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Curtis, J. Randall. "Interventions to Improve Care during Withdrawal of Life-Sustaining Treatments." Journal of Palliative Medicine 8, supplement 1 (December 2005): s—116—s—131. http://dx.doi.org/10.1089/jpm.2005.8.s-116.
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Campbell, ML, and MC Thill. "Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan." American Journal of Critical Care 5, no. 5 (September 1, 1996): 339–45. http://dx.doi.org/10.4037/ajcc1996.5.5.339.
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BACKGROUND: The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. OBJECTIVE: The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy. METHODS: This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics. RESULTS: There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity. CONCLUSIONS: These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.
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Wagner, Ira J. "Private Attending Physician Status and the Withdrawal of Life-Sustaining Interventions." Critical Care Medicine 25, no. 2 (February 1997): 375. http://dx.doi.org/10.1097/00003246-199702000-00030.
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Kollef, Marin H. "Private Attending Physician Status and the Withdrawal of Life-Sustaining Interventions." Critical Care Medicine 25, no. 2 (February 1997): 375. http://dx.doi.org/10.1097/00003246-199702000-00031.
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Kramer, Andreas H., and Christopher J. Doig. "Premortem Heparin Administration and Location of Withdrawal of Life-Sustaining Interventions in DCD." Transplantation 100, no. 10 (October 2016): e102-e103. http://dx.doi.org/10.1097/tp.0000000000001378.
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Campbell, ML, and RW Carlson. "Terminal weaning from mechanical ventilation: ethical and practical considerations for patient management." American Journal of Critical Care 1, no. 3 (November 1, 1992): 52–56. http://dx.doi.org/10.4037/ajcc1992.1.3.52.
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Decisions to withdraw life-sustaining therapy are being made more often as patients and healthcare providers increase their awareness of patient rights. The process of withdrawal of mechanical ventilation must be conducted in a humane fashion. An understanding of the ethical, legal and practical considerations for patient management during this type of intervention will enhance the ability of the healthcare provider to participate.
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Barker, Virgil M. "Deactivation of Pacemakers at the End of Life." Ethics & Medics 44, no. 9 (2019): 1–2. http://dx.doi.org/10.5840/em201944912.
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The liceity of deactivating pacemakers and implantable cardio-defibrillators at the end of life has been considered only recently. The current discussion divides into two main camps: those who view deactivation as the moral equivalent of the withdrawal of other life-sustaining interventions, and those who hold deactivation as the equivalent of physician-assisted suicide. Some authors contend that similar to a transplanted organ, the pacemaker establishes an organic unity with the human body. Hence, its deactivation is equivalent to the removal or disabling of an organ. On the contrary, the relationship of a pacemaker to the human body is similar to other supportive mechanical devices. There are burdens associated with the presence of these devices. In the face of a terminal diagnosis, the deactivation of a cardio-pacemaker is morally similar to the withdrawal of other extraordinary measures currently accepted within the Catholic moral teachings.
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Kollef, Marin H. "Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population." Critical Care Medicine 24, no. 6 (June 1996): 968–75. http://dx.doi.org/10.1097/00003246-199606000-00016.
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RICH, BEN A. "The Tyranny of Judicial Formalism: Oral Directives and the Clear and Convincing Evidence Standard." Cambridge Quarterly of Healthcare Ethics 11, no. 3 (May 17, 2002): 292–302. http://dx.doi.org/10.1017/s0963180102113119.
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A decision by the Supreme Court of California in the case Conservatorship of Wendland, issued in August 2001, forces us once again to confront the all-too-common situation in which an individual has, on multiple occasions, expressed strongly held personal convictions about life-sustaining interventions but failed to incorporate those convictions into a formal advance directive. Many courts have recognized that lay citizens do not consistently resort to written legal formalities in their day-to-day lives, and reasonable accommodation must be made to this fundamental fact about human nature. However, a small but apparently growing minority of courts adamantly insist on either formal written directives or prescience and prophetic precision on the part of the patient before a surrogate can direct the withdrawal of life-sustaining treatment. The chronology of cases that comprise this minority position in American medical jurisprudence raise important ethical issues.
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Yun, Young Ho, Kyoung-Nam Kim, Jin-Ah Sim, Shin Hye Yoo, Miso Kim, Young Ae Kim, Beo Deul Kang, et al. "Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population." BMJ Open 8, no. 9 (September 2018): e020519. http://dx.doi.org/10.1136/bmjopen-2017-020519.
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ObjectivesThis study determined attitudes of four groups—Korean patients with cancer, their family caregivers, physicians and the general Korean population—towards five critical end-of-life (EOL) interventions—active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide.Design and settingWe enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a ‘good death’ with critical interventions at EoL care.ResultsAll participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling ‘life was meaningful’ (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing ‘freedom from pain’ negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, ‘not being a burden to the family’ was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89).ConclusionGroups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
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Hansen, Lissi, Teresa T. Goodell, Josi DeHaven, and MaryDenise Smith. "Nurses’ Perceptions of End-of-Life Care After Multiple Interventions for Improvement." American Journal of Critical Care 18, no. 3 (May 1, 2009): 263–71. http://dx.doi.org/10.4037/ajcc2009727.
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Background Nurses working in intensive care units may lack knowledge and skills in end-of-life care, find caring for dying patients and the patients’ families stressful, and lack support to provide this care.Objectives To describe nurses’ perceptions of (1) knowledge and ability, (2) work environment, (3) support for staff, (4) support for patients and patients’ families, and (5) stress related to specific work situations in the context of end-of-life care before (phase 1) and after (phase 2) implementation of approaches to improve end-of-life care. The approaches were a nurse-developed bereavement program for patients’ families, use of a palliative medicine and comfort care team, preprinted orders for the withdrawal of life-sustaining treatment, hiring of a mental health clinical nurse specialist, and staff education in end-of-life care.Methods Nurses in 4 intensive care units at a university medical center reported their perceptions of end-of-life care by using a 5-subscale tool consisting of 30 items scored on a 4-point Likert scale. The tool was completed by 91 nurses in phase 1 and 127 in phase 2.Results Improvements in overall mean scores on the 5 sub-scales indicated that the approaches succeeded in improving nurses’ perceptions. In phase 2, most of the subscale overall mean scores were higher than a desired criterion (<2.0, good). Analysis of variance indicated that some improvements occurred over time differently in the units; other improvements occurred uniformly.Conclusions Continued practice development is needed in end-of-life care issues.
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Efstathiou, Nikolaos, Brandi Vanderspank-Wright, Amanda Vandyk, Mustafa Al-Janabi, Zeinab Daham, Aimee Sarti, Jesse W. Delaney, and James Downar. "Terminal withdrawal of mechanical ventilation in adult intensive care units: A systematic review and narrative synthesis of perceptions, experiences and practices." Palliative Medicine 34, no. 9 (June 27, 2020): 1140–64. http://dx.doi.org/10.1177/0269216320935002.
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Background: During the terminal withdrawal of life-sustaining measures for intensive care patients, the removal of respiratory support remains an ambiguous practice. Globally, perceptions and experiences of best practice vary due to the limited evidence in this area. Aim: To identify, appraise and synthesise the latest evidence around terminal withdrawal of mechanical ventilation in adult intensive care units specific to perceptions, experiences and practices. Design: Mixed methods systematic review and narrative synthesis. A review protocol was registered on PROSPERO (CRD42018086495). Data sources: Four electronic databases were systematically searched (Medline, Embase, CENTRAL and CINAHL). Obtained articles published between January 2008 and January 2020 were screened for eligibility. All included papers were appraised using relevant appraisal tools. Results: Twenty-five papers were included in the review. Findings from the included papers were synthesised into four themes: ‘clinicians’ perceptions and practices’; ‘time to death and predictors’; ‘analgesia and sedation practices’; ‘physiological and psychological impact’. Conclusions: Perceptions, experiences and practices of terminal withdrawal of mechanical ventilation vary significantly across the globe. Current knowledge highlights that the time to death after withdrawal of mechanical ventilation is very short. Predictors for shorter duration could be considered by clinicians and guide the choice of pharmacological interventions to address distressing symptoms that patients may experience. Clinicians ought to prepare patients, families and relatives for the withdrawal process and the expected progression and provide them with immediate and long-term support following withdrawal. Further research is needed to improve current evidence and better inform practice guidelines.
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Kim, SooOk, and MeeSuk Wang. "Perception of Older People on Dying, Withdrawal of Life Sustaining Intervention and Advance Directives in South Korea." International Journal of Elderly Welfare Promotion and Management 4, no. 1 (May 30, 2020): 23–30. http://dx.doi.org/10.21742/ijewpm.2020.4.1.04.
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Prabhakaran, Shyam, Margueritte Cox, Barbara Lytle, Phillip J. Schulte, Ying Xian, Darin Zahuranec, Eric E. Smith, Mathew Reeves, Gregg C. Fonarow, and Lee H. Schwamm. "Early transition to comfort measures only in acute stroke patients." Neurology: Clinical Practice 7, no. 3 (May 24, 2017): 194–204. http://dx.doi.org/10.1212/cpj.0000000000000358.
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AbstractBackground:Death after acute stroke often occurs after forgoing life-sustaining interventions. We sought to determine the patient and hospital characteristics associated with an early decision to transition to comfort measures only (CMO) after ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Get With The Guidelines–Stroke registry.Methods:We identified patients with IS, ICH, or SAH between November 2009 and September 2013 who met study criteria. Early CMO was defined as the withdrawal of life-sustaining treatments and interventions by hospital day 0 or 1. Using multivariable logistic regression, we identified patient and hospital factors associated with an early (by hospital day 0 or 1) CMO order.Results:Among 963,525 patients from 1,675 hospitals, 54,794 (5.6%) had an early CMO order (IS: 3.0%; ICH: 19.4%; SAH: 13.1%). Early CMO use varied widely by hospital (range 0.6%–37.6% overall) and declined over time (from 6.1% in 2009 to 5.4% in 2013; p < 0.001). In multivariable analysis, older age, female sex, white race, Medicaid and self-pay/no insurance, arrival by ambulance, arrival off-hours, baseline nonambulatory status, and stroke type were independently associated with early CMO use (vs no early CMO). The correlation between hospital-level risk-adjusted mortality and the use of early CMO was stronger for SAH (r = 0.52) and ICH (r = 0.50) than AIS (r = 0.15) patients.Conclusions:Early CMO was utilized in about 5% of stroke patients, being more common in ICH and SAH than IS. Early CMO use varies widely between hospitals and is influenced by patient and hospital characteristics.
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McStay, Rob. "Terminal Sedation: Palliative Care for Intractable Pain, Post Glucksberg and Quill." American Journal of Law & Medicine 29, no. 1 (2003): 45–76. http://dx.doi.org/10.1017/s0098858800002331.
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In 1997, the U.S. Supreme Court tacitly endorsed terminal sedation as an alternative to physician-assisted suicide, thus intensifying a debate in the legal and medical communities as to the propriety of terminal sedation and setting the stage for a new battleground in the “right to die” controversy. Terminal sedation is the induction of an unconscious state to relieve otherwise intractable distress, and is frequently accompanied by the withdrawal of any life-sustaining intervention, such as hydration and nutrition. This practice is a clinical option of “last resort” when less aggressive palliative care measures have failed. Terminal sedation has also been described as “the compromise in the furor over physician-assisted suicide.”Medical literature suggests that terminal sedation was a palliative care option long before the Supreme Court considered the constitutional implications of physician-assisted suicide. Terminal sedation has been used for three related but distinct purposes: (1) to relieve physical pain; (2) to produce an unconscious state before the withdrawal of artificial life support; and (3) to relieve non-physical suffering.
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Ogando Portilla, N., S. M. Bañon González, and M. G. García Jiménez. "Multidisciplinary approach in old aged dying patients." European Psychiatry 41, S1 (April 2017): S581—S582. http://dx.doi.org/10.1016/j.eurpsy.2017.01.875.
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IntroductionOver centuries, clinicians have had the responsibility to take care of dying patients. Lately, the withdrawal of life sustaining treatments have assumed a main role in these patients because of ethical aspects. Competent patients have the right to refuse medical care but not always these rights are respected or even explained to them, especially if they are old or they don’t have any close family. A multidisciplinary team should agree on how they think it is best to care for the patient and whether withdrawal of medical interventions is appropriate by using patient's wishes.ObjectivesTo identify the most relevant aspects to deal with in old aged dying patients.MethodsSystematic literature review in Up-to-date and Pubmed.Clinical case 83 years-old-man with a gastric cancer state IV. Married with a woman with Dementia who is waiting for a long stay public residence. No children. No cognitive damage. Fatal prognosis with a need of permanent enteral nutrition, which, he doesn’t want to use and clinicians strongly recommends. Great anxiety and suffering. Decision making capacity. Wish to die.DiscussionPatients with the capacity to make medical decisions can refuse medical care even if this refusal results in their death. Sometimes, a “comfort measures only” can be a better option than trying to keep life. Old people with no family are often less informed and taken in count in making decisions. A symptom management, good patient-clinicians communication, psychosocial, spiritual, and practical support and respecting patient's wishes and decisions is a main goal in any medical care.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Schroeder, Pamela R., Bryan R. Haugen, Furio Pacini, Christoph Reiners, Martin Schlumberger, Steven I. Sherman, David S. Cooper, et al. "A Comparison of Short-Term Changes in Health-Related Quality of Life in Thyroid Carcinoma Patients Undergoing Diagnostic Evaluation with Recombinant Human Thyrotropin Compared with Thyroid Hormone Withdrawal." Journal of Clinical Endocrinology & Metabolism 91, no. 3 (March 1, 2006): 878–84. http://dx.doi.org/10.1210/jc.2005-2064.
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Abstract Context: Thyroid carcinoma requires lifelong monitoring with serum thyroglobulin, radioactive iodine whole body scanning, and other imaging modalities. Levothyroxine (l-T4) withdrawal for thyroglobulin measurement and whole body scanning increases these tests’ sensitivities but causes hypothyroidism. Recombinant human TSH (rhTSH) enables testing without l-T4 withdrawal. Objective: Our objective was to examine the impact of short-term hypothyroidism on the health-related quality of life (HRQOL) of patients after rhTSH vs.l-T4 withdrawal. Design, Setting, and Patients: In this multicenter study, the SF-36 Health Survey was administered to 228 patients at three time points: on l-T4, after rhTSH, and after l-T4 withdrawal. Interventions: Interventions included administration of rhTSH on l-T4 and withdrawal from thyroid hormone. Main Outcome Measures: Mean SF-36 scores were compared during the two interventions and with the U.S. general population and patients with heart failure, depression, and migraine headache. Results: Patients had SF-36 scores at or above the norm for the general U.S. population in six of eight domains at baseline on l-T4 and in seven of eight domains after rhTSH. Patients’ scores declined significantly in all eight domains after l-T4 withdrawal when compared with the other two periods (P < 0.0001). Patients’ HRQOL scores while on l-T4 and after rhTSH were at or above those for patients with heart failure, depression, and migraine in all eight domains. After l-T4 withdrawal, patients’ HRQOL scores were significantly below congestive heart failure, depression, and migraine headache norms in six, three, and six of the eight domains, respectively. Conclusions: Short-term hypothyroidism after l-T4 withdrawal is associated with a significant decline in quality of life that is abrogated by rhTSH use.
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Davie, M., and A. Kaiser. "Semi-qualitative study of staff attitudes to care following decision to withdraw active treatment in a neonatal intensive care unit." Clinical Ethics 2, no. 3 (September 1, 2007): 133–38. http://dx.doi.org/10.1258/147775007781870100.
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The management of an infant after a decision to withdraw active treatment creates dilemmas. Both lingering death and active killing are undesirable, but palliative interventions can hasten death. We investigated what staff on our neonatal unit thought were the limits of acceptable practice and why. We administered a structured interview to elucidate their views, and asked them to justify their answers. The interviews were analysed quantitatively and qualitatively. A total of 25 participants (15 nurses and 10 doctors) were recruited. 80% emphasized the importance of pain relief following withdrawal, 60% mentioned meeting parental needs at that time. 76% agreed that death can be a desired consequence of withdrawal, yet 52% felt that death should never be hastened. 96% felt that morphine is acceptable after withdrawal, and 72% would give a higher than normal dose if necessary. 56% would stop paralysis at extubation but not reverse it, while 24% would continue paralysis. 16% would consider a drug that ended life instantly in some cases. A wide variety of views emerged, but there were two main positions, a cautious majority, and a more proactive minority. Apparent contradictions within the majority position could be explained using the doctrine of double effect and the acts and omissions distinction.
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Hoffman, Melissa R., Rachel Morris, Terrie Smith, Sheri Denslow, and Michael Schurr. "Early Comfort Care Following Operative Intervention for Traumatic Injury." American Surgeon 86, no. 8 (August 2020): 933–36. http://dx.doi.org/10.1177/0003134820940255.
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Background Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. Methods This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher’s exact test and Mann-Whitney U test. Results Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI −107–29, P = .26) than traumatic brain injury patients. Discussion The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients’ goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.
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Phadsri, Supaluck, Rieko Shioji, Atsuko Tanimura, Jeerawit Jaknissai, Sopida Apichai, and Tippawan Sookruay. "Nonpharmacological Treatment for Supporting Social Participation of Adults with Depression." Occupational Therapy International 2021 (April 29, 2021): 1–13. http://dx.doi.org/10.1155/2021/8850364.
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Background. Social withdrawal is predominantly seen among adults with depression. However, a dearth of reviews exists that explore nonpharmacological treatments, especially occupational therapy (OT) interventions and their effect in promoting social participation. The aim of this research was to review what intervention programs are conducted to support the social participation of adults with depression and their effectiveness. Method. A systematic review was performed wherein relevant articles were searched in PubMed, CINAHL, Wiley Online Library, PsycINFO, and OTseeker databases and AJOT, BJOT, SJOT, and OTMH journals. Only English articles published from January 2010 to December 2018, which tackled intervention for adults aged 20–60 years with depression, were considered. Ten out of 918 studies met the screening criteria. Result. Among the ten studies, the effective intervention programs were categorized as either occupation-based intervention (OBI) or cognitive behavioral therapy-based intervention (CBT-BI). These programs sought the following outcomes: behavioral change in social participation ( n = 4 ), reduction of depression or depressive symptoms ( n = 13 ), life satisfaction ( n = 4 ), and quality of life (QoL) ( n = 1 ). Studies showed moderate ( n = 3 ) to strong ( n = 7 ) level of certainty, whereas they also revealed high to unclear ( n = 3 ) and low ( n = 7 ) risk of bias. Conclusion. Both OBI such as animal-assisted therapy and CBT-BI such as behavioral change program and health education have a strong level of certainty and low risk of bias in promoting social participation by supporting positive behavioral change and reducing depressive symptoms. Furthermore, the sport and exercise program of OBI was popular in encouraging participation and engagement with other people. Other programs were suggested for combined interventions to support social participation, life satisfaction, and QoL.
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Washington, Tiffany R., Laura N. Gitlin, and Matthew L. Smith. "PROMOTING SUCCESSFUL CHRONIC DISEASE SELF-MANAGEMENT THROUGH COMMUNITY-BASED INTERVENTIONS." Innovation in Aging 3, Supplement_1 (November 2019): S68—S69. http://dx.doi.org/10.1093/geroni/igz038.266.
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Abstract Persistent chronic conditions are among the top leading causes of death in the U.S. The majority of older adults live with two or more chronic conditions. When poorly managed, chronic conditions can result in negative psychosocial and health outcomes such as low quality of life, diminished mood, workforce withdrawal, high healthcare utilization, and disability. Fortunately, chronic disease self-management interventions show promise in reducing the negative impact of chronic conditions on health status. This symposium will highlight formative work and recent findings of community-based interventions that promote successful self-management. To start, presenter one will describe findings from four studies that constitute the formative work necessary to inform implementation of self-management interventions in community and healthcare settings. Next, presenter two will report findings from an effectiveness trial of a technology-based intervention to support hypertension self-management. Then, presenter three will describe findings on the feasibility of a Health Passport tool to promote self-health management among individuals with physical limitations. Finally, presenter four will describe factors affecting attendance among African Americans with arthritis who participated in a national dissemination of Chronic Disease Self-Management Education programs. Collectively, these presentations will provide practical evidence and science-based recommendations for ways to increase successful chronic disease self-management and ultimately improve population health among older adults.
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Maulod, Ad, Normala Manap, Sasha Rouse, and Angelique W. M. Chan. "Implications of Exceeding the Age and Interventions to Extend Life Purpose: Perspectives From Asian Centenarians." Innovation in Aging 4, Supplement_1 (December 1, 2020): 23. http://dx.doi.org/10.1093/geroni/igaa057.073.
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Abstract Centenarians have often been regarded as living paradigms of exceptional longevity yet little is known from their perspective about the purpose, meaning and quality of living longer lives. In Singapore, the number of centenarians has multiplied 30-fold from 50 in 1990 to about 1500 in 2020. Although centenarians are respected as ‘national treasures’ – having witnessed Singapore’s transformation from British colony to global city state, their needs remain invisible in both the healthcare and social sectors. The tendency to romanticize exceptional longevity neglects a deeper understanding of (i) its consequence on the oldest old (85+ years) who may be impacted by severe functional and sensory deficits and (ii) their experience of social isolation in the family and communities. This paper discusses findings based on interviews with 15 Singapore centenarians (100 to 111 years old) and their family carers. Diverse experiences of longevity are shaped by these factors: health status; personal disposition; strength of family and social networks; exposure to adversity and coping resources; spiritual beliefs; role loss; and changes in the lived environment. Appropriate health and psychosocial interventions could have been delivered earlier in the life trajectory to enable better quality of life and continued social engagement. Learning from the challenges (eg. social withdrawal; extensive functional and sensory losses) of existing centenarians contributes to a more precise understanding of how best to harness the productive capacities of our oldest old.
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Clarke, Mary, Ross Brannigan, Antti Tanskanen, Matti Huttunen, Finbarr Leacy, and Mary Cannon. "M129. PATTERNS OF CHILDHOOD TEMPERAMENT ARE ASSOCIATED WITH ADULT PSYCHOTIC DISORDER IN A PROSPECTIVE COHORT STUDY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S184. http://dx.doi.org/10.1093/schbul/sbaa030.441.
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Abstract Background Childhood temperament has previously been shown to be associated with mood and anxiety disorders later in life. Studies have also suggested possible links between childhood temperament and later psychosis. Aim To investigate the association between childhood temperament and its individual component factors, measured at age 5, and later psychiatric disorders including psychosis. Methods Using a sample from a Finnish birth cohort (N=1014), we used logistic regression models to examine associations between maternal reported childhood temperament at age 5, and later psychiatric diagnoses, ascertained through linkage with the Finnish Hospital Discharge Register. Results Individuals with a childhood temperament rated as difficult at age 5 had almost 5-times the odds of developing a psychotic disorder in adulthood compared to those with a temperament rated as average by their mothers (OR = 4.91, 95% CI = 1.51 – 15.91). The individual temperament factors of approach withdrawal, adaptability and quality of mood were each independently associated with later psychotic disorder while different temperament components were associated with increased risk of mood disorders. Discussion Early childhood temperament could be used in combination with other early life indicators to identify those at greatest risk for the development of psychosis later in life, and to inform the implementation of early interventions such as parent-training programs and school-based interventions to support children in developing more adaptive behavioural and self-regulatory strategies. Additionally, intervening early in a child’s life to support more optimal temperament development, such as better adaptability to new stressful situations through specific skills training, could be a viable target for early intervention to reduce psychosis risk.
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Cohen, Jonah N., Dane Jensen, M. Taylor Dryman, and Richard G. Heimberg. "Enmeshment Schema and Quality of Life Deficits: The Mediating Role of Social Anxiety." Journal of Cognitive Psychotherapy 29, no. 1 (2015): 20–31. http://dx.doi.org/10.1891/0889-8391.29.1.20.
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Social anxiety is associated with significant functional impairment and poor quality of life. However, there is a paucity of research on how early childhood and family dynamics may be related to social anxiety and its impact on quality of life. We investigated the role of enmeshment schemas, cognitive structures associated with emotional over-involvement with and lack of differentiation from family. Enmeshment is associated with considerable functional impairment, including elevated anxiety and depression and impaired relationship satisfaction. As enmeshment schemas predict withdrawal from stressful social interactions, they may facilitate the development of social anxiety and, through that mechanism, lead to reduced quality of life. Participants completed measures of these constructs. Social anxiety mediated the negative association between enmeshment and quality of life, particularly within the domains of personal growth, social functioning, and achievement. Implications for novel etiological conceptualizations of social anxiety and subsequent treatment interventions are discussed.
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Sedhom, Ramy, Jasmet Bajaj, Vadim Finklestein, Mindy Tanpiengco, and David Barile. "A communication strategy using a video support tool and structured family meetings for relatives of patients dying in the ICU." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 81. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.81.
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81 Background: Death in the ICU is an extraordinarily stressful event. Qualitative and quantitative studies have identified effective communication between caregivers and families to be important throughout the decision making process. In many ICUs, the end-of-life family conference is an opportunity to ask questions, express concerns, and confront painful emotions with the help of compassionate professionals. Methods: A prospective study in a single ICU center. The ICU physician, palliative care team, and research nurse interviewed surrogate decision makers. The only criterion for inclusion in the study was anticipated death in one year. Patients younger than 18 were excluded from the study, as were those unable to speak English. Prior to the family meeting, families were offered an opportunity to watch a video on EOL decision-making made by the research team. The meeting itself followed a script, guided by four steps:establish diagnosis, share prognosis, elicit goals of care, recommend treatment. The investigators recorded ICU and patient characteristics on standardized forms. Results: 22 families were included. A decision to forego life-sustaining treatment and transition to comfort care or hospice was pursued by 77% of families. There were few non-beneficial interventions, such as CRRT or use of artificial nutrition; withdrawal of mechanical ventilation and vasopressors was common. Qualitative commentary suggested that time spent by providers were sufficient and the video support tool was clear and easy to understand. Conclusions: EOL family conferences improve communication between ICU staff and family members and assist families in decision making, especially for cancer syndromes. The structured family meetings offered opportunities to discuss patient’s wishes, alleviate feelings of guilt, and understand the goals of care. Patients received few non-beneficial treatments and families were likely to accept realistic goals of care. This highlights the potential role for video-support tools in advance care planning. Future studies reporting overall LOS and bereavement data are important quality markers and pending in a future report.
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Prats-Sánchez, Luis, Marina Guasch-Jiménez, Ignasi Gich, Elba Pascual-Goñi, Noelia Flores, Pol Camps-Renom, Daniel Guisado-Alonso, et al. "Influence of time to admission to a comprehensive stroke centre on the outcome of patients with intracerebral haemorrhage." European Stroke Journal 5, no. 2 (January 29, 2020): 115–22. http://dx.doi.org/10.1177/2396987320901616.
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Introduction In patients with spontaneous intracerebral haemorrhage, it is uncertain if diagnostic and therapeutic measures are time-sensitive on their impact on the outcome. We sought to determine the influence of the time to admission to a comprehensive stroke centre on the outcome of patients with acute intracerebral haemorrhage. Patients and methods We studied a prospective database of consecutive patients with intracerebral haemorrhage attended at two comprehensive stroke centres (2005–2017). We excluded patients with an unwitnessed time of onset of the intracerebral haemorrhage, or previous modified Rankin Scale >3 or in those in whom withdrawal of life-sustaining interventions were decided <24 h from admission. We recorded the time from the intracerebral haemorrhage onset to admission, demographic, clinical, radiological data, the functional outcome (favourable when modified Rankin Scale ≤3) and mortality at 90 days. We conducted a propensity score-matching analysis to evaluate functional outcome and mortality. Results We included 487 patients (mean age 72.3 ± 13.9 years), and 53.2% were men. Compared to patients with an admission >110 min, patients who were admitted ≤110 min were significantly younger, and had higher National Institutes of Health Stroke Scale scores. Moreover, patients admitted ≤110 min were more likely to have basal ganglia intracerebral haemorrhage, and to show neurological deterioration. The propensity score groups were well matched. We did not find an association between time to admission and the favourable outcome (OR: 1.42 (95% CI: 0.93–2.16)) or mortality (OR: 0.64 (0.41–0.99)) at 90 days. Conclusions Our results suggest that in patients with intracerebral haemorrhage and known symptom onset who are admitted to a comprehensive stroke centre, an early admission (≤110 min) does not influence the outcome at 90 days.
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Sensky, T. "Withdrawal of life sustaining treatment." BMJ 325, no. 7357 (July 27, 2002): 175–76. http://dx.doi.org/10.1136/bmj.325.7357.175.
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Hinderer, Katherine A., Erika Friedmann, and Joseph J. Fins. "Withdrawal of Life-Sustaining Treatment." Dimensions of Critical Care Nursing 34, no. 2 (2015): 91–99. http://dx.doi.org/10.1097/dcc.0000000000000097.
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Jericho, Barbara G. "Withdrawal of life-sustaining therapy." Current Opinion in Anaesthesiology 31, no. 2 (April 2018): 179–84. http://dx.doi.org/10.1097/aco.0000000000000570.
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Stacy, Kathleen M. "Withdrawal of Life-Sustaining Treatment." Critical Care Nurse 32, no. 3 (June 1, 2012): 14–24. http://dx.doi.org/10.4037/ccn2012152.
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Withdrawal of life support is an option for patients with prolonged mechanical ventilation when all attempts at weaning have failed and it is deemed futile to continue the therapy, when quality of life is unacceptable, or when it is perceived that the patient is suffering. The purpose of this article is to present the nursing aspects of managing an adult patient undergoing the withdrawal of mechanical ventilation as an end-of-life procedure. Withdrawal of mechanical ventilation is a complex and difficult process that requires meticulous planning and management. Conferences with the patient and the patient’s family are critical to addressing emotional support and ensuring that everyone understands the process and is provided an opportunity to gather information. Clear communication with patients and their families can ensure that the process goes smoothly. Having an organized approach can ensure that patients experience a peaceful death and staff experience closure regarding the event.
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Catlin, Anita, and Brian Carter. "Creation of a Neonatal End-of-Life Palliative Care Protocol." Neonatal Network 21, no. 4 (June 2002): 37–49. http://dx.doi.org/10.1891/0730-0832.21.4.37.
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Objective: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support.Study design: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period.Results/Conclusion: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of lifeextending interventions; family follow-up care; and necessary ongoing staff support.
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Inoue, Sachiko, Tsuguhiko Kato, and Takashi Yorifuji. "Life Satisfaction, Interpersonal Relationships, and Learning Influence Withdrawal from School: A Study among Junior High School Students in Japan." International Journal of Environmental Research and Public Health 15, no. 10 (October 20, 2018): 2309. http://dx.doi.org/10.3390/ijerph15102309.
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School absenteeism, particularly among junior high school students, has increased annually in Japan. This study demonstrates the relationship between subjective adjustment to school life and students’ absenteeism. Data were collected from 17,378 junior high school students in Japan. A longitudinal design was used for the study. Teachers were asked to distribute the Adaptation Scale for School Environments on Six Spheres (ASSESS) questionnaire to junior high school students and ask the students to fill out the questionnaire at the beginning of the 2014 academic year in April 2014, and the relationship between their subjective adjustment and absenteeism as measured by the total number of absent days during the 2014 academic year was evaluated by logistic regression and a survival analysis model. Low life satisfaction was associated with absences. The corresponding odds ratio (OR) was higher for seventh graders (OR 3.29, confidence interval (CI): 2.41–4.48, hazard ratio (HR) 5.57, CI: 3.51–8.84) than for students in other grades. Interpersonal relationships were significantly related to absenteeism for seventh and eighth graders in the group with scores less than 39 points. Lower adjustment to learning seemed to be related to absenteeism for seventh and eighth graders. For effective interventions, a well-designed study that uses detailed information regarding life-related covariates is necessary.
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Seymour, Jane, and David Clark. "The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England." Wellcome Open Research 3 (February 22, 2018): 15. http://dx.doi.org/10.12688/wellcomeopenres.13940.1.
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Background: The Liverpool Care Pathway for the Dying Patient (‘the LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review. The ensuing debate among clinicians polarised between ‘blaming’ of the LCP and regret at its removal. Employing the concept of ‘boundary objects’, we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP ‘scandal’ demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.
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Herrmann, Nathan. "Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 28, S1 (May 2001): S96—S107. http://dx.doi.org/10.1017/s0317167100001268.
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Background:The behavioral and psychological symptoms of dementia (BPSD) are common, serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best available evidence, a qualitative literature review was performed.Methods:A search of the English language medical literature published between 1966 and 2000 was performed. The quality of the studies was assessed by considering the subjects, trial design, analysis and results. Final recommendations were based upon the quality of available evidence.Results:The management of BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensory impairment ameliorated. Nonpharmacological approaches should be instituted prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioral techniques. Antipsychotics are the best studied pharmacological intervention for agitation and aggression and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors, as well as anticonvulsants such as carbamazepine and valproic acid have also demonstrated efficacy. Benzodiazepines can be used for short-term treatment as p.r.n. agents when necessary. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate.Conclusion:The management of BPSD can significantly improve the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.
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Avram, Carmen M., Leah Yieh, Dmitry Dukhovny, and Aaron B. Caughey. "A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal." American Journal of Perinatology 37, no. 01 (August 1, 2019): 001–7. http://dx.doi.org/10.1055/s-0039-1693716.
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Abstract Objective Our cost-effectiveness analysis investigated rooming-in versus not rooming-in to determine optimal management of neonates with neonatal opioid withdrawal (NOW). Study Design A decision-analytic model was constructed using TreeAge to compare rooming-in versus not rooming-in in a theoretical cohort of 23,200 newborns, the estimated annual number affected by NOW in the United States. Additional considerations included the effect of breast milk versus formula milk in evaluating the need for pharmacotherapy. Primary outcomes were needed for pharmacotherapy and neurodevelopment. We assumed a societal perspective in evaluating costs and maternal-neonatal quality-adjusted life years (QALYs) using a willingness-to-pay threshold of $100,000/QALY. Model inputs were derived from literature and varied in sensitivity analyses. Results Rooming-in resulted in fewer neonates requiring pharmacotherapy when compared with not rooming-in. The rooming-in group had more neonates with intact/mild neurodevelopmental impairment and fewer cases of moderate to severe impairment. Rooming-in resulted in cost savings of $509,652,728 and 12,333 additional QALYs per annual cohort. When the risk ratio of need for pharmacotherapy in rooming-in was varied across a clinically plausible range, rooming-in remained the cost-effective strategy. Conclusion Maternal rooming-in with newborns affected by NOW leads to reduced costs and increased effectiveness. Management strategies should optimize nonpharmacological interventions as first-line treatment.
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Taddei, Raquel N., Seyda Cankaya, Sandeep Dhaliwal, and K. Ray Chaudhuri. "Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition." Parkinson's Disease 2017 (2017): 1–18. http://dx.doi.org/10.1155/2017/3256542.
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Investigation into neuropsychiatric symptoms in Parkinson’s disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future.
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Albion, Majella J., Gerard J. Fogarty, Michael A. Machin, and Jeff Patrick. "Predicting absenteeism and turnover intentions in the health professions." Australian Health Review 32, no. 2 (2008): 271. http://dx.doi.org/10.1071/ah080271.
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Objectives: The study examined the mediating influence of individual psychological reactions to work on the relationship between organisational climate and job withdrawal behaviours (viz, intention to leave and absenteeism). Methods: 1097 hospital employees were surveyed using the Queensland Public Agency Staff Survey (QPASS) to obtain measures of organisational climate, psychological reactions to work, job satisfaction, and self-reported levels of intention to leave. Group-level absenteeism data were provided from the Health Service District files. Results: Two psychological states, quality of work life and job satisfaction, were found to fully mediate the relationship between the organisational climate variable, role clarity, and intention to leave, while individual distress was found to partially mediate the same relationship. However, the hypothesised mediation effect of psychological states on the relationship between organisational climate and absenteeism did not emerge. Conclusion: Skills shortages and increasing demands for health services make retention of staff in the health service industry vitally important. As a means of addressing this issue, this study presents an emergent mediating model defining relationships among individual psychological factors, aspects of organisational climate and intention to leave. Identification of the processes associated with staff withdrawal behaviours or intentions will assist in devising interventions to improve retention.
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Gamble, Joel L., Nathan K. Gamble, and Michal Pruski. "To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport." Journal of Medical Ethics 45, no. 12 (July 18, 2019): 832–34. http://dx.doi.org/10.1136/medethics-2019-105393.
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In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.
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MYIN-GERMEYS, I., N. A. NICOLSON, and P. A. E. G. DELESPAUL. "The context of delusional experiences in the daily life of patients with schizophrenia." Psychological Medicine 31, no. 3 (April 2001): 489–98. http://dx.doi.org/10.1017/s0033291701003646.
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Background. Global characteristics and psychosocial risk factors related to delusions have been identified. The present study extends these findings to the level of everyday functioning, identifying characteristics of delusional moments (DMs) and contextual risk and protective factors for delusional exacerbations in daily life.Methods. Data were collected using the Experience Sampling Method (ESM), a time-sampling technique. Forty-eight chronic patients diagnosed with schizophrenia rated the intensity of pathological symptoms and mood states and described their thoughts and the environmental context during consecutive moments in daily life. Delusions were defined on the basis of self-rated suspicion, preoccupation, feeling controlled, and coded thought pathology. Daily context included current activity, persons present and location. Characteristics of DMs and non-delusional moments (nDMs) were compared, and a multilevel logistic regression model was used to identify contexts that might trigger or prevent DMs.Results. On average, patients experienced delusions less than one-third of the time. DMs were characterized by higher negative affect and lower positive affect. The presence of family or acquaintances decreased the risk of subsequently experiencing a DM, whereas withdrawal from activities increased this risk.Conclusions. Data support the validity of ESM for investigating delusions in schizophrenia. Daily life contexts appear to alter the probability that delusions will occur. Knowledge about such contexts may therefore be useful in helping patients develop better coping strategies and in creating therapeutic interventions that can lessen emotional distress.
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Valenti, Giusy Danila, and Palmira Faraci. "Predicting University Adjustment from Coping-Styles, Self-Esteem, Self-Efficacy, and Personality: Findings from a Survey in a Sample of Italian Students." European Journal of Investigation in Health, Psychology and Education 11, no. 3 (August 17, 2021): 894–907. http://dx.doi.org/10.3390/ejihpe11030066.
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Starting university life requires that students learn to cope with several personal, academic, and social challenges. A wide array of variables affects how students adjust to university life. This study was aimed to investigate which factors among coping styles, self-esteem, self-efficacy, and personality traits (i.e., diligence, relational availability, mental flexibility, activity, and emotional stability) best predicted the levels of university adjustment in a sample of university freshmen (N = 204, 63% women). Data were collected using self-report instruments. Multiple regressions analyses were conducted to identify the most significant predictors of adjustment to college. Our findings reported that self-efficacy, task-, and emotion-oriented coping were the most significant predictors, together with relational availability and mental flexibility. These findings might improve the growing knowledge concerning university adjustment, supporting main previous research. The observed relationships between university adjustment and the measured variables suggest intriguing considerations about the importance for schools and universities of providing interventions for students that aim to develop and strengthen the investigated personality facets, reducing withdrawal, behavioral and/or mental disengagement, and promoting academic achievement and success.
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Liu, Shijie, Tao Xiao, Lin Yang, and Paul D. Loprinzi. "Exercise as an Alternative Approach for Treating Smartphone Addiction: A Systematic Review and Meta-Analysis of Random Controlled Trials." International Journal of Environmental Research and Public Health 16, no. 20 (October 15, 2019): 3912. http://dx.doi.org/10.3390/ijerph16203912.
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Background: With the emergence of electronic products, smartphones have become an indispensable tool in our daily life. On the other hand, smartphone addiction has become a public health issue. To help reduce smartphone addiction, cost-effective interventions such as exercise are encouraged. Purpose: We therefore performed a systematic review and meta-analysis evaluating existing literature on the rehabilitative effects of exercise interventions for individuals with a smartphone addiction. Methods: We searched PubMed, Web of Science, Scopus, CNKI, and Wanfang from inception to September 2019. Nine eligible randomized controlled trials (RCT) were finally included for meta-analysis (SMD represents the magnitude of effect of exercise) and their methodological quality were assessed using the PEDro scale. Results: We found significant positive effects of exercise interventions (Taichi, basketball, badminton, dance, run, and bicycle) on reducing the total score (SMD = −1.30, 95% CI −1.53 to −1.07, p < 0.005, I2 = 62%) of smartphone addiction level and its four subscales (withdrawal symptom: SMD = −1.40, 95% CI −1.73 to −1.07, p < 0.001, I2 = 81%; highlight behavior: SMD = −1.95, 95% CI −2.99 to −1.66, p < 0.001, I2 = 79%; social comfort: SMD = −0.99, 95% CI −1.18 to −0.81, p = 0.27, I2 = 21%; mood change: SMD = −0.50, 95% CI 0.31 to 0.69, p = 0.25, I2 = 25%). Furthermore, we found that individuals with severe addiction level (SMD = −1.19, I2 = 0%, 95%CI:−1.19 to −0.98) benefited more from exercise engagement, as compared to those with mild to moderate addiction levels (SMD = − 0.98, I2 = 50%, 95%CI:−1.31 to −0.66); individuals with smartphone addiction who participated in exercise programs of 12 weeks and above showed significantly greater reduction on the total score (SMD = −1.70, I2 = 31.2%, 95% CI −2.04 to −1.36, p = 0.03), as compared to those who participated in less than 12 weeks of exercise intervention (SMD = −1.18, I2 = 0%, 95% CI−1.35 to −1.02, p < 0.00001). In addition, individuals with smartphone addiction who participated in exercise of closed motor skills showed significantly greater reduction on the total score (SMD = −1.22, I2 = 0 %, 95% CI −1.41 to −1.02, p = 0.56), as compared to those who participated in exercise of open motor skills (SMD = −1.17, I2 = 44%, 95% CI−1.47 to −0.0.87, p = 0.03). Conclusions: Exercise interventions may have positive effects on treating smartphone addiction and longer intervention durations may produce greater intervention effects.
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Seymour, Jane, and David Clark. "The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England." Wellcome Open Research 3 (April 24, 2018): 15. http://dx.doi.org/10.12688/wellcomeopenres.13940.2.
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Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.
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Lemmers-Jansen, Imke, Mandy Wisman-Van der Teen, Lisa Krijnen, Margreet Oorschot, and Lydia Krabbendam. "M229. EXPERIMENTAL TRUST AND REAL LIFE SOCIAL INTERACTIONS: CLOSENESS OF THE CONTACT AND EMPATHIC SKILLS MAKE THE DIFFERENCE." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S223—S224. http://dx.doi.org/10.1093/schbul/sbaa030.541.
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Abstract Background Psychosis is associated with profound problems in interpersonal functioning. One of the key elements of social relationships is trust. Previous research has shown that patients with psychotic disorders display reduced trust in others. Reduced trust may lead to paranoid ideation and (as a consequence) to social withdrawal. Patients with psychotic disorders have fewer social contacts and less social support than comparison groups and they frequently have difficulties in developing and maintaining social relationships. This has also been found in young people with first episode psychosis (FEP), who report having less close friends. However, social functioning and social support are a strong predictor for future outcome: Social networks buffer against the impact of adversities. Social isolation, in turn, is associated with reduced quality of life, increased mortality and poor patient outcomes. Therefore, investigating trust and responses to social interactions in daily life is essential for developing interventions to improve social functioning in the field of schizophrenia research. This study investigated the underlying mechanisms of reduced trust in early psychosis patients by linking experimental trust data with emotional responses to day to day social interactions by means of experience sampling. We hypothesized that early psychosis patients, similar to chronic patients with schizophrenia, show more social withdrawal, and report higher levels of negative affect and lower positive affects when in company of others compared to controls. We expect that these social aspects are associated with reduced trust. Methods The sample consisted of 28 patients, of which 16 FEP and 12 patients at clinical high-risk, and 28 healthy controls. Participants performed a trust game during fMRI, and filled in a questionnaire about their social activities and their emotions and symptoms during these activities, 10 times a day, during a week. Results Patients had less social contact, and less contact with familiar others than healthy controls. Furthermore, social contact in general was associated with more positive affect. Contact with familiar others was associated with lower positive symptoms in the patient group, and with more positive affect and less negative affect in patients, whereas patients showed higher negative affect when being alone compared to controls. Empathy was a moderator between closeness of contact and mental health. Group differences in baseline trust, with patients showing reduced baseline trust, were not moderated by social withdrawal (the amount of social contact). Nor was baseline trust moderated by negative or positive affect when in company of others. Social contact was not significantly associated with neural activation. However, in the caudate and the temporo-parietal junction a decrease in activation was apparent, if participants showed more social withdrawal. Discussion The results indicate that familiar company is related to better outcomes in psychotic disorders. Subjects with low levels of empathy had more negative affect when in company of close others when compared to being in company of less familiar others. Furthermore, associations of daily social interactions with baseline trust and its neural correlates show link between reduced baseline trust and frequently being alone. Being alone affects neural responses to received trust in patients. Future research should investigate the role of perceived social support, and the motivation to engage in social contact with good friends or family. Treatment involving familiar contacts may be effective in patients with psychotic symptoms to facilitate social contact and strengthen their relationships.
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de Bijl-Marcus, Karen, Annemieke Johanna Brouwer, Linda S. De Vries, Floris Groenendaal, and Gerda van Wezel-Meijler. "Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 4 (November 15, 2019): 419–24. http://dx.doi.org/10.1136/archdischild-2018-316692.
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ObjectiveTo investigate the effect of a nursing intervention bundle, applied during the first 72 hours of life, on the incidence of germinal matrix-intraventricular haemorrhage (GMH-IVH) in very preterm infants.DesignMulticentre cohort study.SettingTwo Dutch tertiary neonatal intensive care units.PatientsThe intervention group consisted of 281 neonates, whereas 280 infants served as historical controls (gestational age for both groups <30 weeks).InterventionsAfter a training period, the nursing intervention bundle was implemented and applied during the first 72 hours after birth. The bundle consisted of maintaining the head in the midline, tilting the head of the incubator and avoidance of flushing/rapid withdrawal of blood and sudden elevation of the legs.Main outcome measuresThe incidence of GMH-IVH occurring and/or increasing after the first ultrasound (but within 72 hours), cystic periventricular leukomalacia and/or in-hospital death was the primary composite outcome measure. Logistic regression analysis was used to explore differences between groups.ResultsThe nursing intervention bundle was associated with a lower risk of developing a GMH-IVH (any degree), cystic periventricular leukomalacia and/or mortality (adjusted OR 0.42, 95% CI 0.27 to 0.65). In the group receiving the bundle, also severe GMH-IVH, cystic periventricular leukomalacia and/or death were less often observed (adjusted OR 0.54, 95% CI 0.33 to 0.91).ConclusionsThe application of a bundle of nursing interventions is associated with reduced risk of developing a new/progressive (severe) GMH-IVH, cystic periventricular leukomalacia and/or mortality in very preterm infants when applied during the first 72 hours postnatally.
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Leblanc, Guillaume, Amélie Boutin, Michèle Shemilt, François Lauzier, Lynne Moore, Véronique Potvin, Ryan Zarychanski, et al. "Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review." Clinical Trials 15, no. 4 (June 4, 2018): 398–412. http://dx.doi.org/10.1177/1740774518771233.
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Background Most deaths following severe traumatic brain injury follow decisions to withdraw life-sustaining therapies. However, the incidence of the withdrawal of life-sustaining therapies and its potential impact on research data interpretation have been poorly characterized. The aim of this systematic review was to assess the reporting and the impact of withdrawal of life-sustaining therapies in randomized clinical trials of patients with severe traumatic brain injury. Methods We searched Medline, Embase, Cochrane Central, BIOSIS, and CINAHL databases and references of included trials. All randomized controlled trials published between January 2002 and August 2015 in the six highest impact journals in general medicine, critical care medicine, and neurocritical care (total of 18 journals) were considered for eligibility. Randomized controlled trials were included if they enrolled adult patients with severe traumatic brain injury (Glasgow Coma Scale ≤ 8) and reported data on mortality. Our primary objective was to assess the proportion of trials reporting the withdrawal of life-sustaining therapies in a publication. Our secondary objectives were to describe the overall mortality rate, the proportion of deaths following the withdrawal of life-sustaining therapies, and to assess the impact of the withdrawal of life-sustaining therapies on trial results. Results From 5987 citations retrieved, we included 41 randomized trials (n = 16,364, ranging from 11 to 10,008 patients). Overall mortality was 23% (range = 3%–57%). Withdrawal of life-sustaining therapies was reported in 20% of trials (8/41, 932 patients in trials) and the crude number of deaths due to the withdrawal of life-sustaining therapies was reported in 17% of trials (7/41, 884 patients in trials). In these trials, 63% of deaths were associated with the withdrawal of life-sustaining therapies (105/168). An analysis carried out by imputing a 4% differential rate in instances of withdrawal of life-sustaining therapies between study groups yielded different results and conclusions in one third of the trials. Conclusion Data on the withdrawal of life-sustaining therapies are incompletely reported in randomized controlled trials of patients with severe traumatic brain injury. Given the high proportion of deaths due to the withdrawal of life-sustaining therapies in severe traumatic brain injury patients, and the potential of this medical decision to influence the results of clinical trials, instances of withdrawal of life-sustaining therapies should be systematically reported in clinical trials in this group of patients.
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Sanderson, Amy, and Jeffrey P. Burns. "Withdrawal of Life-Sustaining Therapy at Home." Pediatric Critical Care Medicine 18, no. 1 (January 2017): 92–93. http://dx.doi.org/10.1097/pcc.0000000000001005.
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McCullough, Laurence B., Bruce W. Richman, and James W. Jones. "Withdrawal of life-sustaining low-burden care." Journal of Vascular Surgery 42, no. 1 (July 2005): 176–77. http://dx.doi.org/10.1016/j.jvs.2005.04.020.
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Wiegand, Debra Lynn-McHale. "Families and Withdrawal of Life-Sustaining Therapy." Journal of Family Nursing 12, no. 2 (May 2006): 165–84. http://dx.doi.org/10.1177/1074840706287686.
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Shemie, S. D., and P. S. Fontela. "Variability in withdrawal of life-sustaining therapies." Canadian Medical Association Journal 184, no. 3 (February 21, 2012): 326. http://dx.doi.org/10.1503/cmaj.112-2020.
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Halpern, Scott D., and John Hansen-Flaschen. "Terminal Withdrawal of Life-Sustaining Supplemental Oxygen." JAMA 296, no. 11 (September 20, 2006): 1397. http://dx.doi.org/10.1001/jama.296.11.1397.
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