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hydratation at the end of life

Miwa Yoshimoto, Daisuke Inoue, Satoshi Matsumoto
PURPOSE: To conduct a questionnaire survey to elicit physicians' directions about artificialhydration and nutrition at end-oflife. METHODS: A questionnaire was sent to 2,773 randomly selected Japanese physicians who were registrants of Rakuten Research Inc.(Tokyo, Japan). Of the respondents, 500 returned the questionnaire, and their reposes were analyzed. The Fisher's exact test was used to compare the respective responses. RESULTS: Of the 500 physicians, 22...
November 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Shravan Kumar Porika, Krishna Chaitanya Veligandla, Shashi Kanth Muni, Shivani Acharya, Suyog C Mehta, Akhilesh D Sharma
INTRODUCTION: Functional dyspepsia (FD) is a highly prevalent condition which reduces patients' quality of life (QoL) and imparts a significant economic burden on the healthcare system. Acotiamide is a novel prokinetic agent useful in treatment of FD, and this study evaluated the effectiveness of acotiamide hydrochloride hydrate in management of FD over a 4-week period in a real-world setting. METHODS: This study was a prospective, observational, real-world data collection of 132 patients (85 male, 47 female) over 18 years of age diagnosed with FD as per Rome III criteria and treated with acotiamide for 4 weeks at a gastroenterology unit of a medical school in India...
October 22, 2018: Advances in Therapy
Paola Di Giulio, Silvia Finetti, Fabrizio Giunco, Ines Basso, Debora Rosa, Francesca Pettenati, Alessandro Bussotti, Daniele Villani, Simona Gentile, Lorenzo Boncinelli, Massimo Monti, Sandro Spinsanti, Massimo Piazza, Lorena Charrier, Franco Toscani
CONTEXT: End-of-life care in nursing homes (NH) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy). OBJECTIVES: To compare End-of-Life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care. METHODS: The intervention consisted of a 7-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff...
October 10, 2018: Journal of Pain and Symptom Management
U Suchner, C Reudelsterz, C Gog
Dehydration in palliative care patients can be associated with increased morbidity and mortality and is nevertheless therapeutically controversial. This article provides an overview of possible causes of dehydration at the end of life and places special emphasis on "terminal" dehydration in the dying. Empirical attitudes of healthcare professionals and persons concerned (patients and relatives) as well as evidence-based findings on "terminal" dehydration are elucidated and the limitations are described...
September 2018: Der Anaesthesist
Samane Maroufi, Rasoul Khayyam Nekouei, Mohammad Assefi, Veena Sahajwalla
This paper describes a clean approach of waste-cleaning waste. Two-dimensional (2D) ZnO porous nano-sheets were synthesized from end-of-life zinc-carbon batteries via a simple homogeneous precipitation-calcination route, and the as-synthesized product was applied as photocatalyst for the purpose of photodegradation of methylene blue/MB aqueous solution under UV-Vis irradiation. Precipitation at ambient temperature resulted in the formation of the crystalline phase of zinc hydroxide nitrate hydrate [Zn5 (OH)8 (NO3 )2 (H2 O)2 ], which was then transformed to ZnO through calcination...
August 9, 2018: Environmental Science and Pollution Research International
Katsura Mori, Tsuyoshi Seki, Kazuhiro Kaizu, Yutaka Takagi, Masahiro Miyaki, Chiaki Ishizaki, Ichiro Katayama
BACKGROUND: Skin moisturizing is advocated to take care of the skin of patients with atopic dermatitis (AD). However, many patients stop using moisturizers in the summer because of excessive sweating and high humidity. OBJECTIVES: To examine the efficacy of a moisturizing gel containing a pseudo-ceramide and a eucalyptus extract, which enhances epidermal ceramide synthesis of patients with mild AD in the summer. METHODS: We performed a single-blinded 4-week clinical trial of body care on 44 Japanese subjects who had mild AD...
August 6, 2018: Journal of Cosmetic Dermatology
Evie G Marcolini, Andrew T Putnam, Ani Aydin
The question of whether to provide artificial nutrition and hydration (ANH) to a patient with terminal illness or at end of life has been debated over many years. Due to the nature of the question and the setting in which it presents, prospective trials are not feasible, and the health care professional is left to work with the patient and family to make decisions. This perspectives piece addresses the issue in a format designed to inform the reader as to the pertinent considerations around ANH. We briefly review significant historic, religious, ethical, and legal contributions to this discussion and physiologic underpinnings...
June 2018: Yale Journal of Biology and Medicine
Jacqueline Oehme, Caitlin Sheehan
BACKGROUND: Dying is ubiquitous, yet the optimal management of hydration in the terminal phase is undetermined. Palliative care (PC) doctors' practices may act as a de facto measure of the benefits and burdens of artificial hydration (AH) use. OBJECTIVE: To identify PC doctors' AH prescribing practices for imminently dying patients and possible influencing factors. METHODS: An online survey of doctors belonging to the Australian and New Zealand Society of Palliative Medicine...
August 2018: Journal of Palliative Medicine
Jessica Baillie, Despina Anagnostou, Stephanie Sivell, Jordan Van Godwin, Anthony Byrne, Annmarie Nelson
BACKGROUND: Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients' symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives' distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives...
April 16, 2018: BMC Palliative Care
Razvigor Darlenski, Evgeniya Hristakieva, Ufuk Aydin, Desisslava Gancheva, Tanya Gancheva, Antoaneta Zheleva, Veselina Gadjeva, Joachim W Fluhr
BACKGROUND: Psoriasis is a multi-systemic inflammatory disease that results from dysregulation between epidermal keratinocyte homeostasis and both innate and acquired immunity. Epidermal barrier defect has been described in psoriatic lesions. Furthermore an imbalance between pro-oxidative stress and antioxidant defense mechanisms are known in psoriasis patients. AIM: The aim of this study was to address the link between disease activity, epidermal barrier and systemic oxidative stress in the course of 311 nm narrow band ultraviolet B (NB-UVB) therapy of psoriasis...
July 2018: Journal of Dermatological Science
Roschelle Heuberger, Helen Wong
OBJECTIVE: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). METHODS: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia...
March 1, 2018: Journal of Aging and Health
Tahereh Ghane, Rene F Gorriz, Sandro Wrzalek, Senta Volkenandt, Ferand Dalatieh, Marco Reidelbach, Petra Imhof
Proton transfer in cytochrome c oxidase (CcO) from the cellular inside to the binuclear redox centre as well as proton pumping through the membrane takes place through proton entrance via two distinct pathways, the D- and K-channel. Both channels show a dependence of their hydration level on the protonation states of their key residues, K362 for the K-channel, and E286 or D132 for the D-channel. In the oxidative half of CcO's catalytic cycle the D-channel is the proton-conducting path. For this channel, an interplay of protonation state of the D-channel residues with the water and hydrogen-bond dynamics has been observed in molecular dynamics simulations of the CcO protein, embedded in a lipid bi-layer, modelled in different protonation states...
June 2018: Journal of Membrane Biology
Andrew N Davies, Melanie Waghorn, Katherine Webber, Sigurd Johnsen, Jeewaka Mendis, Julia Boyle
BACKGROUND: The provision of clinically assisted hydration at the end-of-life is one of the most contentious issues in medicine. AIM: The aim of this feasibility study was to answer the question 'can a definitive (adequately powered) study be done?' DESIGN: The study was a cluster randomised trial, with sites randomised on a one-to-one basis to intervention 'A' (regular mouth care and usual other care) or intervention 'B' (clinically assisted hydration, mouth care and usual other care)...
April 2018: Palliative Medicine
Hsien-Liang Huang, Chien-An Yao, Wen-Yu Hu, Shao-Yi Cheng, Shinn-Jang Hwang, Chih-Dao Chen, Wen-Yuan Lin, Yen-Chun Lin, Tai-Yuan Chiu
CONTEXT: Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES: To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. METHODS: This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan...
March 2018: Journal of Pain and Symptom Management
Alexandria J Bear, Elizabeth A Bukowy, Jayshil J Patel
Initiation or continuation of artificial hydration (AH) at the end of life requires unique considerations. A combination of ethical precedents and medical literature may provide clinical guidance on how to use AH at the end of life. The purpose of this review is to describe the ethical framework for and review current literature relating to the indications, benefits, and risks of AH at the end of life. Provider, patient, and family perspectives will also be discussed.
October 2017: Nutrition in Clinical Practice
Bettina S Husebø, Elisabeth Flo, Knut Engedal
BACKGROUND: The Liverpool Care Pathway (LCP) is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying people with dementia...
August 9, 2017: BMC Medical Ethics
Ali Rajabi-Estarabadi, Hournaz Hasanzadeh, Arash Taheri, Steven R Feldman, Alireza Firooz
BACKGROUND: Scalp psoriasis can have a considerable impact on patients' quality of life and is considered difficult to treat. Treatment failure may, however, be due to poor adherence, as application of topical treatments to hair bearing areas is difficult and time consuming and also poor communication between physician and patient. OBJECTIVE: To assess the efficacy of short-term treatment of scalp psoriasis with topical clobetasol lotion. MATERIALS AND METHODS: Twelve patients with mild to severe scalp psoriasis were recruited for this study...
March 2018: Journal of Dermatological Treatment
Lenora Smith, Rita Ferguson
The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers...
June 2017: Home Healthcare Now
Augustin Boulanger, Théo Chabal, Marie Fichaux, Mireille Destandau, Jean Marc La Piana, Pascal Auquier, Karine Baumstarck, Sébastien Salas
BACKGROUND: In February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are "obviously inappropriate" in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient's situation...
January 21, 2017: BMC Palliative Care
Liz Forbat, Natalie Kunicki, Michael Chapman, Clare Lovell
AIMS AND OBJECTIVES: To identify the mechanisms of subcutaneous fluid administration in advanced illness. BACKGROUND: Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously...
May 2017: Journal of Clinical Nursing
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