To be alive when dying: moral catharsis and hope in patients with limited life prognosis

2021 ◽  
Author(s):  
Oscar Vergara
Keyword(s):  
Limited Life ◽  
Life Prognosis

Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study

2016 ◽  
Vol 31 (8) ◽  
pp. 754-763 ◽  
Author(s):  
Xavier Gómez-Batiste ◽  
Marisa Martínez-Muñoz ◽  
Carles Blay ◽  
Jordi Amblàs ◽  
Laura Vila ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Predictive Validity ◽  
Chronic Conditions ◽  
Screening Tools ◽  
Care Needs ◽  
Predictive Values ◽  
Limited Life ◽  
Life Prognosis ◽  
Surprise Question

Background: The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. Aim: To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. Design: Longitudinal, prospective and observational cohort study. Setting/participants: Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. Results: Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ−) and 45.8% (NECPAL+) versus 18.3% (NECPAL−) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7–94.1 and 87.5, CI: 84.3–90.7) with high negative predictive values (84.2, CI: 79.4–89.0 and 81.7, CI: 77.2–86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. Conclusion: SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.

Enhancing the Bearing Capacity of Rigid Footing Using Limited Life Kenaf Geotextile Reinforcement

2020 ◽  
pp. 1-17
Author(s):  
Mohammad Gharehzadeh Shirazi ◽  
Ahmad Safuan A Rashid ◽  
Ramli Nazir ◽  
Azrin Hani Abdul Rashid ◽  
Suksun Horpibulsuk
Keyword(s):  
Bearing Capacity ◽  
Limited Life ◽  
Rigid Footing

scholarly journals COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1113
Author(s):  
Takeshi Kikutani ◽  
Yoko Ichikawa ◽  
Eri Kitazume ◽  
Arato Mizukoshi ◽  
Takashi Tohara ◽  
...  
Keyword(s):  
Weight Loss ◽  
Oral Feeding ◽  
Parenteral Feeding ◽  
Psychiatric Ward ◽  
Swallowing Function ◽  
Obesity Index ◽  
Life Prognosis ◽  
Before And After ◽  
Schizophrenic Patients ◽  
Level Scale

Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).

scholarly journals RT-01 Treatment results of salvage gamma knife and bevacizumab (AVAgamma therapy) for recurrent glioblastoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii11-ii11
Author(s):  
Kenichi Sato ◽  
Taku Asanome ◽  
Yuuki Ishida ◽  
Hironori Sugio ◽  
Yoshimaru Ozaki ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Initial Treatment ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Treatment Results ◽  
Free Survival ◽  
Life Prognosis ◽  
Irradiation Volume ◽  
The Mean ◽  
Extended Discussion

Abstract Purpose: We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent glioblastoma. Subjects: From August 2013 to April 2020, 44 patients (88 lesions) with recurrent glioblastoma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 61.5 years, with 26 men and 18 women. The tumor volume is 150 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of GK is 15 ml or less, a single irradiation with a boundary dose of 20 to 26 Gy was performed, and when the irradiation volume was 15 ml or more, a single irradiation boundary dose was divided into two divided irradiations of 12 to 15 Gy. The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK. Methods: Median progression-free survival (mPFS), 6-month progression-free survival (PFS-6m), 6-month survival (OS-6m), median survival (mOS) from treatment with AVAgamma Considered mOS from initial treatment. Results: The mPFS from AVAgamma therapy was 5 months, PFS-6m was 37%, OS-6m was 79%, and mOS was 9 months. The mOS from initial treatment were 25 months. In relapsing glioma RPA classification, NABTT CNC class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 9 months in class 5, 9 months in class 6. The survival time has been extended. Discussion: By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged. Conclusion: AVAgamma therapy is thought to prolong the survival of recurrent glioblastoma and play an important role as salvage treatment.

Ring the Bell for Sickle Cell: Encouraging Advocacy in an Underserved Community

2021 ◽  
pp. 152483992110241
Author(s):  
Ellen M. Bloom ◽  
Kisha C. Hampton ◽  
Kimber Blackwell ◽  
Gary A. Gibson ◽  
Christopher Roberson ◽  
...  
Keyword(s):  
Workforce Development ◽  
Sickle Cell ◽  
Health Care Services ◽  
State Funding ◽  
Care Services ◽  
Department Of Health ◽  
Limited Life ◽  
Underserved Community ◽  
Access To Medical Care ◽  
Medical Advances

Sickle cell disease (SCD) was once a disease of childhood because of a limited life expectancy. Due to medical advances, it is now common for people with SCD to live into adulthood. Funding and resources for adults with SCD, however, remain limited. Adult patients would benefit from increased access to medical care, mental health care services, and workforce development. The Indiana Sickle Cell Consortium, a group of medical providers and community-based organizations, worked closely with people living with SCD and their family members to create a campaign advocating for state funding for programs for adults with SCD. This campaign culminated with the passage of a bill that provides $250,000 in funding for program development for adults with SCD. The bill also directs the Indiana Department of Health to carry out a needs assessment for people with SCD in Indiana. However, continued efforts are needed to reduce health disparities for people with SCD. The Indiana Sickle Cell Consortium will continue advocacy efforts in future legislative cycles and bring attention to the health inequities that affect people with SCD.

scholarly journals Who Orders Screening Mammograms in Older Women with Limited Life Expectancy?

2019 ◽  
Vol 34 (12) ◽  
pp. 2720-2722 ◽  
Author(s):  
Nancy L. Schoenborn ◽  
Jin Huang ◽  
Cynthia M. Boyd ◽  
Sarah Nowak ◽  
Craig E. Pollack
Keyword(s):  
Life Expectancy ◽  
Older Women ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Screening Mammograms

scholarly journals Mitochondrial Group II Introns, Cytochrome c Oxidase, and Senescence in Podospora anserina

1999 ◽  
Vol 19 (6) ◽  
pp. 4093-4100 ◽  
Author(s):  
Odile Begel ◽  
Jocelyne Boulay ◽  
Beatrice Albert ◽  
Eric Dufour ◽  
Annie Sainsard-Chanet
Keyword(s):  
Life Span ◽  
Integration Site ◽  
Group Ii Intron ◽  
Podospora Anserina ◽  
Wild Type ◽  
First Intron ◽  
Limited Life ◽  
Related Group ◽  
Group Ii ◽  
Mitochondrial Chromosome

ABSTRACT Podospora anserina is a filamentous fungus with a limited life span. It expresses a degenerative syndrome called senescence, which is always associated with the accumulation of circular molecules (senDNAs) containing specific regions of the mitochondrial chromosome. A mobile group II intron (α) has been thought to play a prominent role in this syndrome. Intron α is the first intron of the cytochrome c oxidase subunit I gene (COX1). Mitochondrial mutants that escape the senescence process are missing this intron, as well as the first exon of theCOX1 gene. We describe here the first mutant of P. anserina that has the α sequence precisely deleted and whose cytochrome c oxidase activity is identical to that of wild-type cells. The integration site of the intron is slightly modified, and this change prevents efficient homing of intron α. We show here that this mutant displays a senescence syndrome similar to that of the wild type and that its life span is increased about twofold. The introduction of a related group II intron into the mitochondrial genome of the mutant does not restore the wild-type life span. These data clearly demonstrate that intron α is not the specific senescence factor but rather an accelerator or amplifier of the senescence process. They emphasize the role that intron α plays in the instability of the mitochondrial chromosome and the link between this instability and longevity. Our results strongly support the idea that in Podospora, “immortality” can be acquired not by the absence of intron α but rather by the lack of active cytochromec oxidase.

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