Advance Care Planning among People Living with Dialysis.

Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members' attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study.

Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future.

Evaluation of the impact of comprehensive medication management services delivered posthospitalization on readmissions and emergency department visits.

Background: The impact of providing cognitive pharmacy services following hospital discharge has been studied with various results. This study is specifically focused on comprehensive medication management services delivered postdischarge in an interprofessional team environment to patients aged >65 years.

Objective: To determine if delivery of comprehensive medication management services postdischarge will prevent hospital readmissions or emergency department visits within 6 months following discharge in patients aged >65 years.

Recovery of the gut microbiome following fecal microbiota transplantation.

Unlabelled: Clostridium difficile infection is one of the most common health care-associated infections, and up to 40% of patients suffer from recurrence of disease following standard antibiotic therapy. Recently, fecal microbiota transplantation (FMT) has been successfully used to treat recurrent C. difficile infection.

Shifting responses in quality of life: people living with dialysis.

Purpose: People assess their quality of life (QoL) using internal standards, values, and priorities. With health changes, QoL responses shift to reflect current realities. This qualitative study investigated the life experience and QoL assessments of people living with dialysis (PWDs).

Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels.

Background: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN). Use of these agents is reported to cause anemia.

Methods: We examined the association between standard care use of ACEI or ARB and subsequent change in hemoglobin (Hgb) in a population of 701 adult primary care patients with DM, CHF and/or HTN.

Healing through reflective writing: Breast cancer survivors' experience.

This article describes an intervention for breast cancer survivors called Journal of My Medical Experiences in which participants engaged in reflective writing over six weeks. The 107 participants were encouraged to explore concerns and issues in a safe online environment. About half of the women posted writings to a website once a week or more; others logged on solely to read what others had written.

Regional variation in care at the end of life: discontinuation of dialysis.

Background: Regional variation in the intensity of end-of-life care contributes significantly to the overall cost of health care. The interpretation of patterns of regional variation hinges, in part, on appropriate adjustment for regional variation in demographic variables such as age, race, sex, and rural vs. urban residence.

Nursing home quality: a comparative analysis using CMS Nursing Home Compare data to examine differences between rural and nonrural facilities.

Background: Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum.

Working after breast cancer treatment: lessons from musicians.

Objective: The Life and Livelihood Study was created to examine the impact of breast cancer treatment on musicians. The current report summarizes findings from the second (interview) phase of this study.

Methods: Female musicians who had been treated for breast cancer 1 to 5 years earlier were recruited to participate in the first (survey) phase of the study.

Fecal microbiome transplantation for recurrent Clostridium difficile infection: report on a case series.

Background: Clostridium difficile infection (CDI) continues to increase in incidence and severity, and was the most common nosocomial infection in the USA in 2010. Most cases of CDI respond to a standard course of antibiotics, but recurrent C. difficile infection (RCDI) has become increasingly frequent, and alternative treatments are needed.

Religious beliefs and practices in end-stage renal disease: implications for clinicians.

Context: Several components of palliative care are particularly applicable in end-stage renal disease (ESRD), including the spiritual domain.

Objectives: To investigate how ESRD patients and their families make decisions and cope with their circumstances and dialysis treatment.

Methods: A prospective qualitative study interviewed 31 elderly dialysis patients and their family members; interviews lasted 30-90 minutes.

Livelihood vs. life: the occupational well-being of women musician survivors of breast cancer.

The Life and Livelihood Study was designed to describe and understand the experience of women musicians treated for breast cancer. This report focuses on Phase I of the study, a web-based survey that examined subjects' physical symptoms and side effects following breast cancer treatment. Subjects were recruited nationally, using advertisements in musicians' publications and presentations at national meetings.

Randomized, double-blind trial of 220 mg zinc sulfate twice daily in the treatment of rosacea.

A 2006 article published in the International Journal of Dermatology reported that oral zinc sulfate 100 mg three times daily was associated with improvement in the severity of facial rosacea (Sharquie et al. 2006; 45: 857-861). The current study was undertaken to further assess the role of zinc in the management of rosacea.

Treating alcohol withdrawal with oral baclofen: a randomized, double-blind, placebo-controlled trial.

Background: Abrupt cessation of alcohol intake causes habituated drinkers to experience symptoms of alcohol withdrawal syndrome (AWS).

Objective: To determine the effect of the gamma-aminobutyric acid (GABA)-B agonist baclofen on the course of acute symptomatic AWS.

Design: Prospective, randomized, double-blind, placebo-controlled clinical study.

Differences in breast tissue oxygenation following radiotherapy.

Tissue perfusion and oxygenation changes following radiotherapy may result from and/or contribute to the toxicity of treatment. Breast tissue oxygenation levels were determined in the treated and non-treated breast 1 year after radiotherapy for breast conserving treatment. Transcutaneous oxygenation varied between subjects in both treated and non-treated breast.

Perspectives of community members regarding tube feeding in patients with end-stage dementia: findings from African-American and Caucasian focus groups.

Research has demonstrated that placement of permanent feeding tubes to provide artificial nutrition is more common among non-white populations, but there is a scarcity of research regarding why those differences may exist. The purpose of this study is to describe and understand community members' attitudes toward tube feeding and end-of-life decision-making. Four focus groups were convened in Greenville, NC.

The use of a series of ketamine infusions in two patients with treatment-resistant depression.

Treatment-resistant depression often leads to increased morbidity and disability. The authors report the use of ketamine, a selective N-methyl-D-aspartate (NMDA) receptor antagonist, in two patients with treatment-resistant depression. Multiple ketamine treatments may provide an effective rapid antidepressant effect with prolonged benefit.

Family decision-making in advanced dementia: narrative and ethics.

Background: Traditionally, family members become decision-makers for ageing parents with cognitive impairment. Our understanding of how families negotiate the ethical issues in this decision-making is still developing.

Aim: To describe and understand the ethical thinking used in end-of-life decision-making by family surrogates on behalf of their cognitively impaired elders.

Massage in the management of agitation in nursing home residents with cognitive impairment.

This was a prospective study designed to examine the potential of massage to reduce agitation in cognitively impaired nursing home residents. Subjects were identified as susceptible to agitation by nursing home staff or by Minimum Data Set (MDS) report. Data was collected during baseline (3 days), intervention (6 days), and at follow-up.

Medicare hospital charges in the last year of life: distribution by quarter for rural and urban nursing home decedents with cognitive impairment.

Background: Medicare beneficiaries incur 27%-30% of lifetime charges in the last year of life; most charges occur in the last quarter. Factors associated with high end-of-life Medicare charges include less advanced age, non-white race, absence of advance directive, and urban residence.

Methods: We analyzed Medicare hospital charges in the last year of life for nursing home residents with severe cognitive impairment, focusing on rural-urban differences.