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1.
J Palliat Care ; 38(1): 17-23, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34918559

RESUMEN

BACKGROUND: Hospice care for end-of-life patients in the ICU should focus on quality of life. Currently, there are no specific quality-of-life measures for ICU end-of-life patients in China. OBJECTIVE: The aim of this study was to revise and culturally adapt the Taiwanese version of the McGill Quality of Life Questionnaire (MQOL-Taiwan) and to test its reliability and validity to provide an effective instrument for assessing the quality of life of ICU patients at the end of life. METHODS: The revision and cultural adaptation of the MQOL-Taiwan were performed to develop a Chinese version of the McGill Quality of Life Questionnaire for ICU end-of-life patients (MQOL-ICU). A total of 156 ICU doctors, 286 ICU nurses and 120 ICU family members of end-of-life patients were surveyed with the revised scale to evaluate the quality of life of ICU patients at the end of life. The content validity, construct validity, and internal consistency of the scale were measured after the revision. RESULTS: The Chinese version of the MQOL-ICU scale was formed based on the MQOL-Taiwan scale, which includes 8 items. For the Chinese version of the MQOL-ICU, the item-content validity index (I-CVI) ranged from 0.789 to 0.905, and the average scale-level content validity index (S-CVI/Ave) was 0.845. After exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) value was 0.700, and 3 dominant factors were extracted: physical and psychological symptoms, existential well-being, and support. In addition, 70.385% of the total variance was explained. The internal consistency (Cronbach's α) coefficient of the whole MQOL-ICU was 0.804, and the coefficients for the 3 domains ranged from 0.779 to 0.833. CONCLUSION: The Chinese version of the MQOL-ICU showed good reliability and validity, and it can be used to assess the quality of life of ICU patients at the end of life.


Asunto(s)
Cuidados Paliativos , Calidad de Vida , Humanos , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Cuidados Paliativos/psicología , Encuestas y Cuestionarios , China , Muerte , Unidades de Cuidados Intensivos , Psicometría
4.
Adv Anesth ; 40(1): 1-14, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36333041

RESUMEN

Anesthesiologists receive extensive training in the area of perioperative care and the specialized skills required to maintain life during surgery and complex procedures. Integrated into almost every facet of contemporary medicine, they interact with patients at multiple stages of their health care journeys. While traditionally thought of as the doctors best equipped to save lives, they may also be some of the best doctors to help navigate the chapters at the end of life. Successfully navigating end-of-life care, particularly in the COVID-19 era, is a complicated task. Competing ethical principles of autonomy and nonmaleficence may often be encountered as sophisticated medical technologies offer the promise of extending life longer than ever before seen. From encouraging patients to actively engage in advance care planning, normalizing the conversations around the end of life, employing our skills to relieve pain and suffering associated with dying, and using our empathy and communication skills to also care for the families of dying patients, there are many ways for the anesthesiologist to elevate the care provided at the end of life. The aim of this article is to review the existing literature on the role of the anesthesiologist in end-of-life care, as well as to encourage future development of our specialty in this area.


Asunto(s)
Planificación Anticipada de Atención , COVID-19 , Cuidado Terminal , Humanos , Anestesiólogos , Cuidado Terminal/métodos , Muerte
6.
Int J Palliat Nurs ; 28(11): 522-530, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36417288

RESUMEN

Background: It is recognised good practice to prescribe 'as required' parenteral medication (ARPM) to provide individualised symptom control in the final days of life. The decision to administer the medication and, sometimes, to decide the dose, usually lies with the nurse. Aims: To explore attitudes towards administration of ARPM at end of life (EOL) among hospital nurses. Methods: The views of registered nurses, recruited from wards with high death rates, were explored through questionnaires and semi-structured interviews. Questionnaire responses were coded and statistically analysed. Interviews were recorded, transcribed, manually coded and thematically analysed. Results: Almost 50% of questionnaire respondents (n=62) reported feeling 'very confident' in recognising symptoms at the EOL. Only 39% of respondents reported undertaking specific training. Three main themes emerged through the interviews: experience; factors influencing the decision to administer ARPM; and education. Conclusion: Wider accessibility to training may support confident decision making by hospital nurses administering ARPM at the EOL.


Asunto(s)
Actitud , Muerte , Humanos , Preparaciones Farmacéuticas , Encuestas y Cuestionarios , Hospitales
7.
BMC Palliat Care ; 21(1): 202, 2022 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-36419147

RESUMEN

BACKGROUND: Many people living with dementia eventually require care services and spend the remainder of their lives in long-term care (LTC) homes. Yet, many residents with dementia do not receive coordinated, quality palliative care. The stigma associated with dementia leads to an assumption that people living in the advanced stages of dementia are unable to express their end-of-life needs. As a result, people with dementia have fewer choices and limited access to palliative care. The purpose of this paper is to describe the protocol for a qualitative study that explores end-of-life decision-making processes for LTC home residents with dementia. METHODS/DESIGN: This study is informed by two theoretical concepts. First, it draws on a relational model of citizenship. The model recognizes the pre-reflective dimensions of agency as fundamental to being human (irrespective of cognitive impairment) and thereby necessitates that we cultivate an environment that supports these dimensions. This study also draws from Smith's critical feminist lens to foreground the influence of gender relations in decision-making processes towards palliative care goals for people with dementia and reveal the discursive mediums of power that legitimize and sanction social relations. This study employs a critical ethnographic methodology. Through data collection strategies of interview, observation, and document review, this study examines decision-making for LTC home residents with dementia and their paid (LTC home workers) and unpaid (family members) care partners. DISCUSSION: This research will expose the embedded structures and organizational factors that shape relationships and interactions in decision-making. This study may reveal new ways to promote equitable decision-making towards palliative care goals for LTC home residents with dementia and their care partners and help to improve their access to palliative care.


Asunto(s)
Demencia , Enfermería de Cuidados Paliativos al Final de la Vida , Humanos , Cuidados a Largo Plazo , Muerte , Investigación Cualitativa , Demencia/terapia
8.
Tokai J Exp Clin Med ; 47(4): 189-193, 2022 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-36420551

RESUMEN

While palliative care for patients with cancer is actively performed, it is provided only occasionally for patients with chronic non-cancerous respiratory diseases. This is due to various factors, including the fact that palliative care is not covered by health insurance and the difficulty in determining end-of-life in these patients. This paper presents two case studies to highlight the significance of palliative care team intervention for patients in the terminal stage of chronic non-cancerous respiratory diseases. Palliative care is essential to support physical problems, such as dyspnea, as well as mental disorders, such as depression, and to provide nutrition therapy and rehabilitation. To achieve care at the appropriate time in accordance with the patient's wishes, it is essential for patients to understand and accept the progress and deterioration of their disease and prepare for the end of life at an earlier stage under multidisciplinary involvement (advance care planning).


Asunto(s)
Neoplasias , Cuidados Paliativos , Humanos , Muerte , Neoplasias/terapia
9.
Glob Heart ; 17(1): 77, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36382162

RESUMEN

Background: Evidence regarding the clinical outcomes of rotational atherectomy (RA) in middle-income countries is limited. We analyzed the clinical outcomes of patients with heavily calcified coronary lesions who underwent RA-assisted percutaneous coronary intervention (PCI) and explored the risks for developing major adverse cardiovascular and cerebrovascular events (MACCE). Methods: This is a single-center, retrospective cohort analysis that enrolled consecutive patients who underwent RA-assisted PCI at the largest tertiary hospital in Thailand. The primary endpoint is the incidence of MACCE during the first-year follow-up. MACCE consists of cardiac death, ischemic stroke, definite stent thrombosis, target lesion revascularization, and target vessel revascularization. Results: From January 2015 to December 2018, 616 patients (663 lesions) were enrolled. The mean age was 72.8 ± 9.7 years, 292 (47.4%) patients were female and 523 (84.9%) completed one-year follow-up. Drug-eluting stents were deployed in 606 (91.4%) lesions. The RA success rate - defined as when the operator successfully passed the burr across the target lesion - was 99.4% and the angiographic success rate was 94.8%. 130 (21.4%) procedures developed periprocedural complications. The cumulative MACCE rate at 30-days was 1.5% and at 1-year was 6.3%. The in-hospital mortality rate was 1.1% and the cardiac death rate was 1.6%. Independent risk factors for developing MACCE included the use of an intra-aortic balloon pump (hazard ratio [HR] 3.96, 95% confidence interval [CI] 1.54-10.21; P = 0.004), a history coronary artery bypass graft (HR 2.30, 95% CI 1.01-5.25; P = 0.048), and increased serum creatinine (HR 1.16, 95% CI 1.04-1.30; P = 0.008). Conclusions: RA is an effective revascularization technique for heavily calcified lesions. This study demonstrates a high success rate and good short- to intermediate-term results of RA-assisted PCI in middle-income countries which are similar to high-income countries. Nevertheless, the rate of periprocedural complications remains high.


Asunto(s)
Aterectomía Coronaria , Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Calcificación Vascular , Humanos , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Aterectomía Coronaria/efectos adversos , Aterectomía Coronaria/métodos , Intervención Coronaria Percutánea/efectos adversos , Estudios Retrospectivos , Tailandia/epidemiología , Enfermedad de la Arteria Coronaria/cirugía , Resultado del Tratamiento , Muerte , Calcificación Vascular/cirugía
10.
Age Ageing ; 51(11)2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36413588

RESUMEN

BACKGROUND: this study aimed to identify distinct subgroups of trajectories of disability over time before 3 years of death and examine the factors associated with trajectory group membership probabilities among community-dwelling Japanese older adults aged 65 years and above. METHODS: participants included 4,875 decedents from among community-dwelling Japanese older adults, aged ≥ 65 years at baseline (men: 3,020; women: 1,855). The certified long-term care levels of the national long-term care insurance (LTCI) system were used as an index of functional disability. We combined data from the 2010 Japan Gerontological Evaluation Study and data from the 2010 to 2016 LTCI system. Group-based mixture models and multinominal logistic regression models were used for data analysis. RESULTS: five distinct trajectories of functional disability in the last 3 years of life were identified: 'persistently severe disability' (10.3%), 'persistently mild disability' (13.0%), 'accelerated disability' (12.6%), 'catastrophic disability' (18.8%) and 'minimum disability' (45.2%). Multinominal logistic regression analysis found several factors associated with trajectory membership; self-rated health was a common predictor regardless of age and gender. The analysis also showed a paradoxical association; higher education was associated with trajectory group membership probabilities of more severe functional decline in men over 85 years at death. CONCLUSIONS: individual perception of health was a strong predictor of trajectories, independent of demographic factors and socio-economic status. Our findings contribute to the development of policies for the long-term care system, particularly for end-of-life care, in Asian countries.


Asunto(s)
Actividades Cotidianas , Personas con Discapacidad , Masculino , Humanos , Femenino , Anciano , Japón , Vida Independiente , Muerte
11.
Clin J Oncol Nurs ; 26(6): 612-620, 2022 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-36413713

RESUMEN

BACKGROUND: Clinical oncology nurses (CONs) support and guide patients and caregivers by encouraging open dialogue and using effective communication skills. Palliative care (PC) and preparing for the end of life require that CONs apply experienced communication skills that are focused, nuanced, and helpful. OBJECTIVES: The aim of this article is to review communication methods and competencies, which can contribute to a best practices foundation for PC-focused conversations with patients and caregivers. METHODS: Expert CONs provided case studies and responded to clinical scenarios, which illustrated and highlighted communication competencies as applied to PC-focused conversations. FINDINGS: To establish communication competencies applied during PC-focused conversations with patients and caregivers, CONs can develop, enhance, and apply timely and effective communication skills in clinical oncology practice. To build a foundation for PC-focused communication competencies, nurses can access PC and communication skill resources, including mentoring by expert interprofessional practitioners from PC teams.


Asunto(s)
Cuidados Paliativos , Cuidado Terminal , Humanos , Oncología Médica , Comunicación , Muerte
12.
Healthc Q ; 25(3): 36-41, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36412527

RESUMEN

For patients desiring end-of-life care in a palliative care unit, ensuring a safe and timely transfer while reducing length of stay in acute care is optimal. A chart review of 130 patients was completed on those who either died in acute care or were transferred to a palliative care unit. In all, 31% of patients died in acute care and 69% were transferred to a palliative care unit. Barriers impacting a timely transfer included disposition planning, behavioural changes requiring monitoring, imminently dying patients and those awaiting medical assistance in dying. This article makes clinical recommendations to address these barriers.


Asunto(s)
Cuidados Paliativos , Cuidado Terminal , Humanos , Cuidados Críticos , Muerte
13.
J Trauma Nurs ; 29(6): 291-297, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36350166

RESUMEN

BACKGROUND: Witnessing death can be difficult and emotionally draining for health care workers and presents a risk factor for burnout. The practice of a ritual pause at patient death to recognize the patient as a person, reflect, and acknowledge the health care team is an emerging intervention that has not been well studied in trauma. OBJECTIVE: This study aims to explore the effect of a team pause on trauma team member attitudes after emergency department patient death. METHODS: This is a pre- and postintervention study of the implementation of a Trauma PAUSE (Promoting Acknowledgment, Unity, and Sympathy at the End of Life) conducted from March 2018 to June 2020. RESULTS: A total of 466 participated in this study. Emergency department employee responses to the pre- (296 of 745 employees contacted responded) and postimplementation surveys (170 of 732 employees contacted responded) were compared. Although not statistically significant, responses to the postsurvey suggested an increased connection to patients and belief in the need for a moment of silence following a death. Employees who had participated in a PAUSE (57/170) reported improvements in internal conflict, feeling of emptiness, resilience, and ability to move on to the next task. Overall, 84.2% (48/57) of Trauma PAUSE participants were satisfied with the Trauma PAUSE. CONCLUSION: The Trauma PAUSE is a meaningful way to help trauma staff members find peace, maintain resiliency, and readily shift their focus to providing care to other patients.


Asunto(s)
Agotamiento Profesional , Humanos , Servicio de Urgencia en Hospital , Agotamiento Psicológico , Grupo de Atención al Paciente , Muerte
14.
Int J Paleopathol ; 39: 85-92, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36332400

RESUMEN

OBJECTIVES: We report a contemporary individual who died with advanced holoprosencephaly (HPE) to encourage recognition of rare diseases (RDs), especially congenital conditions in archaeological samples. We also explore the range of conditions associated with hydrocephalus in support of nuanced interpretations of this disease. MATERIALS: The skeleton of a 17-year-old male who died with clinically diagnosed HPE, along with an age and sex matched comparative sample of 6 individuals who suffered accidental death and who were normal. METHODS: We observed and measured all remains using standard osteological methods. The clinical records for Ecce Homo were scrutinized; his family was interviewed, and his skull was X-rayed. RESULTS: The morphology and morphometry of Ecce Homo's skeleton display irregularities along the cranial midline and the postcranial skeleton consistent with anomalies derived from HPE as well as related congenital disorders and physical anomalies. CONCLUSIONS: We have reported HPE here and developed a differential diagnosis with closely related conditions. Likewise we relate the information generated in the clinical history and interviews with the family of Ecce Homo to facilitate an understanding of the social context. SIGNIFICANCE: This case is exceptional in providing information from the life context of a contemporary individual who suffered from a rare disease (HPE), with skeletal remains could be studied extensively. The differential diagnosis is useful in identifying HPE and other closely related conditions. LIMITATIONS: This is a single example with clinical intervention. SUGGESTIONS FOR FURTHER RESEARCH: Future osteological research should occur on other cases of HPE; molecular studies may offer further clarity.


Asunto(s)
Restos Mortales , Osteología , Humanos , Masculino , Adolescente , Muerte , Cabeza , Cráneo
15.
BMC Geriatr ; 22(1): 869, 2022 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-36384478

RESUMEN

BACKGROUND: Dementia is a leading cause of death in developed nations. Despite an often distressing and symptom laden end of life, there are systematic barriers to accessing palliative care in older people dying of dementia. Evidence exists that 70% of people living with severe dementia attend an emergency department (ED) in their last year of life. The aim of this trial is to test whether a Carer End of Life Planning Intervention (CELPI), co-designed by consumers, clinicians and content specialists, improves access to end of life care for older people with severe dementia, using an ED visit as a catalyst for recognising unmet needs and specialist palliative care referral where indicated. METHODS: A randomised controlled trial (RCT) enrolling at six EDs across three states in Australia will be conducted, enrolling four hundred and forty dyads comprising a person with severe dementia aged ≥ 65 years, and their primary carer. Participants will be randomly allocated to CELPI or the control group. CELPI incorporates a structured carer needs assessment and referral to specialist palliative care services where indicated by patient symptom burden and needs assessment. The primary outcome measure is death of the person with dementia in the carer-nominated preferred location. Secondary outcomes include carer reported quality of life of the person dying of dementia, hospital bed day occupancy in the last 12 months of life, and carer stress. An economic evaluation from the perspective of a health funder will be conducted. DISCUSSION: CELPI seeks to support carers and provide optimal end of life care for the person dying of dementia. This trial will provide high level evidence as to the clinical and cost effectiveness of this intervention. TRIAL REGISTRATION: ACTRN12622000611729 registered 22/04/2022.


Asunto(s)
Cuidadores , Demencia , Humanos , Anciano , Demencia/terapia , Demencia/diagnóstico , Calidad de Vida , Cuidados Paliativos , Muerte , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
BMC Health Serv Res ; 22(1): 1356, 2022 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-36384554

RESUMEN

BACKGROUND: Documentation of older people's end-of-life care should cover the care given and provide an overview of their entire situation. Older people approaching the end of life often have complex symptoms, live with bodily losses, and face an unknown future in which existential aspects come to the forefront. Knowledge of the existential aspects recorded in palliative care documentation is sparse and merits improvement. This knowledge is relevant to the development of more holistic documentation and is necessary in order to promote reflection on and discussion of documentation of the sensitive existential considerations arising in palliative care. The aim of this study was to describe the documentation of existential aspects in the patient records of older people receiving specialized palliative care. METHODS: Data were obtained from a retrospective review of the free-text notes in 84 records of randomly selected patients aged ≥75 years enrolled in specialized palliative care units who died in 2017. The notes were analysed using an inductive qualitative content analysis. RESULTS: The notes documented existential aspects in terms of connotations of well-being and ill-being. Documented existential aspects were related to the patients' autonomy concerning loss of freedom and self-determination, social connectedness concerning loneliness and communion, emotional state concerning anxiety and inner peace, and state of being concerning despair and hope. The notes on existential aspects were, however, not recorded in a structured way and no care plans related to existential aspects were found. CONCLUSIONS: Existential aspects concerning both ill-being and well-being were sparsely and unsystematically documented in older people's patient records, but when notes were extracted from these records and analysed, patterns became evident. Existential aspects form an important basis for delivering person-centred palliative care. There is a need to develop structured documentation concerning existential aspects; otherwise, patients' thoughts and concerns may remain unknown to healthcare professionals.


Asunto(s)
Enfermería de Cuidados Paliativos al Final de la Vida , Cuidado Terminal , Humanos , Anciano , Cuidados Paliativos/psicología , Estudios Retrospectivos , Cuidado Terminal/psicología , Soledad/psicología , Muerte
17.
Prof Case Manag ; 28(1): 1-2, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36394853

RESUMEN

Death doulas are people who help people at the end of life with dying, just like birth doulas help at the beginning of life. Views of traditions surrounding death, such as funerals and other ways to memorialize loved ones, are shifting. Death doula associations are seeing an increased interest from people who are seeking death doulas and those who wish to become death doulas.


Asunto(s)
Doulas , Humanos , Muerte
18.
Narrat Inq Bioeth ; 12(2): 177-181, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36373538

RESUMEN

It can be difficult for families to accept when loved ones experience a change in saliency of values due to serious illness and inevitable death. When patients lose decision-making capacity, family members often refuse to withdraw care and insist on the continuation of non-beneficial treatment. Through a joint ethical and psychological analysis, this case study examines the narrative of a husband and wife, wed for over 50 years, and how the patient's values, his life's story, and the wife's interpretation of his preferences were reconciled to achieve a resolution that respected the patient's autonomy and previously expressed wishes.


Asunto(s)
Análisis Ético , Esposos , Humanos , Esposos/psicología , Principios Morales , Narración , Muerte , Toma de Decisiones
20.
Cardiovasc Diabetol ; 21(1): 237, 2022 11 08.
Artículo en Inglés | MEDLINE | ID: mdl-36348348

RESUMEN

BACKGROUND: Optimal treatment strategies for patients with heart failure with preserved ejection fraction (HFpEF) remain uncertain. The goal of this study was to compare the treatment effects of different therapeutic agents for patients with HFpEF. METHODS: Randomized controlled trials (RCTs) published before June 2022 were searched from PubMed, Clinical Trials gov, and the Cochrane Central Register databases. Combined odds ratios (ORs) with 95% confidence intervals (CI) were calculated for the primary and secondary outcomes. All-cause death was the primary endpoint and cardiac death, hospitalization for HF, and worsening HF (WHF) events were secondary endpoints in this meta-analysis. RESULTS: Fifteen RCTs including 31,608 patients were included in this meta-analysis. All-cause and cardiac death were not significantly correlated between drug treatments and placebo. Compared with placebo, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor neprilysin inhibitors (ARNIs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced HF hospitalizations [odds ratio (OR) = 0.64, (95% confidence interval (95%CI 0.43 - 0.96), OR = 0.73, (95%CI 0.61 - 0.86), and OR = 0.74, (95%CI 0.66 - 0.83), respectively] without heterogeneity among studies. Only SGLT2 inhibitors significantly reduced WHF events [OR = 0.75, (95%CI 0.67 - 0.83)]. CONCLUSIONS: No treatments were effective in reducing mortality, but ARNIs, ACEIs or SGLT2 inhibitors reduced HF hospitalizations and only SGLT2 inhibitors reduced WHF events for patients with HFpEF.


Asunto(s)
Insuficiencia Cardíaca , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Humanos , Volumen Sistólico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Muerte
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