scholarly journals Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 44
Author(s):  
Shelley A. Sternberg ◽  
Shiri Shinan-Altman ◽  
Ladislav Volicer ◽  
David J. Casarett ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Hospice Care ◽  
The United States ◽  
Artificial Nutrition ◽  
Advanced Dementia ◽  
Case Scenario ◽  
Artificial Nutrition And Hydration ◽  
Positive Elements ◽  
The Us

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), the Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and the Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in the Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in the Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in the Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

scholarly journals The carbon footprint of dietary guidelines around the world: a seven country modeling study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Brittany Kovacs ◽  
Lindsey Miller ◽  
Martin C. Heller ◽  
Donald Rose
Keyword(s):  
The Netherlands ◽  
Carbon Footprint ◽  
The United States ◽  
Dietary Guidelines ◽  
Consumption Patterns ◽  
Consumption Pattern ◽  
Carbon Footprints ◽  
Country Level ◽  
The Us ◽  
The World

Abstract Background Do the environmental impacts inherent in national food-based dietary guidelines (FBDG) vary around the world, and, if so, how? Most previous studies that consider this question focus on a single country or compare countries’ guidelines without controlling for differences in country-level consumption patterns. To address this gap, we model the carbon footprint of the dietary guidelines from seven different countries, examine the key contributors to this, and control for consumption differences between countries. Methods In this purposive sample, we obtained FBDG from national sources for Germany, India, the Netherlands, Oman, Thailand, Uruguay, and the United States. These were used to structure recommended diets using 6 food groups: protein foods, dairy, grains, fruits, vegetables, and oils/fats. To determine specific quantities of individual foods within these groups, we used data on food supplies available for human consumption for each country from the UN Food and Agriculture Organization’s food balance sheets. The greenhouse gas emissions (GHGE) used to produce the foods in these consumption patterns were linked from our own database, constructed from an exhaustive review of the life cycle assessment literature. All guidelines were scaled to a 2000-kcal diet. Results Daily recommended amounts of dairy foods ranged from a low of 118 ml/d for Oman to a high of 710 ml/d for the US. The GHGE associated with these two recommendations were 0.17 and 1.10 kg CO2-eq/d, respectively. The GHGE associated with the protein food recommendations ranged from 0.03 kg CO2-eq/d in India  to 1.84 kg CO2-eq/d in the US, for recommended amounts of 75 g/d and 156 g/d, respectively. Overall, US recommendations had the highest carbon footprint at 3.83 kg CO2-eq/d, 4.5 times that of the recommended diet for India, which had the smallest footprint. After controlling for country-level consumption patterns by applying the US consumption pattern to all countries, US recommendations were still the highest, 19% and 47% higher than those of the Netherlands and Germany, respectively. Conclusions Despite our common human biology, FBDG vary tremendously from one country to the next, as do the associated carbon footprints of these guidelines. Understanding the carbon footprints of different recommendations can assist in future decision-making to incorporate environmental sustainability in dietary guidance.

scholarly journals Comparative-Legal Analysis of Alternative Tax Dispute Resolution: the Practice of the Russian Federation, the United States, the Netherlands and Germany

2017 ◽  
pp. 58-64
Author(s):  
Елена Цветкова ◽  
Elena Tsvetkova
Keyword(s):  
United States ◽  
The Netherlands ◽  
Dispute Resolution ◽  
The United States ◽  
Alternative Methods ◽  
Main Trend ◽  
Legal Analysis ◽  
Tax Rate ◽  
The Us ◽  
The Moment

The main trend of recent years is the complication of tax administration. In order to improve it states develop forms of work with taxpayers, including alternative tax dispute resolution. The author analyses alternative tax dispute resolution that have already developed in Russia and compares them with similar procedures in the United States, the Netherlands and Germany. To the alternative methods that are applied in Russia the author refers tax monitoring and agreement on the settlement of a tax dispute. Tax monitoring is not seen as a form of tax control, but as a mean of resolving and preventing the occurrence of a tax dispute. The conclusion of an agreement between a tax authority and a taxpayer on the settlement of a dispute in court is possible by reaching a compromise on the qualification of relations, on actual circumstances, on the interpretation of the tax rate. The article contains examples of programs that exist in the US and Germany in the sphere of tax dispute resolution. Also issues related to the implementation of the mediation procedure existing in the United States, the Netherlands and Germany and the possibility of their application in Russia are considered. The author emphasizes the impossibility of applying the procedure of mediation in tax disputes in Russia at the moment due to the lack of legislative regulation.

High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

Clinical and Ethical Issues in Palliative Care and Dementia - An Overview

2010 ◽  
Vol 5 (2) ◽  
pp. 29 ◽  
Author(s):  
Emma L Teper ◽  
Julian C Hughes ◽  
◽  
Keyword(s):  
Palliative Care ◽  
Ethical Issues ◽  
Terminal Condition ◽  
Ethical Framework ◽  
Artificial Nutrition ◽  
Spiritual Needs ◽  
Artificial Nutrition And Hydration ◽  
Expert Opinions ◽  
People With Dementia ◽  
Broad Term

The prevalence of dementia across Europe and the world is increasing. People die with and from dementia and, as such, advanced dementia can be considered a terminal condition. This, alongside the realisation that care for people with dementia is deficient, has led to increasing interest in palliative care in dementia. Palliative care can be a rather broad term with different meanings, but nonetheless guidelines and expert opinions have been developed with the aim of improving overall care for people with dementia. Although at times the evidence on which these guidelines are based is somewhat sparse, they provide guidance in specific areas relevant to dementia. The main areas covered are pain, infection and fevers, artificial nutrition and hydration, resuscitation and psychological, social and spiritual needs. We shall consider the evidence on which guidance is based and then highlight a recent ethical framework developed to help thinking around the issues that arise in dementia care.

Charitable contributions and quality in the us hospice care setting

2014 ◽  
Vol 26 (4) ◽  
pp. 539-556 ◽  
Author(s):  
Kelly Noe ◽  
Dana A. Forgione
Keyword(s):  
Quality Of Care ◽  
Hospice Care ◽  
The United States ◽  
Charitable Contributions ◽  
The Us ◽  
Home Health Aide ◽  
Report Data ◽  
Worker Quality ◽  
Cost Report

This paper examines the association of charitable donations with quality of care proxies for nonprofit hospice providers in the United States (US). An estimated 1.45 million patients received hospice care in the US in 2008. Medicare hospice spending exceeded $10 billion in 2007 and is expected to more than double over the next 10 years. Using Guidestar and Medicare Hospice Cost Report data, we find donations are positively associated with proxies for nurse and social worker quality of care, but not with our home-health aide quality proxy. This research adds to our understanding of charitable contributions in hospice provider organizations.

Baby O and the Withdrawal of Life-Sustaining Medical Treatment in the Devastated Neonate: A Review of Clinical, Ethical, and Legal Issues

2016 ◽  
Vol 34 (10) ◽  
pp. 925-930 ◽  
Author(s):  
Joseph Sacco ◽  
Rebecca Virata
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Research ◽  
Medical Treatment ◽  
Clinical Guidelines ◽  
Legal Issues ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Ethical And Legal Issues

The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care.

scholarly journals Rural-Urban Disparities in Place of Death in Hematologic Malignancies in the US from 2003 to 2019

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4137-4137
Author(s):  
Syed M. Qasim Hussaini ◽  
Arjun Gupta
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
Rural Areas ◽  
Hospice Care ◽  
Metropolitan Areas ◽  
Hematologic Malignancies ◽  
The United States ◽  
Medical Facility ◽  
Nursing Facility ◽  
The Us

Abstract Background: more than 60,000 people die annually from hematologic malignancies in the united states (us). Patients with hematologic malignancies more frequently receive aggressive care toward the end-of-life and are more likely to die in a hospital compared to those with a solid tumor. Appropriate care of such patients is very dependent on an existing healthcare infrastructure. There are notable challenges to rural healthcare in the united states which contains less than 1/5th of all hospices in the us. In this study, we sought to investigate rural-urban disparities in place of death the us in individuals that died from hematologic malignancies. Methods: we utilized the us centers for disease control and prevention wide-ranging online data for epidemiologic research database to analyze all deaths from hematologic malignancies in the us from 2003 to 2019. A population classification utilizing the 2013 us census was made using the national center for health statistics urban-rural classification scheme. These classifications included: large metropolitan area (1 million), small- or medium-sized metropolitan area (50 000-999 999), and rural area (<50 000). We estimated deaths in a medical facility, hospice, home, or nursing care facility. We stratified the results by age, sex, and race/ethnicity. The annual percentage change (apc) in deaths was estimated. All data was publicly available and de-identified. Findings: from 2003-2019, there were a total 1,088,589 deaths form hematologic malignancies in the united states, predominantly in large metropolitan areas (50.2%), followed by small or medium sized metropolitan areas (31.7%) and rural areas (18.2%). All regions noted decreases in medical facility and nursing facility related deaths, and increase in hospice and home deaths. While rural areas demonstrated the quickest uptake of hospice care (apc 61.5), they had the lowest overall presence of hospice care (8.3% of all rural deaths in 2019 vs. 14.9% for small or medium metropolitan vs. 12% for large metropolitan) and larger share of nursing facility related deaths (15.8% of all rural deaths in 2019 vs 12.3% for small or medium metropolitan vs 10.6% for large metropolitan). Discussion: we demonstrate end-of-life disparities in hematologic malignancies based on where an individual resides in the us with rural areas having notably lower share of deaths in hospice facilities. Older infrastructure, inadequate access to care, and financial barriers add to the medical complexity of care for all patients, and especially hematologic patients with high needs and complex treatment planning. These have been aggravated by rural hospital closures in the previous 18 months. The us senate is currently debating a bipartisan infrastructure that may add billions in building rural healthcare infrastructure to state budgets. Our findings are timely in helping inform congressional policy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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