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[PMID]:29466595
[Au] Autor:Rosenberg LB
[Ad] Endereço:Division of Geriatrics and Palliative Care, Massachusetts General Hospital, Boston, Massachusetts.
[Ti] Título:A Teaching Case.
[So] Source:JAMA;319(7):657-658, 2018 Feb 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Medicina Paliativa/educação
Relações Médico-Paciente
Doente Terminal
[Mh] Termos MeSH secundário: Seres Humanos
Medicina Interna/educação
Internato e Residência
Masculino
Cuidados Paliativos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PERSONAL NARRATIVES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0071


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[PMID]:29360304
[Au] Autor:Seiler LW; Thomson Reuters Accelus.
[Ti] Título:Long-Term Care: End-of-Life Issues.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-96, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência de Longa Duração/organização & administração
Assistência Terminal/organização & administração
[Mh] Termos MeSH secundário: Diretivas Antecipadas
Afroamericanos
Moradias Assistidas
Canadá
Capitação
Ensaios de Uso Compassivo
Comportamento do Consumidor
Aconselhamento
Demência/terapia
Depressão
Europa (Continente)
Grupo com Ancestrais do Continente Europeu
Custos de Cuidados de Saúde
Hispano-Americanos
Cuidados Paliativos na Terminalidade da Vida
Seres Humanos
Reembolso de Seguro de Saúde
Maconha Medicinal
Medicare/economia
Musicoterapia
Enfermagem/recursos humanos
Casas de Saúde
Cuidados Paliativos
Planejamento de Assistência ao Paciente
Direitos do Paciente
Prisioneiros
Qualidade da Assistência à Saúde
Ordens quanto à Conduta (Ética Médica)
Cônjuges
Governo Estadual
Suicídio Assistido
Telemedicina
Doente Terminal
Obtenção de Tecidos e Órgãos
Estados Unidos
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Medical Marijuana)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


  3 / 6021 MEDLINE  
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[PMID]:29236435
[Au] Autor:Hawkins M
[Ti] Título:BREAKING THE SILENCE--THE TERMINALLY ILL MENTAL HEALTH CLIENT.
[So] Source:Aust Nurs Midwifery J;24(1):30, 2016 07.
[Is] ISSN:2202-7114
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Both mental illness and terminal disease require an adjustment of expectations from both therapist and client if management of either condition is to be achieved. When mental illness is present in the terminal patient, these adjustments are both radical and very difficult. Which beckons the question, does this provide a basis for integrated mental health services within palliative care?
[Mh] Termos MeSH primário: Enfermagem de Cuidados Paliativos na Terminalidade da Vida
Transtornos Mentais/enfermagem
Papel do Profissional de Enfermagem
Enfermagem Psiquiátrica
Doente Terminal
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


  4 / 6021 MEDLINE  
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[PMID]:29204621
[Au] Autor:Lederle FA
[Ad] Endereço:From University of Minnesota and Veterans Affairs Health Care System, Minneapolis, Minnesota.
[Ti] Título:Terminal.
[So] Source:Ann Intern Med;167(11):826-827, 2017 Dec 05.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Emoções
Doente Terminal/psicologia
[Mh] Termos MeSH secundário: Seres Humanos
Neoplasias Pancreáticas/psicologia
[Pt] Tipo de publicação:PERSONAL NARRATIVES
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.7326/M17-2788


  5 / 6021 MEDLINE  
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[PMID]:29045355
[Au] Autor:Sullivan SS; Li J; Wu YB; Hewner S
[Ad] Endereço:Author Affiliations: PhD Student (Ms Sullivan), Associate Professor (Dr Wu), and Assistant Professor (Dr Hewner), School of Nursing, University at Buffalo, State University of New York; and Postoctoral Research Fellow (Dr Li), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
[Ti] Título:Complexity of Chronic Conditions' Impact on End-of-Life Expense Trajectories of Medicare Decedents.
[So] Source:J Nurs Adm;47(11):545-550, 2017 Nov.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling. RESULTS: In the final year of life, monthly medical expense increases rapidly for all disease groupings and forms distinct patterns of change. CONCLUSION: Type of condition can be used to classify decedents into distinctly different cost trajectories. Conditions including chronic disease, system failure, or cancer may be used to identify patients who may benefit from supportive care.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados/normas
Centers for Medicare and Medicaid Services (U.S.)/economia
Doença Crônica/economia
Cuidados Paliativos na Terminalidade da Vida/economia
Doente Terminal/estatística & dados numéricos
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados/organização & administração
Idoso
Centers for Medicare and Medicaid Services (U.S.)/estatística & dados numéricos
Doença Crônica/classificação
Doença Crônica/mortalidade
Comunicação
Custos e Análise de Custo
Registros Eletrônicos de Saúde/normas
Registros Eletrônicos de Saúde/estatística & dados numéricos
Cuidados Paliativos na Terminalidade da Vida/utilização
Seres Humanos
Uso Significativo/normas
Uso Significativo/estatística & dados numéricos
Relações Médico-Paciente
Prognóstico
Estudos Retrospectivos
Medição de Risco/métodos
Estados Unidos/epidemiologia
Procedimentos Desnecessários/economia
Procedimentos Desnecessários/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000541


  6 / 6021 MEDLINE  
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[PMID]:29019887
[Au] Autor:Ko MC; Huang SJ; Chen CC; Chang YP; Lien HY; Lin JY; Woung LC; Chan SY
[Ad] Endereço:aDepartment of Urology, Taipei City Hospital, Taipei City bDepartment of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City cSchool of Medicine, Fu-Jen Catholic University, New Taipei City dSuperintendent Office, Taipei City Hospital, Taipei City eDepartment of Surgery, National Taiwan University, Taipei City fCenter of Quality Management, Taipei City Hospital, Taipei City gCross-Strait Medical and Management Communication Center, Taipei City Hospital, Taipei City hAdministrative Center, Ministry of Health and Welfare Taipei Hospital, New Taipei City iDepartment of Cardiology, Taipei City Hospital, Taipei City, Taiwan.
[Ti] Título:Factors predicting a home death among home palliative care recipients.
[So] Source:Medicine (Baltimore);96(41):e8210, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death.The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93-5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06-4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34-0.95) had lower likelihood of a home death.Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.
[Mh] Termos MeSH primário: Esclerose Amiotrófica Lateral
Serviços de Assistência Domiciliar/organização & administração
Neoplasias
Cuidados Paliativos
Assistência Terminal
Doente Terminal/psicologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Esclerose Amiotrófica Lateral/mortalidade
Esclerose Amiotrófica Lateral/psicologia
Esclerose Amiotrófica Lateral/terapia
Feminino
Visita Domiciliar/estatística & dados numéricos
Seres Humanos
Masculino
Mortalidade
Neoplasias/mortalidade
Neoplasias/psicologia
Neoplasias/terapia
Cuidados Paliativos/métodos
Cuidados Paliativos/psicologia
Cuidados Paliativos/estatística & dados numéricos
Preferência do Paciente
Relações Médico-Paciente
Distribuição Espacial da População
Medição de Risco/métodos
Serviços de Saúde Rural/organização & administração
Assistência Terminal/métodos
Assistência Terminal/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008210


  7 / 6021 MEDLINE  
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[PMID]:28975232
[Au] Autor:Hedberg K; New C
[Ad] Endereço:From Oregon Health Authority, Portland, Oregon.
[Ti] Título:Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate.
[So] Source:Ann Intern Med;167(8):579-583, 2017 Oct 17.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Twenty years ago, Oregon voters approved the Death With Dignity Act, making Oregon the first state in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten their death. This report summarizes the experience in Oregon, including the numbers and types of participating patients and providers. These data should inform the ongoing policy debate as additional jurisdictions consider such legislation.
[Mh] Termos MeSH primário: Suicídio Assistido/ética
Suicídio Assistido/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Política de Saúde/legislação & jurisprudência
Seres Humanos
Meia-Idade
Oregon
Papel do Médico
Suicídio Assistido/estatística & dados numéricos
Doente Terminal/legislação & jurisprudência
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.7326/M17-2300


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[PMID]:28783766
[Au] Autor:Hickner J
[Ad] Endereço:The Journal of Family Practice, Editor-in-Chief.
[Ti] Título:Getting it right at the end of life.
[So] Source:J Fam Pract;66(8):486, 2017 Aug.
[Is] ISSN:1533-7294
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:As medical care has become more sophisticated, there is a great deal more we can do to keep people alive as they approach the end of life, and a great many more decisions to be made. Additionally, people are much less likely today to be cared for in their dying days by a family physician who knows them, their wishes, and their family well. Now, most dying hospitalized patients are cared for by hospitalists who may be meeting the patient for the first time.
[Mh] Termos MeSH primário: Empatia
Médicos Hospitalares/normas
Cuidados Paliativos/normas
Relações Médico-Paciente
Assistência Terminal/normas
Doente Terminal
[Mh] Termos MeSH secundário: Idoso
Aconselhamento
Seres Humanos
Consentimento Livre e Esclarecido
Assistência Terminal/métodos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE


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[PMID]:28676557
[Au] Autor:Gaertner J; Siemens W; Meerpohl JJ; Antes G; Meffert C; Xander C; Stock S; Mueller D; Schwarzer G; Becker G
[Ad] Endereço:Clinic for Palliative Care, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
[Ti] Título:Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis.
[So] Source:BMJ;357:j2925, 2017 Jul 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: To assess the effect of specialist palliative care on quality of life and additional outcomes relevant to patients in those with advanced illness. Systematic review with meta-analysis. Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and trial registers searched up to July 2016. Randomised controlled trials with adult inpatients or outpatients treated in hospital, hospice, or community settings with any advanced illness. Minimum requirements for specialist palliative care included the multiprofessional team approach. Two reviewers independently screened and extracted data, assessed the risk of bias (Cochrane risk of bias tool), and evaluated the quality of evidence (GRADE tool). Primary outcome was quality of life with Hedges' g as standardised mean difference (SMD) and random effects model in meta-analysis. In addition, the pooled SMDs of the analyses of quality of life were re-expressed on the global health/QoL scale (item 29 and 30, respectively) of the European Organization for Research and Treatment of Cancer QLQ-C30 (0-100, high values=good quality of life, minimal clinically important difference 8.1). Of 3967 publications, 12 were included (10 randomised controlled trials with 2454 patients randomised, of whom 72% (n=1766) had cancer). In no trial was integration of specialist palliative care triggered according to patients' needs as identified by screening. Overall, there was a small effect in favour of specialist palliative care (SMD 0.16, 95% confidence interval 0.01 to 0.31; QLQ-C30 global health/QoL 4.1, 0.3 to 8.2; n=1218, six trials). Sensitivity analysis showed an SMD of 0.57 (-0.02 to 1.15; global health/QoL 14.6, -0.5 to 29.4; n=1385, seven trials). The effect was marginally larger for patients with cancer (0.20, 0.01 to 0.38; global health/QoL 5.1, 0.3 to 9.7; n=828, five trials) and especially for those who received specialist palliative care early (0.33, 0.05 to 0.61, global health/QoL 8.5, 1.3 to 15.6; n=388, two trials). The results for pain and other secondary outcomes were inconclusive. Some methodological problems (such as lack of blinding) reduced the strength of the evidence. Specialist palliative care was associated with a small effect on QoL and might have most pronounced effects for patients with cancer who received such care early. It could be most effective if it is provided early and if it identifies though screening those patients with unmet needs. PROSPERO CRD42015020674.
[Mh] Termos MeSH primário: Hospitais para Doentes Terminais
Cuidados Paliativos
Qualidade de Vida
Doente Terminal/psicologia
[Mh] Termos MeSH secundário: Adulto
Cuidadores/psicologia
Tomada de Decisões
Seres Humanos
Avaliação de Resultados (Cuidados de Saúde)
Cuidados Paliativos/normas
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j2925


  10 / 6021 MEDLINE  
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[PMID]:28658025
[Au] Autor:Chen YC; Fan HY; Curtis JR; Lee OK; Liu CK; Huang SJ
[Ad] Endereço:1Department of Family Medicine, Taipei City Hospital, ZhongXing Branch, Taipei, Taiwan. 2School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan. 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA. 4Taipei City Hospital, Taipei, Taiwan. 5Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 6Department of Medicine and Graduate Institute of Business Administration, Fu-Jen Catholic University, Taipei, Taiwan. 7Surgical Department, Medical College, National Taiwan University, Taipei, Taiwan.
[Ti] Título:Determinants of Receiving Palliative Care and Ventilator Withdrawal Among Patients With Prolonged Mechanical Ventilation.
[So] Source:Crit Care Med;45(10):1625-1634, 2017 Oct.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. DESIGN: Cross-sectional study. SETTING: Five different hospitals of Taipei City Hospital system. PATIENTS: Adult patients with ventilatory support for more than 60 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1%). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4%) with 17.3% of the family members agreeing to ventilator withdrawal currently and 67.5% terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7%). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. CONCLUSIONS: During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Família/psicologia
Cuidados Paliativos
Procurador
Respiração Artificial
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Idoso
Estudos Transversais
Feminino
Hospitalização
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Qualidade de Vida
Taiwan/epidemiologia
Doente Terminal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002569



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