New Clinical Insights Into Pediatric DRESS to Tailor Future Care?

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

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Advance care planning: the future

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002304 ◽

2020 ◽

pp. bmjspcare-2020-002304

Author(s):

Judith Rietjens ◽

Ida Korfage ◽

Mark Taubert

Keyword(s):

Advance Care Planning ◽

Public Awareness ◽

Care Planning ◽

Decisional Capacity ◽

Best Interest ◽

Awareness Campaigns ◽

People With Dementia ◽

Future Care ◽

Advance Care ◽

Improve Patient

ObjectivesThere is increased global focus on advance care planning (ACP) with attention from policymakers, more education programmes, laws and public awareness campaigns.MethodsWe provide a summary of the evidence about what ACP is, and how it should be conducted. We also address its barriers and facilitators and discuss current and future models of ACP, including a wider look at how to best integrate those who have diminished decisional capacity.ResultsDifferent models are analysed, including new work in Wales (future care planning which includes best interest decision-making for those without decisional capacity), Asia and in people with dementia.ConclusionsACP practices are evolving. While ACP is a joint responsibility of patients, relatives and healthcare professionals, more clarity on how to apply best ACP practices to include people with diminished capacity will further improve patient-centred care.

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STEMI and COVID ‐19: Unmasking failures and opportunities to enhance future care

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29475 ◽

2021 ◽

Vol 97 (2) ◽

pp. 215-216

Author(s):

Reshma R. Golamari ◽

Ian C. Gilchrist

Keyword(s):

Future Care

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Older survivors of cancer in the COVID-19 pandemic: Reflections and recommendations for future care

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2020.11.009 ◽

2020 ◽

Author(s):

Kristen R. Haase ◽

Danielle Kain ◽

Shaila Merchant ◽

Christopher Booth ◽

Rachel Koven ◽

...

Keyword(s):

Future Care

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7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.7 ◽

2018 ◽

Vol 8 (3) ◽

pp. 362.2-362

Author(s):

Anna-Maria Bielinska ◽

Stephanie Archer ◽

Catherine Urch ◽

Ara Darzi

Keyword(s):

Older Adults ◽

Decision Making ◽

End Of Life Care ◽

Healthcare Professionals ◽

List Type ◽

Care Planning ◽

Life Care ◽

Topic Guide ◽

Future Care ◽

Advance Care

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.

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Prognostic value of circulating markers of neutrophil activation, neutrophil extracellular traps, coagulation and fibrinolysis in patients with terminal cancer

Scientific Reports ◽

10.1038/s41598-021-84476-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Axel Rosell ◽

Katherina Aguilera ◽

Yohei Hisada ◽

Clare Schmedes ◽

Nigel Mackman ◽

...

Keyword(s):

Advanced Cancer ◽

Prognostic Value ◽

Neutrophil Extracellular Traps ◽

Neutrophil Activation ◽

Terminal Cancer ◽

Extracellular Traps ◽

Terminal Cancer Patients ◽

Future Care ◽

Circulating Markers ◽

Coagulation And Fibrinolysis

AbstractPredicting survival accurately in patients with advanced cancer is important in guiding interventions and planning future care. Objective tools are therefore needed. Blood biomarkers are appealing due to their rapid measurement and objective nature. Thrombosis is a common complication in cancer. Recent data indicate that tumor-induced neutrophil extracellular traps (NETs) are pro-thrombotic. We therefore performed a comprehensive investigation of circulating markers of neutrophil activation, NET formation, coagulation and fibrinolysis in 106 patients with terminal cancer. We found that neutrophil activation and NET markers were prognostic in terminal cancer patients. Interestingly, markers of coagulation and fibrinolysis did not have a prognostic value in this patient group, and there were weak or no correlations between these markers and markers of neutrophil activation and NETs. This suggest that NETs are linked to a poor prognosis through pathways independent of coagulation. Additional studies are needed to determine the utility of circulating neutrophil activation and NET markers, alone or in concert with established clinical parameters, as objective and reliable prognostic tools in advanced cancer.

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Court of Appeal Rules That Periodical Payments for Long-Term Future Care Are Not Adequately and Fairly Met by the RPI

Medico-Legal Journal ◽

10.1258/rsmmlj.76.1.2 ◽

2008 ◽

Vol 76 (1) ◽

pp. 2-2

Author(s):

Diana Brahams

Keyword(s):

Future Care ◽

Court Of Appeal

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Antibiotic use towards the end of life: development of good practice recommendations

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002732 ◽

2021 ◽

pp. bmjspcare-2020-002732

Author(s):

R Andrew Seaton ◽

Lesley Cooper ◽

Jack Fairweather ◽

Stephen Fenning ◽

Libby Ferguson ◽

...

Keyword(s):

End Of Life ◽

Good Practice ◽

Symptom Burden ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Optimal Care ◽

Time To Death ◽

Practice Recommendations ◽

Published Evidence ◽

Future Care

ObjectivesDevelopment of evidence-based good practice recommendations for clinicians considering the use of antibiotics in patients towards the end of life.DesignA multiprofessional group of experts in end-of-life care and antimicrobial stewardship was convened. Findings from a scoping review of the literature and a consultation of clinicians were triangulated. Expert discussion was used to generate consensus on how to approach decision-making.SettingRepresentatives from hospital and a range of community health and care settings.ParticipantsMedical, pharmacy and nursing professionals.Main outcome measuresGood practice recommendations based on published evidence and the experience of prescribers in Scotland.ResultsThe findings of 88 uncontrolled, observational studies of variable quality were considered alongside a survey of over 200 prescribers. No national or international guidelines were identified. Antibiotic use towards the end of life was common but practice was highly variable. The potential harms associated with giving antibiotics tended to be less well considered than the potential benefits. Antibiotics often extended the length of time to death but this was sometimes at the cost of higher symptom burden. There was strong consensus around the importance of effective communication with patients and their families and making treatment decisions aligned to a patient’s goals and priorities.ConclusionsGood practice recommendations were agreed with focus on three areas: making shared decisions about future care; agreeing clear goals and limits of therapy; reviewing all antibiotic prescribing decisions regularly. These will be disseminated widely to support optimal care for patients towards the end of life. A patient version of the recommendations has also been produced to support implementation.

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Chronic post-amputation pain & blast injury: An analysis of British First World War Veterans’ pension records, 1914-85

Journal of Military Veteran and Family Health ◽

10.3138/jmvfh-2021-0044 ◽

2021 ◽

Author(s):

Sarah Dixon Smith ◽

David Henson ◽

George Hay ◽

Andrew S.C. Rice

Keyword(s):

Blast Injury ◽

First World War ◽

World War ◽

The Public ◽

The First World War ◽

Future Care ◽

Medical Teams ◽

The Uk ◽

First World

LAY SUMMARY The First World War created the largest group of amputees in history. There were over 41,000 amputee Veterans in the UK alone. Recent studies estimate that over two thirds of amputees will suffer long-term pain because of their injuries. Medical files for the First World War have recently been released to the public. Despite the century between the First World War and the recent Afghanistan conflict, treatments for injured soldiers and the most common types of injuries have not changed much. A team of historians, doctors, and amputee Veterans have collaborated to investigate what happened next for soldiers injured in the war and how their wounds affected their postwar lives, and hope that looking back at the First World War and seeing which treatments worked and what happened to the amputees as they got older (e.g., if having an amputation put them at risk of other illnesses or injuries) can assist today’s Veterans and medical teams in planning for their future care.

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