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[PMID]:28449093
[Au] Autor:Mokhles S; Maat APWM; Aerts JGJV; Nuyttens JJME; Bogers AJJC; Takkenberg JJM
[Ad] Endereço:Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands.
[Ti] Título:Opinions of lung cancer clinicians on shared decision making in early-stage non-small-cell lung cancer.
[So] Source:Interact Cardiovasc Thorac Surg;25(2):278-284, 2017 08 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To investigate the opinions of lung cancer clinicians concerning shared decision making (SDM) in early-stage non-small-cell lung cancer patients. METHODS: A survey was conducted among Dutch cardiothoracic surgeons and lung surgeons, pulmonologists and radiation oncologists. The opinions of clinicians on the involvement of patients in treatment decision making was assessed using a 1-5 Likert-type scale. Through open questions, we queried barriers to and drivers of SDM in clinical practice. Clinicians were asked to review 7 hypothetical cases and indicate which treatment strategy they would choose using a 1-7 Likert-type scale. RESULTS: Twenty-six percent of surgeons, 20% of pulmonologists and 12% of radiation oncologists indicated that they always engage in SDM (16% missing; P-value = 0.10). Most respondents stated that, ideally, doctors and patients should decide together (surgeons 52%, pulmonologists 67% and radiation oncologists 35%; P-value = 0.005). Thirty percent of surgeons, 27% of pulmonologists and 44% of radiation oncologists indicated that doctors are not properly trained to implement SDM in clinical practice (P-value = 0.37). SDM may not always be feasible due to low patient education level and minimal knowledge about lung cancer. Wide variations in the clinicians' lung cancer treatment preferences were observed in the responses to the hypothetical cases. CONCLUSIONS: In current clinical decision making in lung cancer treatment, a majority of clinicians agree that it is important to involve lung cancer patients in treatment decision making but that time constraints and the inability of some patients to make a weighted decision are important barriers. The observed variation in lung cancer treatment preferences among clinicians suggests that for most patients both surgery and radiotherapy are suitable options, and it underlines the sensitive nature of treatment choices in early-stage non-small-cell lung cancer.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/diagnóstico
Tomada de Decisões
Diagnóstico Precoce
Neoplasias Pulmonares/diagnóstico
Estadiamento de Neoplasias/métodos
Participação do Paciente
Pneumonectomia
[Mh] Termos MeSH secundário: Adulto
Carcinoma Pulmonar de Células não Pequenas/cirurgia
Feminino
Seres Humanos
Neoplasias Pulmonares/cirurgia
Masculino
Meia-Idade
Preferência do Paciente
Relações Médico-Paciente
Cirurgiões
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivx103


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[PMID]:28463635
[Au] Autor:O'Hare AM; Song MK; Kurella Tamura M; Moss AH
[Ad] Endereço:1 Department of Medicine, University of Washington and Veterans Affairs Puget Sound Healthcare System , Seattle, Washington.
[Ti] Título:Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease.
[So] Source:J Palliat Med;20(5):453-460, 2017 May.
[Is] ISSN:1557-7740
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population. In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the "best care possible" for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD. Research priorities include identifying opportunities for improving the end-of-life experience of older adults with CKD and their caregivers; developing and testing communication interventions before and during dialysis to ensure that treatment decisions reflect patients' preferences; and assessing the effectiveness of palliative care in improving quality of life for patients and caregivers, satisfaction with care, and aligning treatment decisions with patient goals and preferences.
[Mh] Termos MeSH primário: Diálise/métodos
Enfermagem Geriátrica/métodos
Cuidados Paliativos/métodos
Preferência do Paciente
Assistência Centrada no Paciente/métodos
Insuficiência Renal Crônica/enfermagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Tomada de Decisões
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1089/jpm.2016.0571


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[PMID]:29291278
[Au] Autor:van Loon Y; Hendriksma M; Langeveld TPM; de Jong MA; Baatenburg de Jong RJ; Sjögren EV
[Ad] Endereço:1 Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
[Ti] Título:Treatment Preferences in Patients With Early Glottic Cancer.
[So] Source:Ann Otol Rhinol Laryngol;127(3):139-145, 2018 Mar.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: For early glottic carcinoma, the 2 main treatment modalities are radiotherapy (RT) and transoral CO laser microsurgery (TLM). The aim of this study was to investigate treatment preferences and considerations in patients with early glottic carcinoma (T1-T2) who were given a choice between TLM and RT. SUBJECTS AND METHODS: Patients with early glottic cancer (suspected or confirmed extended T1 or limited T2) were counseled by an ENT-surgeon. A subset of 32 patients was also counseled by a radiotherapist. Treatment choice and considerations were recorded and analyzed. RESULTS: Of 175 patients, 168 patients (96%) chose TLM, and 7 patients (4%) chose RT. The most common reason for choosing TLM was shorter treatment and more treatment options in case of recurrence. Subanalysis showed that additional counseling by the radiotherapist did not seem to affect our patients' preferences for TLM in this group. CONCLUSIONS: The majority of patients in our study prefer TLM to RT when given a choice. Reasons given indicate that optimizing future treatment options and practical considerations seemed more important to our patients than primary functional outcome. Further research is needed to study patient-related and physician-related factors to gain more insight into this complicated process of shared decision making.
[Mh] Termos MeSH primário: Carcinoma
Glote/patologia
Neoplasias Laríngeas
Terapia a Laser
Preferência do Paciente/estatística & dados numéricos
Radioterapia
[Mh] Termos MeSH secundário: Carcinoma/patologia
Carcinoma/psicologia
Carcinoma/terapia
Feminino
Seres Humanos
Neoplasias Laríngeas/patologia
Neoplasias Laríngeas/psicologia
Neoplasias Laríngeas/terapia
Terapia a Laser/métodos
Terapia a Laser/psicologia
Terapia a Laser/estatística & dados numéricos
Masculino
Microcirurgia/métodos
Meia-Idade
Recidiva Local de Neoplasia
Estadiamento de Neoplasias
Países Baixos
Radioterapia/métodos
Radioterapia/psicologia
Radioterapia/estatística & dados numéricos
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180102
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417749253


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[PMID]:29233273
[Au] Autor:Karwaki TE; Hazlet TK
[Ad] Endereço:University of Washington, School of Pharmacy, Box 357630, Seattle, WA 98195-7630, United States. Electronic address: tkarwaki@uw.edu.
[Ti] Título:A qualitative analysis of student-written law and ethics cases: A snapshot of PY2 student experience.
[So] Source:Curr Pharm Teach Learn;9(3):369-375, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: This study was designed to better understand pharmacy students' experiences and recognition of legal and ethical tensions existing in pharmacy practice as demonstrated in student-written law and ethics cases. METHODS: A qualitative analysis of 132 student-written cases representing the team efforts of 1053 students over a 12-year time period was conducted. Student-written cases were coded and analyzed thematically. RESULTS: Our results demonstrate the types of ethical and legal issues our students have experienced in pharmacy practice during the first five quarters of their professional education. Our data highlight three themes: 1) ethical dilemmas presented when the law is misapplied; 2) ethical dilemmas presented when an institutional policy or law was viewed as insufficient; and 3) ethical dilemmas presented as provider distress. The third theme was further subdivided into five subthemes. CONCLUSION: The themes that emerged from this study represent some of the ethical dilemmas that second professional year students have encountered and how these dilemmas may intersect with legal boundaries. Educators can use cases demonstrating these themes to reinforce law and ethics education in the curriculum, thus helping prepare students for pharmacy practice. This article recommends how and when to use case examples.
[Mh] Termos MeSH primário: Educação em Farmácia
Assistência Farmacêutica/ética
Assistência Farmacêutica/legislação & jurisprudência
Estudantes de Farmácia
[Mh] Termos MeSH secundário: Confidencialidade/ética
Confidencialidade/legislação & jurisprudência
Emprego/ética
Seres Humanos
Erros de Medicação/ética
Política Organizacional
Aceitação pelo Paciente de Cuidados de Saúde
Preferência do Paciente/legislação & jurisprudência
Papel Profissional
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29241900
[Au] Autor:van Nooten FE; Houghton K; van Exel J; van Agthoven M; Brouwer WBF; Stull DE
[Ad] Endereço:Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
[Ti] Título:A (Latent) Class of Their Own: Response Patterns in Trading Off Quantity and Quality of Life in Time Trade-Off Exercises.
[So] Source:Value Health;20(10):1403-1410, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Conflicting results regarding associations of time trade-off (TTO) valuations with respondent characteristics have been reported, mostly on the basis of regression analyses. Alternative approaches, such as the latent class analysis (LCA), may add to the further understanding of variations in TTO responses. OBJECTIVES: To identify whether subgroups of respondents can be identified on the basis of their responses to TTO exercises and to investigate which respondent characteristics are associated with membership of the identified subgroups. METHODS: Members of the Dutch general public, aged 18 to 65 years, completed a Web-based questionnaire concerning sociodemographic characteristics, three TTO exercises valuing health states described using the domains of the EuroQol five-dimensional questionnaire, and preference for quality versus quantity of life. LCA was used to identify patterns in the responses. Predictive variables were included in the final LCA model to identify the particular respondent characteristics that predict subgroup membership. RESULTS: The sample consisted of 1067 respondents. Four latent classes were identified in the responses to TTO exercises. Two were high traders, focusing on quality of life and trading off a relatively high number of years. The other two were low traders, focusing on length of life. Predictive analyses revealed significant differences between subgroups in terms of age, sex, subjective life expectancy, and preference for quantity over quality of life. CONCLUSIONS: We showed that distinct classes of respondents can be discerned in TTO responses from the general public, distinguishing subgroups of low and high traders. More research in this area should confirm our findings and investigate their implications for health state valuation exercises.
[Mh] Termos MeSH primário: Nível de Saúde
Preferência do Paciente
Qualidade de Vida
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Expectativa de Vida
Masculino
Meia-Idade
Modelos Teóricos
Países Baixos
Análise de Regressão
Inquéritos e Questionários
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29241898
[Au] Autor:Marshall T; Pugh A; Fairchild A; Hass S
[Ad] Endereço:AbbVie, Inc., North Chicago, IL, USA. Electronic address: t.marshall@abbvie.com.
[Ti] Título:Patient Preferences for Device-Aided Treatments Indicated for Advanced Parkinson Disease.
[So] Source:Value Health;20(10):1383-1393, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Effective treatment for advanced Parkinson disease (PD) uncontrolled with oral medication includes device-aided therapies such as deep brain stimulation (DBS) and continuous levodopa-carbidopa infusion to the duodenum via a portable pump. OBJECTIVE: Our objective was to quantify patient preferences for attributes of these device-aided treatments. METHODS: We administered a Web-enabled survey to 401 patients in the United States. A discrete-choice experiment (DCE) was used to evaluate patients' willingness to accept tradeoffs among efficacy, tolerability, and convenience of alternative treatments. DCE data were analyzed using random-parameters logit. Best-worst scaling (BWS) was used to elicit the relative importance of device-specific attributes. Conditional logit was used to analyze the BWS data. We tested for differences in preferences among subgroups of patients. RESULTS: Improving ability to think clearly was twice as important as a 6-hour-per-day improvement in control of movement symptoms. After controlling for efficacy, treatment delivered via portable infusion pump was preferred over DBS, and both devices were preferred to oral therapy with poor symptom control. Patients were most concerned about device attributes relating to risk of stroke, difficulty thinking, and neurosurgery. Avoiding surgery to insert a wire in the brain was more important than avoiding surgery to insert a tube into the small intestine. Some differences in preferences among subgroups were statistically, but not qualitatively, significant. CONCLUSIONS: This study clarifies the patient perspective in therapeutic choices for advanced PD. These findings may help improve communication between patients and providers and also provide evidence on patient preferences to inform regulatory and access decisions.
[Mh] Termos MeSH primário: Antiparkinsonianos/administração & dosagem
Carbidopa/administração & dosagem
Estimulação Encefálica Profunda/métodos
Levodopa/administração & dosagem
Doença de Parkinson/terapia
Preferência do Paciente
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Comportamento de Escolha
Combinação de Medicamentos
Sistemas de Liberação de Medicamentos
Duodeno
Desenho de Equipamento
Feminino
Seres Humanos
Bombas de Infusão
Internet
Masculino
Meia-Idade
Doença de Parkinson/fisiopatologia
Doença de Parkinson/psicologia
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Drug Combinations); 0 (carbidopa, levodopa drug combination); 46627O600J (Levodopa); MNX7R8C5VO (Carbidopa)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29241896
[Au] Autor:Finch AP; Brazier JE; Mukuria C; Bjorner JB
[Ad] Endereço:Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. Electronic address: APFinch1@sheffield.ac.uk.
[Ti] Título:An Exploratory Study on Using Principal-Component Analysis and Confirmatory Factor Analysis to Identify Bolt-On Dimensions: The EQ-5D Case Study.
[So] Source:Value Health;20(10):1362-1375, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Generic preference-based measures such as the EuroQol five-dimensional questionnaire (EQ-5D) are used in economic evaluation, but may not be appropriate for all conditions. When this happens, a possible solution is adding bolt-ons to expand their descriptive systems. Using review-based methods, studies published to date claimed the relevance of bolt-ons in the presence of poor psychometric results. This approach does not identify the specific dimensions missing from the Generic preference-based measure core descriptive system, and is inappropriate for identifying dimensions that might improve the measure generically. This study explores the use of principal-component analysis (PCA) and confirmatory factor analysis (CFA) for bolt-on identification in the EQ-5D. METHODS: Data were drawn from the international Multi-Instrument Comparison study, which is an online survey on health and well-being measures in five countries. Analysis was based on a pool of 92 items from nine instruments. Initial content analysis provided a theoretical framework for PCA results interpretation and CFA model development. PCA was used to investigate the underlining dimensional structure and whether EQ-5D items were represented in the identified constructs. CFA was used to confirm the structure. CFA was cross-validated in random halves of the sample. RESULTS: PCA suggested a nine-component solution, which was confirmed by CFA. This included psychological symptoms, physical functioning, and pain, which were covered by the EQ-5D, and satisfaction, speech/cognition,relationships, hearing, vision, and energy/sleep which were not. These latter factors may represent relevant candidate bolt-ons. CONCLUSIONS: PCA and CFA appear useful methods for identifying potential bolt-ons dimensions for an instrument such as the EQ-5D.
[Mh] Termos MeSH primário: Nível de Saúde
Preferência do Paciente/psicologia
Qualidade de Vida
Inquéritos e Questionários
[Mh] Termos MeSH secundário: Análise Fatorial
Seres Humanos
Análise de Componente Principal
Psicometria
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29256573
[Au] Autor:Schilder AG; Chong LY; Ftouh S; Burton MJ
[Ad] Endereço:evidENT, Ear Institute, Faculty of Brain Sciences, University College London, 330 Grays Inn Road, London, UK, WC1X 8DA.
[Ti] Título:Bilateral versus unilateral hearing aids for bilateral hearing impairment in adults.
[So] Source:Cochrane Database Syst Rev;12:CD012665, 2017 12 19.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Acquired hearing loss is common and its incidence increases markedly with age. In most people, 'age-related' hearing loss is sensorineural (due to the loss of cochlear hair cells) and bilateral, affecting both ears to the same degree. Hearing loss categorised as mild, moderate or severe is primarily managed with hearing aids. People with bilateral hearing loss may be offered one aid, fitted to one specific ear, or two aids fitted to both ears. There is uncertainty about the relative benefits to people with hearing loss of these different strategies. OBJECTIVES: To assess the effects of bilateral versus unilateral hearing aids in adults with a bilateral hearing impairment. SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; Cochrane Register of Studies Online; PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 June 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the fitting of two versus one ear-level acoustic hearing aids in adults (over 18 years) with a bilateral hearing impairment, both ears being eligible for hearing aids. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were patient preference for bilateral or unilateral aids, hearing-specific health-related quality of life and adverse effects (pain or discomfort in the ear, initiation or exacerbation of middle or outer ear infection). Secondary outcomes included: usage of hearing aids (as measured by, for example, data logging or battery consumption), generic health-related quality of life, listening ability and audiometric benefit measured as binaural loudness summation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included four cross-over RCTs with a total of 209 participants, ranging in age from 23 to 85 and with a preponderance of men. All the studies allowed the use of hearing aids for a total period of at least eight weeks before questions on preference were asked. All studies recruited patients with bilateral hearing loss but there was considerable variation in the types and degree of sensorineural hearing loss that the participants were experiencing.Three of the studies were published before the mid-1990s whereas the fourth study was published in 2011. Therefore, only the most recent study used hearing aids incorporating technology comparable to that currently readily available in high-income settings. Of the four studies, two were conducted in the UK in National Health Service (NHS - public sector) patients: one recruited patients from primary care with hearing loss detected by a screening programme whereas the other recruited patients who had been referred by their primary care practitioner to an otolaryngology department for hearing aids. The other two studies were conducted in the United States: one study recruited only military personnel or veterans with noise-induced hearing loss whereas about half of the participants in the other study were veterans.Only one primary outcome (patient preference) was reported in all studies. The percentage of patients who preferred bilateral hearing aids varied between studies: this was 54% (51 out of 94 participants), 39% (22 out of 56), 55% (16 out of 29) and 77% (23 out of 30), respectively. We have not combined the data from these four studies. The evidence for this outcome is of very low quality.The other outcomes of interest were not reported in the included studies. AUTHORS' CONCLUSIONS: This review identified only four studies comparing the use of one hearing aid with two. The studies were small and included participants of widely varying ages. There was also considerable variation in the types and degree of sensorineural hearing loss that the participants were experiencing.For the most part, the types of hearing aid evaluated would now be regarded, in high-income settings, as 'old technology', with only one study looking at 'modern' digital aids. However, the relevance of this is uncertain, as this review did not evaluate the differences in outcomes between the different types of technology.We were unable to pool data from the four studies and the very low quality of the evidence leads us to conclude that we do not know if people with hearing loss have a preference for one aid or two. Similarly, we do not know if hearing-specific health-related quality of life, or any of our other outcomes, are better with bilateral or unilateral aids.
[Mh] Termos MeSH primário: Auxiliares de Audição
Perda Auditiva Bilateral/reabilitação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Correção de Deficiência Auditiva/instrumentação
Correção de Deficiência Auditiva/métodos
Estudos Cross-Over
Feminino
Auxiliares de Audição/utilização
Seres Humanos
Masculino
Meia-Idade
Preferência do Paciente
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
Localização de Som
Inteligibilidade da Fala
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012665.pub2


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[PMID]:28457142
[Au] Autor:Ceriana P; Surbone S; Segagni D; Schreiber A; Carlucci A
[Ad] Endereço:a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy.
[Ti] Título:Decision-making for tracheostomy in amyotrophic lateral sclerosis (ALS): a retrospective study.
[So] Source:Amyotroph Lateral Scler Frontotemporal Degener;18(7-8):492-497, 2017 Nov.
[Is] ISSN:2167-9223
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. AIM OF THE STUDY: To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. METHODS: We studied the charts of a group of ALS patients after tracheostomy. An interview focusing on the existence of anticipated directives was carried out. Tracheostomies were classified as planned or unplanned according to the presence of a decision plan. RESULTS: A total of 209 ALS patients were cared for during a three-year period. Of these patients, 34 (16%) were tracheotomised. In 38% of cases, tracheostomy was planned, 41% were unplanned, and 21% remained undiagnosed. CONCLUSIONS: A minority of ALS patients make a voluntary decision for tracheostomy before the procedure is conducted. The advising process of care still presents limits that have been thus far poorly addressed. In the future, we will need to develop guidelines for the timing and content of the shared-decision making process.
[Mh] Termos MeSH primário: Esclerose Amiotrófica Lateral/epidemiologia
Esclerose Amiotrófica Lateral/cirurgia
Tomada de Decisão Clínica
Preferência do Paciente/estatística & dados numéricos
Insuficiência Respiratória/epidemiologia
Insuficiência Respiratória/cirurgia
Traqueostomia/utilização
[Mh] Termos MeSH secundário: Esclerose Amiotrófica Lateral/psicologia
Comorbidade
Tomada de Decisões
Feminino
Seres Humanos
Itália/epidemiologia
Masculino
Meia-Idade
Preferência do Paciente/psicologia
Prevalência
Insuficiência Respiratória/psicologia
Estudos Retrospectivos
Medição de Risco/métodos
Traqueostomia/psicologia
Revisão da Utilização de Recursos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1080/21678421.2017.1317812


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Fotocópia
[PMID]:29240360
[Au] Autor:Bayliss DR; Duff J; Stricker P; Walker K
[Ti] Título:Decision-Making in Prostate Cancer ­ Choosing Active Surveillance Over Other Treatment Options: A Literature Review.
[So] Source:Urol Nurs;37(1):15-22, 2017 Jan-Feb.
[Is] ISSN:1053-816X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A literature review was done using the Cognitive-Social Health Information Processing (C-SHIP) framework to identify how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. Findings indicated men who choose active surveillance have a stronger preference for active or collaborative decision-making than those who choose other treatments. Men primarily choose active surveillance to avoid the side effects of incontinence and erectile dysfunction. This literature review informed the study by Bayliss, Duff, Strieker, and Walker (2016) and found physician recommendation to be the most influential factor when patients make a treatment decision.
[Mh] Termos MeSH primário: Tomada de Decisões
Participação do Paciente
Neoplasias da Próstata/terapia
Conduta Expectante
[Mh] Termos MeSH secundário: Seres Humanos
Masculino
Preferência do Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE



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