Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
1.
Am J Hosp Palliat Care ; 36(9): 760-766, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30744386

RESUMEN

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. DESIGN: Retrospective chart review of all noncancer patients with life-limiting diseases referred to palliative specialist clinic at a tertiary hospital in Hong Kong over a 4-year period. RESULTS: Over the study period, a total of 566 noncancer patients were seen, 119 of them completed their own DNR directives. Patients had a mean age of 74.9. Top 3 diagnoses were chronic renal failure (37%), congestive heart failure (16%), and motor neuron disease (11%). Forty-two percent of patients signed their DNR directives at first clinic attendance. Most Chinese patients (76.5%) invited family caregivers at DNR decision-making, especially for female gender (84.4% vs 69.1%; P = .047) and older (age >75) age group (86.2% vs 66.7%; P = .012). Of the 40 deceased patients, median time from signed directives to death was 5 months. Vast majority (95%) had their DNR directives being honored. CONCLUSION: Health-care workers should be sensitive toward the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family oriented decision-making.


Asunto(s)
Directivas Anticipadas/etnología , Pueblo Asiatico/psicología , Actitud Frente a la Muerte/etnología , Cuidados Paliativos/psicología , Órdenes de Resucitación/psicología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/psicología , Competencia Cultural , Toma de Decisiones , Familia , Femenino , Hong Kong , Humanos , Fallo Renal Crónico/psicología , Masculino , Persona de Mediana Edad , Enfermedad de la Neurona Motora/psicología , Estudios Retrospectivos , Factores Socioeconómicos , Cuidado Terminal/psicología , Factores de Tiempo
2.
Ann Palliat Med ; 7(3): 320-331, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29156920

RESUMEN

Although there is no cure for motor neurone disease (MND), the advent of supportive interventions including multidisciplinary care (MDC) has improved treatment interventions and enhanced quality of life (QOL) for MND patients and their carers. Our integrative review showed evidence-based MDC, respiratory management and disease-modifying therapy that have improved the outcomes of patients diagnosed with MND. Supportive approaches to nutritional maintenance and optimization of symptomatic treatments, including management of communication and neuropsychiatric issues, improve the QOL for MND patients. Notwithstanding improvement to care and QOL, survival benefit has become evident with the advent of a MDC framework, early treatment with non-invasive ventilation (NIV). In addition, weight maintenance remains critical, as weight loss is associated with more rapid disease progression. The endof- life phase is poorly defined in MND patients and treatment remains challenging, yet effective symptom control through palliative care (PC) is achievable and essential.


Asunto(s)
Enfermedad de la Neurona Motora/terapia , Cuidados Paliativos , Análisis Costo-Beneficio , Hospitalización , Humanos , Enfermedad de la Neurona Motora/economía , Enfermedad de la Neurona Motora/fisiopatología , Apoyo Nutricional , Cuidados Paliativos/métodos , Grupo de Atención al Paciente , Calidad de Vida , Terapia Respiratoria , Apoyo Social , Análisis de Supervivencia
3.
Am J Hosp Palliat Care ; 34(4): 380-384, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-26718957

RESUMEN

Normochromic normocytic anemia is a common complication in chronic kidney disease (CKD) and is associated with many adverse clinical consequences. Erythropoiesis-stimulating agents (ESAs) act to replace endogenous erythropoietin for patients with end-stage renal disease having anemia. Today, ESAs remain the main tool for treating anemia associated with CKD. In current practice, the use of ESA is not limited to the patients on renal replacement therapy but has extended to nondialysis patients under palliative care (PC). Current evidence on ESA usage in patients with CKD decided to forego dialysis often have to take reference from studies conducted in other groups of patients with CKD, including pre-dialysis patients and those on renal replacement therapy. There is paucity of studies targeting use of ESAs in renal PC patients. Small-scale retrospective study in renal PC patients had suggested clinical advantage of ESAs in terms of hemoglobin improvement, reduction in fatigue, and hospitalization rate. With the expected growth in elderly patients with CKD decided to forego dialysis and manage conservatively, there remains an urgent need to call for large-scale prospective trial in exploring efficacy of ESAs in this population, targeting on quality of life and symptoms improvement outcome. This article also reviews the mechanism of action, pharmacology, adverse effects, and clinical trial evidence for ESA in patients with CKD under renal PC.


Asunto(s)
Anemia/etiología , Eritropoyetina/uso terapéutico , Hematínicos/uso terapéutico , Fallo Renal Crónico/complicaciones , Cuidados Paliativos/métodos , Monitoreo de Drogas , Eritropoyetina/efectos adversos , Eritropoyetina/farmacología , Hematínicos/efectos adversos , Hematínicos/farmacología , Hemoglobinas , Humanos , Fallo Renal Crónico/terapia , Calidad de Vida , Diálisis Renal/psicología , Estudios Retrospectivos , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA