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Advanced care plans

Shun-Ku Lin, Pei-Chia Lo, Wang-Chuan Chen, Jung-Nien Lai
Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days...
February 2019: Medicine (Baltimore)
Caitlin McArthur, Mehdi Rostami, Olli Saarela, Mohammad Owais Suria, Cindy Feng, Katherine Berg
ABSTRACTHospitalizations of long-term care (LTC) residents can result in adverse outcomes such as functional decline. The objective of our study was to investigate the association between demographic and health information and hospitalization rate for newly admitted LTC residents. We conducted a retrospective cohort study of all LTC homes in six provinces and one territory in Canada, using data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 and the Discharge Abstract Database. We included newly admitted residents with an assessment between January 1 and December 31, 2013 (n = 37,998)...
February 14, 2019: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
Demetris Yannopoulos, Jason A Bartos, Tom P Aufderheide, Clifton W Callaway, Rajat Deo, Santiago Garcia, Henry R Halperin, Karl B Kern, Peter J Kudenchuk, Robert W Neumar, Ganesh Raveendran
Coronary artery disease is prevalent in different causes of out-of-hospital cardiac arrest (OHCA), especially in individuals presenting with shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). The purpose of this report is to review the known prevalence and potential importance of coronary artery disease in patients with OHCA and to describe the emerging paradigm of treatment with advanced perfusion/reperfusion techniques and their potential benefits on the basis of available evidence...
February 14, 2019: Circulation
Doenja M J Lambregts, Thierry N Boellaard, Regina G H Beets-Tan
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation...
February 13, 2019: Insights Into Imaging
Lieve Van den Block
No abstract text is available yet for this article.
March 2019: Palliative Medicine
Lindsay Haines, Omari-Khalid Rahman, Justin J Sanders, Kimberly Johnson, Amy Kelley
BACKGROUND: Goal-concordant care (GCC)-care aligned with a patient's known goals and values-is a measure of the quality of end-of-life (EOL) care that can be assessed by surveying family members after a patient's death. It is unknown whether patient characteristics affect this measure. OBJECTIVE: The objective of the article was to examine family report of GCC and its associations with patient characteristics. METHODS: Using the Health and Retirement Study, which is a nationally representative, longitudinal cohort of adults over age 50, we sampled decedents whose family completed the 2014 postdeath interview...
February 13, 2019: Journal of Palliative Medicine
Stephanie M Munz, Joseph I Helman, Margaret K Tiner, Anita L Hart
This reflection describes a life-limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70-year-old female was diagnosed with a T4aN2bM0 biopsy-proven invasive, well-differentiated keratinizing SCC. Surgical wide-local excision included teeth #11-16 with left unilateral neck dissection, levels I-V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus...
February 12, 2019: Special Care in Dentistry
Matthew J Resnick
No abstract text is available yet for this article.
February 8, 2019: Journal of Urology
Filipa Macedo, Nuno Bonito
PURPOSE OF REVIEW: The review englobes the latest studies published regarding the problem of antimicrobial usage with palliative intent. RECENT FINDINGS: In the advanced stages of illness like cancer, dementia, or neurodegenerative diseases, important decisions have to be made concerning the global treatment plan. Infections are very common among this kind of patients as they typically have multiple comorbidities and are incapacitated. These infections, in a majority of the cases, will be treated with antimicrobial therapy because this is a standard medical procedure...
February 11, 2019: Current Opinion in Oncology
Sean P Geary, Maria R Brown, Christopher Decker, Lisa M Angotti, Ashar Ata, Carl Rosati
Trauma patients admitted to the intensive care unit are a unique population with high mortality. This study aims to identify characteristics predicting the likelihood of progressing to palliative management often referred to as comfort care measures, thus enabling the trauma team to broach end-of-life decisions earlier in these patients' care. This is a retrospective analysis of the prospectively collected New York State Trauma Registry database for a single Level I trauma center for patients admitted from 2008 to 2015...
November 1, 2018: American Surgeon
Adam Hurlow
Anorexia, weight loss and muscle wasting commonly affect people approaching the end of life. It is critical that clinicians caring for people with advanced illness and progressive frailty can assess the nutritional and hydration needs of these people, engage them in shared decision making and support them to plan ahead regarding their nutritional care preferences as their health deteriorates.
February 2, 2019: British Journal of Hospital Medicine
Hon-Wai Benjamin Cheng, Pui-Shan Karen Shek, Ching-Wah Man, Oi-Man Chan, Chun-Hung Chan, Kit-Man Lai, Suk-Ching Cheng, Koon-Sim Fung, W K Lui, Carman Lam, Yuen-Kwan Ng, Wan-To Wong, Cherry Wong
BACKGROUND: Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates. OBJECTIVES: We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach...
February 11, 2019: American Journal of Hospice & Palliative Care
Mutua Irene, Mariga Denver, Marilyn Omondi, Kiptoon Dan
INTRODUCTION: Peptic ulcer perforation is a common surgical emergency that is a complication of 9% of patients with peptic ulcer disease (Kjetil et al., 2015 [1]). Despite advances in the management of peptic ulcer disease, the number of acute complications have remained constant. Intra-abdominal sepsis is defined as inflammation of the peritoneum caused by pathogenic micro-organisms and their products (Pavlidis, 2003). CASE PRESENTATION: We present a case report on intra-abdominal sepsis in a 20 yr old patient admitted in the intensive care unit at our institution following a perforated duodenal ulcer that was repaired by modified Graham patch method but leaked and he had multiple surgeries thereafter necessitating the open abdomen...
February 1, 2019: International Journal of Surgery Case Reports
Encarnación Pérez Bret, Rogelio Altisent Trota, Javier Rocafort Gil, Paula Jaman Mewes
End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory...
January 2019: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
Anna J Janss, Claire Mazewski, Briana Patterson
Pathologies of pediatric brain tumors are more varied than those diagnosed in adults and survival outcomes more optimistic. Therapies for pediatric brain tumors are also diverse and treatment options are expanding. The growing number of adult survivors of childhood brain tumors is quite diverse. Medical management of these adults requires understanding the tumor diagnosis and location, the modalities used to treat the tumor, the age of the survivor at the time of diagnosis and treatment, any complications of treatment, and, most importantly, the baseline medical condition and neurological function of each adult survivor...
February 9, 2019: Current Treatment Options in Oncology
Kyla L Naylor, S Joseph Kim, Eric McArthur, Amit X Garg, Megan K McCallum, Gregory A Knoll
RATIONALE & OBJECTIVE: The mortality rate is high among dialysis patients, but how this compares with other diseases such as cancer is poorly understood. We compared the survival of maintenance dialysis patients with that for patients with common cancers to enhance the understanding of the burden of end-stage kidney disease. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: 33,500 incident maintenance dialysis patients in Ontario, Canada, and 532,452 incident patients with cancer (women: breast, colorectal, lung, or pancreas; men: prostate, colorectal, lung, or pancreas) from 1997 to 2015 using administrative health care databases...
January 28, 2019: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Karen Harrison Dening, Emma Castle, Caroline Scates, Kay De Vries
OBJECTIVES: Historically, dementia has not been recognised as a life-limiting condition or one that may benefit from a palliative approach to its care. There are many challenges in providing palliative and end-of-life care to this group of people, some of which may be reduced through advance care planning (ACP) to support people with dementia to have a greater influence on their care at end of life. ACP has been defined as a process of discussing and recording of wishes, values and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity...
February 8, 2019: BMJ Supportive & Palliative Care
Jason E Marker, Kisha N Davis, Rebecca Etz, Samuel M Jones, Jay W Lee, Michael LeFevre, Robert Phillips
Family Medicine for America's Health (FMAHealth) is a strategic planning organization effort that was created out of the reevaluation of the first Future of Family Medicine project from 2004. This article is a summary of the key findings of the FMAHealth Practice Core Team. At the highest level, we find that family medicine practices have compelling intrinsic and extrinsic reasons to evolve to new models of care delivery. We have demonstrated that payment transformation is imperative to successful practice transformation and that comprehensive payment models that include attention to physician work within the social determinants of health and require fewer administrative burdens will be key to achieving the quadruple aim...
February 2019: Family Medicine
Diane Stollenwerk, Lauren Birchfield Kennedy, Lauren S Hughes, Malachi O'Connor
In 2014, Family Medicine for America's Health (FMAHealth) began implementing a specialty-wide strategic plan. The FMAHealth Board of Directors created an Engagement Tactic Team and charged the team with two major objectives: (1) to engage patients as partners in transforming primary care, and (2) to strengthen working alliances with other primary care professions and key stakeholders to speak with a unified voice for primary care. The team's first objective sought to engage patients as partners to achieve the triple aim...
February 2019: Family Medicine
Melissa K Cousino, Kurt R Schumacher, John C Magee, Joanne Wolfe, Sunkyung Yu, Sally J Eder, Emily M Fredericks
BACKGROUND: Despite advancements in treatment and survival, pediatric organ failure and transplant populations continue to face significant risks of morbidity and mortality. Little scientific attention has been given to addressing the end-of-life care needs of this growing population of young people. This study characterized current practices, beliefs, and challenges specific to the disclosure of prognosis and end-of-life care topics among providers caring for pediatric organ failure and transplant populations...
February 7, 2019: Pediatric Transplantation
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