Articles: adult.
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The elderly have the ethical and legal equivalence of younger adults, yet are treated differently by society. Numerous recent reports have exposed poor inpatient care resulting in part from institutional ageism, which has moral and legal implications for healthcare providers. ⋯ Legally, numerous changes in human rights, equality, consent, capacity, and end-of-life laws and professional guidance have consistently re-emphasised the need for greater communication between doctors, patients, their relatives and carers. This review describes current ethical thinking and legal precedent (in England and Wales), and directs readers to consider areas in which the law might change in the near future, particularly with regard to the end-of-life care of elderly surgical patients.
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A number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. ⋯ Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side-effects that are consequent upon age-related changes in drug pharmacokinetics and pharmacodynamics, co-morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose-related side-effects, particularly of opioids.
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Review
Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies.
Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected. ⋯ Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.
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Ont Health Technol Assess Ser · Jan 2014
ReviewTeam-Based Models for End-of-Life Care: An Evidence-Based Analysis.
End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. ⋯ Moderate-quality evidence shows that a comprehensive, direct-contact, team-based model of care provides the following benefits for end-of-life patients with an estimated survival of up to 9 months: it improves caregiver satisfaction and increases the odds of dying at home while decreasing the odds of dying in a nursing home. Moderate-quality evidence also shows that improvement in patient quality of life, symptom management, and patient satisfaction occur when end-of-life care via this model is provided early (up to 24 months before death). However, using this model to deliver end-of-life care does not impact hospital admissions or hospital length of stay. Team membership includes at minimum a physician and nurse, with at least one having specialist training and/or experience in end-of-life care. Team services include symptom management, psychosocial care, development of patient care plans, end-of-life care planning, and coordination of care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Indications, risk factors, specialities and after-care of surgical treatment for cardiac and thoracic vascular diseases].
Despite a known high risk and complexity in the operative therapy of cardio-thoracic patients, cardiac surgery is medical routine activity today. The German Society of Cardiothoracic Surgery regularly analyses the more than 100.000 cases a year in Germany. Fixing procedural statics, it gives us the knowledge of individual risk factors and success rates for surgical therapy of our patients. Following we want to shortly summarize indications, risk factors, specialities and after-care of surgical treatment for cardiac and thoracic vascular diseases in adults.