Escola de Enfermagem da U S P
https://www.readbyqxmd.com/read/28296604/lessons-from-oregon-in-embracing-complexity-in-end-of-life-care
#16
Susan W Tolle, Joan M Teno
Under the incentives of fee-for-service Medicare, the utilization trends among persons with chronic progressive medical illness include more care in the intensive care unit (ICU), more hospitalizations, and often late or no referrals to hospice care (Figure 1). These utilization patterns are..
March 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28296534/trends-of-do-not-resuscitate-orders-hospice-care-utilization-and-late-referral-to-hospice-care-among-cancer-decedents-in-a-tertiary-hospital-in-taiwan-between-2008-and-2014-a-hospital-based-observational-study
#17
Tzu-Chien Shih, Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Tzeng-Ji Chen, Shinn-Jang Hwang
BACKGROUND: Out of respect for terminal patients' dignity and to decrease end-of-life suffering, patients in Taiwan can choose to sign do-not-resuscitate (DNR) orders and use hospice care when they are in a terminal condition. OBJECTIVES: To explore the trends and characteristics of hospice care utilization and DNR status among terminal cancer patients. Design and Setting/Subjects: A secondary data analysis was conducted to examine the rate of DNR orders, hospice care utilization, the survival time after DNR order, the duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care among patients who died from malignant cancers in a tertiary hospital in Taiwan between 2008 and 2014...
March 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28296280/prevention-of-renal-failure-in-chinese-patients-with-newly-diagnosed-type-2-diabetes-a-cost-effectiveness-analysis
#18
REVIEW
Bin Wu, Suhua Zhang, Houwen Lin, Shan Mou
AIMS: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease (ESRD) in China. The current study is to assess the cost effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes (T2DM) from the Chinese health care perspective. METHODS: A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed T2DM might receive treatment according to one of the following three strategies: "do nothing" strategy (control strategy), treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) (universal strategy), or screening for microalbuminuria followed by ACEI/ARB treatment (screening strategy)...
March 10, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28295138/frequency-and-risk-factors-for-live-discharge-from-hospice
#19
David Russell, Eli L Diamond, Bonnie Lauder, Ritchell R Dignam, Dawn W Dowding, Timothy R Peng, Holly G Prigerson, Kathryn H Bowles
OBJECTIVES: To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice. DESIGN: Retrospective cohort study using electronic medical records of hospice patients who received care from a large urban not-for-profit hospice agency in New York City during a 3-year period between 2013 and 2015 (n = 9,190). RESULTS: Roughly one in five hospice patients were discharged alive (21%; n = 1911). Acute hospitalization was the most frequent reason for live discharge (42% of all live discharges; n = 802)...
March 13, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28294926/-paediatric-palliative-care-multidisciplinary-and-pro-active
#20
G C B Bindels de Heus, L M Ball, E M C Michiels, H A Moll, E H Niks, S M van Walraven
Every child with a life-limiting or threatening illness, and his or her family, has a right to palliative care. Palliative care is not limited to end-of-life care, but starts from the moment of diagnosis and is independent of whether there are curative options. To optimise quality of life of both the child and the family, the emphasis of care should be on both somatic and psychosocial and spiritual aspects from the very start, and goals should be set together with the child and the family. A multidisciplinary and pro-active approach is essential if this is to be achieved...
2017: Nederlands Tijdschrift Voor Geneeskunde
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