32 A casenote review of parenteral infusions in dying patients; a response to recent media hype

Research team of physicians and lab technicians under Izrael Milejkowski’s direction undertook the effort to carry out a series of clinical and biochemical experiments on patients dying of starvation in the Warsaw ghetto so as to receive the fullest possible picture of hunger disease. The research was carried out according to all the rigors of strict scientific discipline, and the authors during their work on academic articles, published it after the war entitled: „Starvation disease: hunger research carried out in the Warsaw ghetto in 1942,” according to their own words, they “supplemented the gap in accordance with the progress of knowledge.” The article is devoted to the reflections over ethical dilemmas of the research team, who were forced in their work to perform numerous medical treatments of experimental nature on extremely exhausted patients. The ill, according to Dr Fajgenblat’s words,“demonstrated negativism toward the research and treatment, which extremely hindered the work, and sometimes even frustrated it.” The article attempts to look at the monumental research work of the Warsaw ghetto doctors as a special kind of response of the medical profession to the feeling of helplessness to the dying patients. The article analyzes the situation of Warsaw ghetto doctors, who undertook the research without support of any outer authority, which could settle their possible ethical dilemmas (Polish deontological codes, European discussions on the conditions of the admissibility of medical research on patients, etc.).

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Faculty Opinions recommendation of Media hype: Patient and scientific perspectives on misleading medical news.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727471483.793537182 ◽

2017 ◽

Author(s):

Andreas Hartmann ◽

Cécile Delorme

Keyword(s):

Medical News ◽

Media Hype

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Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

Palliative Medicine ◽

10.1177/02692163211019885 ◽

2021 ◽

pp. 026921632110198

Author(s):

Catriona R Mayland ◽

Rosemary Hughes ◽

Steven Lane ◽

Tamsin McGlinchey ◽

Warren Donnellan ◽

...

Keyword(s):

Public Health ◽

Family Support ◽

Online Survey ◽

Free Text ◽

Professional Networks ◽

Dying Patients ◽

The Face ◽

Individualised Care ◽

The Impact ◽

Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

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End-of-Life Needs of Dying Patients and Their Families in Mainland China: A Systematic Review

OMEGA - Journal of Death and Dying ◽

10.1177/0030222821997340 ◽

2021 ◽

pp. 003022282199734

Author(s):

Guobin Cheng ◽

Chuqian Chen

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Healthcare Professionals ◽

Web Of Science ◽

Empirical Studies ◽

Symptom Control ◽

Mainland China ◽

Spiritual Needs ◽

Care Needs ◽

Dying Patients

Objective To map the current research status and understand existing findings regarding end-of-life care needs in Mainland China. Method First-hand, empirical studies on the needs of dying patients and/or their families in Mainland China were searched in Web of Science, Scopus, Proquest, Taylor & Francis Online and CNKI in December 2019. Findings were synthesized. Results A total of 33 (10 qualitative) studies were involved. Chinese dying patients and their families had physical, psychological, social, and spiritual needs and needs for knowledge and information. Prevalent needs of dying patients were mainly symptom control and decent look, being treated kindly by professional caregivers, family accompany, dignity, and comfortable environment. Families mainly need healthcare professionals to take good care of patients and wishes for information, knowledge, and facilities to help themselves become better caregivers. Conclusions Findings lay the foundation for effective and tailored services for Chinese clients and provided insights for future investigations.

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Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews

BMC Palliative Care ◽

10.1186/s12904-021-00782-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Xhyljeta Luta ◽

Baptiste Ottino ◽

Peter Hall ◽

Joanna Bowden ◽

Bee Wee ◽

...

Keyword(s):

Palliative Care ◽

Cost Effectiveness ◽

End Of Life ◽

Resource Use ◽

Economic Value ◽

Healthcare Delivery ◽

Dying Patients ◽

Home Based ◽

Population Type ◽

Care Models

Abstract Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.

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The impact of death and dying on the personhood of medical students: a systematic scoping review

BMC Medical Education ◽

10.1186/s12909-020-02411-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chong Yao Ho ◽

Cheryl Shumin Kow ◽

Chin Howe Joshua Chia ◽

Jia Ying Low ◽

Yong Hao Melvin Lai ◽

...

Keyword(s):

Medical Students ◽

Scoping Review ◽

Death And Dying ◽

Support Mechanism ◽

Resource Limited ◽

Dying Patients ◽

Concurrent Use ◽

Effective Training ◽

Longitudinal Support ◽

The Impact

Abstract Background The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them. Methods We adopt Krishna’s Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review. Results Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood. Conclusion Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

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Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

The American Surgeon ◽

10.1177/0003134820972989 ◽

2020 ◽

pp. 000313482097298

Author(s):

Samuel J. Zolin ◽

Jasmin K. Bhangu ◽

Brian T. Young ◽

Sarah E. Posillico ◽

Husayn A. Ladhani ◽

...

Keyword(s):

Critical Care ◽

Trauma Patients ◽

Family Meeting ◽

Comfort Care ◽

Code Status ◽

Family Meetings ◽

Dying Patients ◽

Palliative Care Consultation ◽

Care Consultation ◽

Poor Outcomes

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.

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