Background: Patients with severe stroke often do not have the capacity to participate in discussions on treatment restrictions because of a reduced level of consciousness, aphasia, or another cognitive disorder. We assessed the role of advance directives and proxy opinions in the decision-making process of incapacitated patients.
Methods: Sixty patients with severe functional dependence (Barthel Index ≤6) at day four after ischemic stroke or intracerebral hemorrhage were included in a prospective two-center cohort study. The decision-making process with respect to treatment restrictions was assessed by means of a semi-structured questionnaire administered to the treating physician at the day of inclusion.
Results: Forty-nine patients (82%) did not have the capacity to participate in the decision-making process. In eight patients, there was no discussion on treatment restrictions and full care was installed. In 41 patients, the decision whether to install treatment restrictions was discussed with proxies. One patient had a written advance directive. In the remaining 40 patients, proxies based their opinion on previously expressed wishes of the patient (18 patients) or advised in the best interest of the patient (22 patients). In 36 of 41 patients, treatment restrictions were installed after agreement between physician and proxy. At six months, 23 of 49 patients had survived. In only three of them the decision on treatment restrictions was based on previously expressed wishes. Remarkably, two of these survivors could not recall any of their alleged previously expressed wishes.
Conclusions: Treatment restrictions were installed in the majority of incapacitated patients after stroke. Proxy opinions frequently served as the best way to respect the patients' autonomy, but their accuracy remains unclear.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686946 | PMC |
| http://dx.doi.org/10.1186/s12904-017-0234-8 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Role of Injectable Platelet-Rich Fibrin in the Management of Soft and Hard Tissue Periodontal Regeneration in Dentistry: Protocol for a Systematic Review.
JMIR Res Protoc
January 2025
Department of Research and Development, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, India.
Background: Injectable platelet-rich fibrin (i-PRF) has the capacity to release great amounts of several growth factors, as well as to stimulate increased fibroblast migration and the expression of collagen, transforming growth factor β, and platelet-derived growth factor. Consequently, i-PRF can be used as a bioactive agent to promote periodontal tissue regeneration.
Objective: We aim to compare and evaluate the effectiveness of i-PRF in periodontal tissue regeneration.
An insight into the genome-wide analysis of bacterial defense mechanisms in a uropathogenic Morganella morganii isolate from Bangladesh.
PLoS One
January 2025
Bangladesh Council of Scientific and Industrial Research (BCSIR), Dhaka, Bangladesh.
The gram-negative, facultative anaerobic bacterium Morganella morganii is linked to a number of illnesses, including nosocomial infections and urinary tract infections (UTIs). A clinical isolate from a UTI patient in Bangladesh was subjected to high-throughput whole genome sequencing and extensive bioinformatics analysis in order to gather knowledge about the genomic basis of bacterial defenses and pathogenicity in M. morganii.
View Article and Find Full Text PDFTwo Cases of ROSAH-Like Syndrome Restricted to the Ophthalmologic Presentation.
Ocul Immunol Inflamm
January 2025
Department of Neurology, University Hospital of Angers, Angers, France.
Purpose: To report the clinical presentation and follow-up, including the optical coherence tomography, angiography and electrophysiology of two individuals from the same family presenting with an isolated retinal dystrophy and optic nerve edema who were diagnosed with ROSAH-like syndrome.
Method: Observational case report of a 55-year-old woman and her 36-year-old son with a genetic analysis of ROSAH, after a long-term follow-up.
Results: Both the mother and her son displayed severe optic nerve infiltration and retinal pigment atrophy with intraocular inflammation, which were not improved by immunosuppressive treatment.
Disproportionate, differential and targeted treatment: people who use drugs' experiences of policing during the COVID-19 pandemic.
Health Justice
January 2025
Burnet Institute, Melbourne, Australia.
Background: During the COVID-19 pandemic, governments worldwide introduced law enforcement measures to deter and punish breaches of emergency public health orders. For example, in Victoria, Australia, discretionary fines of A$1,652 were issued for breaching stay-at-home orders, and A$4,957 fines for 'unlawful gatherings'; to date, approximately 30,000 fines remain outstanding or not paid in full. Studies globally have revealed how the expansion of policing powers produced significant collateral damage for marginalized populations, including people from low-income neighboorhoods, Indigenous Peoples, sex workers, and people from culturally diverse backgrounds.
View Article and Find Full Text PDFAutoantibodies, Oxidative Stress, and Nutritional State in Anorexia Nervosa.
Antibodies (Basel)
December 2024
IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy.
: Anorexia nervosa (AN) is a complex psychiatric disorder characterized by an extreme fear of gaining weight, leading to severe calorie restriction and weight loss. Beyond its psychiatric challenges, AN has significant physical consequences affecting multiple organ systems. Recent research has increasingly focused on the interplay between autoantibodies, oxidative stress, and nutritional state in this condition.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!