Palliative Sedation (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Decision Making ◽  
Life Expectancy ◽  
Palliative Sedation ◽  
Refractory Symptoms ◽  
Continuous Sedation ◽  
Special Cases ◽  
Depth Analysis ◽  
Level Of Consciousness ◽  
The Impact

Palliative sedation refers to lowering a patient’s level of consciousness so that she no longer suffers from intolerable and refractory symptoms. Some forms of palliative sedation are ethically uncontroversial, such as emergency or respite sedation. Continuous sedation to unconsciousness (CSU) is controversial in that a patient in such a state is unable to eat or drink and may not be able to protect her airway. Ethically relevant considerations include the inability to participate in subsequent decision-making, the uncertain quality of an unconscious life, and the impact on life expectancy (which is often misunderstood). Special cases of CSU for existential distress and in children demand in-depth analysis.

scholarly journals The Quality of Palliative Sedation in End-Stage Disease: Audit From a Department of Oncology and Haematology

2021 ◽  
Author(s):  
Saviola Alessia ◽  
Schipilliti Francesca Matilde ◽  
Isca Chrystel ◽  
Massimiliano Salati ◽  
Daniele Dini ◽  
...  
Keyword(s):  
Karnofsky Performance Status ◽  
Performance Status ◽  
Critical Role ◽  
Palliative Sedation ◽  
University Hospital ◽  
Refractory Symptoms ◽  
Stage Disease ◽  
End Stage ◽  
The Impact

Abstract PurposePalliative sedation (PS) plays a critical role to give suffering relief from refractory symptoms at the end of life. Our audit aimed to assess and improve quality of PS at the Department of Oncology and Hematology of University Hospital of Modena, to verify the adherence to international guidelines, the cooperation among members of care team, focusing with attention on family’s perception of this delicate situation. MethodsFrom December 2016 to June 2019, data of patients undergoing PS in the Department were collected by an electronic folder tool, “Sedation Tool” (ST), that recorded clinical and PS informations, D-PaP, Rudkin Score and family’s perception. Results245 patients were enrolled. 82% had a Karnofsky Performance Status 10-20%. The most common cancer types were lung and gastro-intestinal carcinomas (27% and 21% respectively). Refractory symptoms observed were confusion and agitation (76%), dyspnea (39%), pain (15%), delirium (10%), psychological distress (5%). Midazolam was the drug of choice for PS. Most of patients had Rudkin score 5 after 24 hours and 33% had terminal event within a period of 24 hours from the beginning of PS. During PS most of Patient’s relatives reported peacefulness (65%), agitation/impatience in 6% of cases, concern for suffering (16%). ConclusionPS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity. The ST can become a simple instrument to evaluate and improve PS quality, providing more attention on the impact of PS on relatives to then possibly develop new supportive procedures for patients and their families.

scholarly journals Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

2021 ◽  
pp. 000313482199475
Author(s):  
Brett M. Chapman ◽  
George M. Fuhrman
Keyword(s):  
Decision Making ◽  
Surgical Education ◽  
Clinical Care ◽  
Well Being ◽  
Educational Environment ◽  
Lessons Learned ◽  
Residency Programs ◽  
Surgical Residency ◽  
The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

Optimizing patient adherence to stroke rehabilitation: A mixed method telerehabilitation trial (Preprint)

2021 ◽  
Author(s):  
Isabelle Gaboury ◽  
Michel Tousignant ◽  
Hélène Corriveau ◽  
Matthew Menear ◽  
Guylaine Le Dorze ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Rehabilitation ◽  
Patient Adherence ◽  
Interprofessional Collaboration ◽  
Interdisciplinary Collaboration ◽  
Control Group ◽  
Shared Decision ◽  
The Impact

BACKGROUND Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration to normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration to normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured on clinicians. METHODS In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will entail 220 patients to receive stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation) versus face-to-face, standard of care (n = 110 patients). RESULTS Results: Our Research Ethics Board has approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS This study will contribute to minimize both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practices guidelines regarding telecare services and the provision of telerehabilitation, including recommendations regarding effective interdisciplinary collaboration regarding stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT04440215

The Impact of Conflict- Generating Techniques on Student Reactions and Decision Quality

1995 ◽  
Vol 58 (4) ◽  
pp. 39-45
Author(s):  
Granger Macy ◽  
Joan C. Neal
Keyword(s):  
Decision Making ◽  
Business Students ◽  
Decision Quality ◽  
Structured Decision Making ◽  
Constructive Conflict ◽  
Significant Difference ◽  
Student Reactions ◽  
Graduate Business Students ◽  
The Impact

This study examined the effectiveness of conflict-generating decision-making techniques in the college classroom. Utiliz ing constructive conflict in classroom exercises may affect decision-making quality and student reactions. This study of undergraduate and graduate business students found significant difference in both the quality of the decisions and in student reactions to the techniques. The findings and discussion indicate the potential for appropriate use of structured decision-making techniques in the classroom.

scholarly journals Influence of eye diseases on the mortality rate of the population

2018 ◽  
Vol 11 (1) ◽  
pp. 47-53
Author(s):  
Andrey V Zolotarev ◽  
Elena V Karlova ◽  
Elena V Miroshnichenko
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Mortality Rate ◽  
Life Expectancy ◽  
Eye Diseases ◽  
Review Of Literature ◽  
The Impact

Evaluating of the correlation between quality of life, life expectancy and mortality rate is an important problem of modern ophthalmology. Many researchers note that eye pathology, which leads to a visual acuity decrease and blindness, has a significant impact on the mortality rate of the population. This review of literature is dedicated to studies examining the impact of eye diseases on the mortality rate of the population. (For citation: Zolotarev AV, Karlova EV, Miroshnichenko EV. Influence of eye diseases on the mortality rate of the population. ­Oph­thal­mology Journal. 2018;11(1):47-53. doi: 10.17816/OV11147-53).

The Use of Palliative Sedation to Treat Existential Suffering: A Scoping Review on Practices, Ethical Considerations, and Guidelines

2019 ◽  
Vol 35 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Allysa L. Ciancio ◽  
Raza M. Mirza ◽  
Amy A. Ciancio ◽  
Christopher A. Klinger
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Research Policy ◽  
Grey Literature ◽  
Palliative Sedation ◽  
Ethical Considerations ◽  
Policy And Practice ◽  
Refractory Symptoms ◽  
Existential Suffering ◽  
The Impact

Context: Though palliative sedation has been recognized as an acceptable practice in Canada for many years now, there is a lack of clinical research and guidelines pertaining to its use as a treatment of existential refractory symptoms in the terminally ill. Objectives: This scoping review aimed to survey the literature surrounding palliative sedation and existential suffering and to inform research, policy, and practice. Methods: To address the main research question: Is palliative sedation an acceptable intervention to treat existential refractory symptoms in adults aged 65 and older? a scoping review following Arksey and O’Malley’s framework was performed, spanning electronic databases of the peer reviewed and grey literature. Articles were screened for inclusion, and a thematic content analysis allowed for a summary of key findings. Results: Out of 427 search results, 71 full text articles were obtained, 20 of which were included. Out of these articles, four themes were identified as key findings. These included: (1) Ethical considerations; (2) The role of the health care provider; looking specifically at the impact on nurses; (3) The need for multidisciplinary care teams; and (4) Existential suffering’s connection to religiosity and spirituality. Conclusion: Palliative sedation to treat existential refractory symptoms was labelled a controversial practice. A shortage of evidence-based resources limits the current literature’s ability to inform policy and clinical practice. There is a need for both qualitative and quantitative multi-center research so health care professionals and regional-level institutions have firm roots to establish proper policy and practice.

scholarly journals The Impact of Sustainable Financial Data Governance, Political Connections, and Creative Accounting Practices on Organizational Outcomes

2019 ◽  
Vol 11 (20) ◽  
pp. 5676 ◽  
Author(s):  
Tha’er Amjed Mahmoud Ababneh ◽  
Mehmet Aga
Keyword(s):  
Decision Making ◽  
Accounting Information ◽  
Financial Data ◽  
Political Connections ◽  
Equation Modeling ◽  
Data Governance ◽  
Creative Accounting ◽  
Information Reporting ◽  
The Impact

Decision-making and financial information quality are key facets of corporate sustainability. The literature is devoid of inquiries investigating the collective impact of sustainable financial data governance and political connections on creative accounting practices, the quality of financial reporting and decision-making effectiveness. The present study integrates these critical factors by obtaining survey data (n = 180) from publicly listed firms in Amman Stock Exchange, Jordan. By applying partial least squares structural equation modeling (PLS-SEM), this study found that (i) sustainable financial data governance does not influence creative accounting practices, (ii) political connections influences the level of firms creative accounting practices, (iii) creative accounting practices influences the quality of financial and accounting information reporting, and (iv) the quality of financial and accounting information reporting influences firms decision-making effectiveness. Implications, limitations, and future research courses are discussed.

Physical activity diminishes aging-related decline of physical and cognitive performance

2014 ◽  
Vol 155 (21) ◽  
pp. 817-821 ◽  
Author(s):  
Péter Apor ◽  
László Babai
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Life Expectancy ◽  
Aging Process ◽  
Muscle Force ◽  
Walking Speed ◽  
Prognostic Impact ◽  
Elderly Persons ◽  
The Impact

Aging-related decline of muscle force, walking speed, locomotor coordination, aerobic capacity and endurance exert prognostic impact on life expectancy. Proper use of training may diminish the aging process and it may improve the quality of life of elderly persons. This paper provides a brief summary on the impact of training on aging-related decline of physical and cognitive functions. Orv. Hetil., 2014, 155(21), 817–821.

Factors explaining the Impact of Performance Measures in European Local Governments

2015 ◽  
Vol 13 (2) ◽  
pp. 229-248 ◽  
Author(s):  
Lourdes Torres ◽  
Vicente Pina ◽  
Caridad Martí
Keyword(s):  
Decision Making ◽  
Human Resources ◽  
Performance Measures ◽  
Local Governments ◽  
Monetary Incentives ◽  
Senior Managers ◽  
Hr Management ◽  
Perceived Impact ◽  
The Impact

This paper seeks to identify the drivers of the variations in the impact perceived by managers of the implementation of performance measures (PM) across European local governments. We argue that insights from the use of PM for managerial processes and human resources (HR) management features condition the perceived impact of PM systems. The data was collected through a questionnaire answered by local governments of 16 European countries. The results show that the higher the use of PM in performance-oriented budgeting processes, the higher the impact of PM on improvements in the quality of decision-making. Monetary incentives linked to performance better explain the actual results in PM implementation than the kind of HR system of the cities and the academic backgrounds of their senior managers.

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