Advance Care Planning: Discussions with patients and/or their representatives about the goals and desired direction of the patient's care, particularly end-of-life care, in the event that the patient is or becomes incompetent to make decisions.Advance Directives: Declarations by patients, made in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them. (Bioethics Thesaurus)Advance Directive Adherence: Compliance by health personnel or proxies with the stipulations of ADVANCE DIRECTIVES (or similar directives such as RESUSCITATION ORDERS) when patients are unable to direct their own care.Living Wills: Written, witnessed declarations in which persons request that if they become disabled beyond reasonable expectation of recovery, they be allowed to die rather than be kept alive by extraordinary means. (Bioethics Thesaurus)Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms.Models, Biological: Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment.Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy.Genomics: The systematic study of the complete DNA sequences (GENOME) of organisms.Clinical Trials as Topic: Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries.History, 20th Century: Time period from 1901 through 2000 of the common era.Legal Guardians: A legal concept for individuals who are designated to act on behalf of persons who are considered incapable of acting in their own behalf, e.g., minors and persons found to be not mentally competent.Signal Transduction: The intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GAMMA-AMINOBUTYRIC ACID-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptor-mediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway.History, 21st Century: Time period from 2001 through 2100 of the common era.Biomedical Research: Research that involves the application of the natural sciences, especially biology and physiology, to medicine.Molecular Biology: A discipline concerned with studying biological phenomena in terms of the chemical and physical interactions of molecules.Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney.Forecasting: The prediction or projection of the nature of future problems or existing conditions based upon the extrapolation or interpretation of existing scientific data or by the application of scientific methodology.Translational Medical Research: The application of discoveries generated by laboratory research and preclinical studies to the development of clinical trials and studies in humans. A second area of translational research concerns enhancing the adoption of best practices.Terminal Care: Medical and nursing care of patients in the terminal stage of an illness.Research: Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. (Webster, 3d ed)Drug Delivery Systems: Systems for the delivery of drugs to target sites of pharmacological actions. Technologies employed include those concerning drug preparation, route of administration, site targeting, metabolism, and toxicity.United StatesAlgorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task.Life Support Care: Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.Mental Competency: The ability to understand the nature and effect of the act in which the individual is engaged. (From Black's Law Dictionary, 6th ed).Individualized Medicine: Therapeutic approach tailoring therapy for genetically defined subgroups of patients.Resuscitation Orders: Instructions issued by a physician pertaining to the institution, continuation, or withdrawal of life support measures. The concept includes policies, laws, statutes, decisions, guidelines, and discussions that may affect the issuance of such orders.Drug Discovery: The process of finding chemicals for potential therapeutic use.History, 19th Century: Time period from 1801 through 1900 of the common era.Withholding Treatment: Withholding or withdrawal of a particular treatment or treatments, often (but not necessarily) life-prolonging treatment, from a patient or from a research subject as part of a research protocol. The concept is differentiated from REFUSAL TO TREAT, where the emphasis is on the health professional's or health facility's refusal to treat a patient or group of patients when the patient or the patient's representative requests treatment. Withholding of life-prolonging treatment is usually indexed only with EUTHANASIA, PASSIVE, unless the distinction between withholding and withdrawing treatment, or the issue of withholding palliative rather than curative treatment, is discussed.Proteomics: The systematic study of the complete complement of proteins (PROTEOME) of organisms.Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., GENETIC ENGINEERING) is a central focus; laboratory methods used include TRANSFECTION and CLONING technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Jet Lag Syndrome: A chronobiologic disorder resulting from rapid travel across a number of time zones, characterized by insomnia or hypersomnolence, fatigue, behavioral symptoms, headaches, and gastrointestinal disturbances. (From Cooper, Sleep, 1994, pp593-8)Medical Laboratory Science: The specialty related to the performance of techniques in clinical pathology such as those in hematology, microbiology, and other general clinical laboratory applications.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Molecular Imaging: The use of molecularly targeted imaging probes to localize and/or monitor biochemical and cellular processes via various imaging modalities that include RADIONUCLIDE IMAGING; ULTRASONOGRAPHY; MAGNETIC RESONANCE IMAGING; FLUORESCENCE IMAGING; and MICROSCOPY.Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories for solving biological problems including manipulation of models and datasets.Drug Design: The molecular designing of drugs for specific purposes (such as DNA-binding, enzyme inhibition, anti-cancer efficacy, etc.) based on knowledge of molecular properties such as activity of functional groups, molecular geometry, and electronic structure, and also on information cataloged on analogous molecules. Drug design is generally computer-assisted molecular modeling and does not include pharmacokinetics, dosage analysis, or drug administration analysis.Disease Models, Animal: Naturally occurring or experimentally induced animal diseases with pathological processes sufficiently similar to those of human diseases. They are used as study models for human diseases.Personal Autonomy: Self-directing freedom and especially moral independence. An ethical principle holds that the autonomy of persons ought to be respected. (Bioethics Thesaurus)Nanomedicine: The branch of medicine concerned with the application of NANOTECHNOLOGY to the prevention and treatment of disease. It involves the monitoring, repair, construction, and control of human biological systems at the molecular level, using engineered nanodevices and NANOSTRUCTURES. (From Freitas Jr., Nanomedicine, vol 1, 1999).Nanotechnology: The development and use of techniques to study physical phenomena and construct structures in the nanoscale size range or smaller.Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.Brain: The part of CENTRAL NERVOUS SYSTEM that is contained within the skull (CRANIUM). Arising from the NEURAL TUBE, the embryonic brain is comprised of three major parts including PROSENCEPHALON (the forebrain); MESENCEPHALON (the midbrain); and RHOMBENCEPHALON (the hindbrain). The developed brain consists of CEREBRUM; CEREBELLUM; and other structures in the BRAIN STEM.Molecular Targeted Therapy: Treatments with drugs which interact with or block synthesis of specific cellular components characteristic of the individual's disease in order to stop or interrupt the specific biochemical dysfunction involved in progression of the disease.Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, and feeding.Antineoplastic Agents: Substances that inhibit or prevent the proliferation of NEOPLASMS.Mutation: Any detectable and heritable change in the genetic material that causes a change in the GENOTYPE and which is transmitted to daughter cells and to succeeding generations.Software: Sequential operating programs and data which instruct the functioning of a digital computer.Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.Medical Oncology: A subspecialty of internal medicine concerned with the study of neoplasms.Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.Phenotype: The outward appearance of the individual. It is the product of interactions between genes, and between the GENOTYPE and the environment.Genetic Therapy: Techniques and strategies which include the use of coding sequences and other conventional or radical means to transform or modify cells for the purpose of treating or reversing disease conditions.Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous system.Proteins: Linear POLYPEPTIDES that are synthesized on RIBOSOMES and may be further modified, crosslinked, cleaved, or assembled into complex proteins with several subunits. The specific sequence of AMINO ACIDS determines the shape the polypeptide will take, during PROTEIN FOLDING, and the function of the protein.Ethics, Medical: The principles of professional conduct concerning the rights and duties of the physician, relations with patients and fellow practitioners, as well as actions of the physician in patient care and interpersonal relations with patient families.Bioengineering: The application of engineering principles and methods to living organisms or biological systems.Cells: The fundamental, structural, and functional units or subunits of living organisms. They are composed of CYTOPLASM containing various ORGANELLES and a CELL MEMBRANE boundary.Sequence Analysis, DNA: A multistage process that includes cloning, physical mapping, subcloning, determination of the DNA SEQUENCE, and information analysis.Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection.Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc.Equipment Design: Methods of creating machines and devices.Congresses as Topic: Conferences, conventions or formal meetings usually attended by delegates representing a special field of interest.Gene Expression Profiling: The determination of the pattern of genes expressed at the level of GENETIC TRANSCRIPTION, under specific circumstances or in a specific cell.Prognosis: A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.Attitude to Death: Conceptual response of the person to the various aspects of death, which are based on individual psychosocial and cultural experience.Regenerative Medicine: A field of medicine concerned with developing and using strategies aimed at repair or replacement of damaged, diseased, or metabolically deficient organs, tissues, and cells via TISSUE ENGINEERING; CELL TRANSPLANTATION; and ARTIFICIAL ORGANS and BIOARTIFICIAL ORGANS and tissues.Genetic Predisposition to Disease: A latent susceptibility to disease at the genetic level, which may be activated under certain conditions.Models, Animal: Non-human animals, selected because of specific characteristics, for use in experimental research, teaching, or testing.Genetic Testing: Detection of a MUTATION; GENOTYPE; KARYOTYPE; or specific ALLELES associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing.Models, Molecular: Models used experimentally or theoretically to study molecular shape, electronic properties, or interactions; includes analogous molecules, computer-generated graphics, and mechanical structures.Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc.Tissue Engineering: Generating tissue in vitro for clinical applications, such as replacing wounded tissues or impaired organs. The use of TISSUE SCAFFOLDING enables the generation of complex multi-layered tissues and tissue structures.Image Processing, Computer-Assisted: A technique of inputting two-dimensional images into a computer and then enhancing or analyzing the imagery into a form that is more useful to the human observer.Molecular Sequence Data: Descriptions of specific amino acid, carbohydrate, or nucleotide sequences which have appeared in the published literature and/or are deposited in and maintained by databanks such as GENBANK, European Molecular Biology Laboratory (EMBL), National Biomedical Research Foundation (NBRF), or other sequence repositories.Gene Expression Regulation: Any of the processes by which nuclear, cytoplasmic, or intercellular factors influence the differential control (induction or repression) of gene action at the level of transcription or translation.Sensitivity and Specificity: Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)Epigenesis, Genetic: A genetic process by which the adult organism is realized via mechanisms that lead to the restriction in the possible fates of cells, eventually leading to their differentiated state. Mechanisms involved cause heritable changes to cells without changes to DNA sequence such as DNA METHYLATION; HISTONE modification; DNA REPLICATION TIMING; NUCLEOSOME positioning; and heterochromatization which result in selective gene expression or repression.Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly.Genetic Diseases, Inborn: Diseases that are caused by genetic mutations present during embryo or fetal development, although they may be observed later in life. The mutations may be inherited from a parent's genome or they may be acquired in utero.History, 18th Century: Time period from 1701 through 1800 of the common era.Genome: The genetic complement of an organism, including all of its GENES, as represented in its DNA, or in some cases, its RNA.Disease: A definite pathologic process with a characteristic set of signs and symptoms. It may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown.Stem Cell Transplantation: The transfer of STEM CELLS from one individual to another within the same species (TRANSPLANTATION, HOMOLOGOUS) or between species (XENOTRANSPLANTATION), or transfer within the same individual (TRANSPLANTATION, AUTOLOGOUS). The source and location of the stem cells determines their potency or pluripotency to differentiate into various cell types.Genome, Human: The complete genetic complement contained in the DNA of a set of CHROMOSOMES in a HUMAN. The length of the human genome is about 3 billion base pairs.Neurobiology: The study of the structure, growth, activities, and functions of NEURONS and the NERVOUS SYSTEM.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism.Genetic Variation: Genotypic differences observed among individuals in a population.Technology: The application of scientific knowledge to practical purposes in any field. It includes methods, techniques, and instrumentation.Tomography, X-Ray Computed: Tomography using x-ray transmission and a computer algorithm to reconstruct the image.Models, Genetic: Theoretical representations that simulate the behavior or activity of genetic processes or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.High-Throughput Nucleotide Sequencing: Techniques of nucleotide sequence analysis that increase the range, complexity, sensitivity, and accuracy of results by greatly increasing the scale of operations and thus the number of nucleotides, and the number of copies of each nucleotide sequenced. The sequencing may be done by analysis of the synthesis or ligation products, hybridization to preexisting sequences, etc.Palliative Care: Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed)Pharmacogenetics: A branch of genetics which deals with the genetic variability in individual responses to drugs and drug metabolism (BIOTRANSFORMATION).Systems Biology: Comprehensive, methodical analysis of complex biological systems by monitoring responses to perturbations of biological processes. Large scale, computerized collection and analysis of the data are used to develop and test models of biological systems.Plants: Multicellular, eukaryotic life forms of kingdom Plantae (sensu lato), comprising the VIRIDIPLANTAE; RHODOPHYTA; and GLAUCOPHYTA; all of which acquired chloroplasts by direct endosymbiosis of CYANOBACTERIA. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (MERISTEMS); cellulose within cells providing rigidity; the absence of organs of locomotion; absence of nervous and sensory systems; and an alternation of haploid and diploid generations.Genetics, Medical: A subdiscipline of human genetics which entails the reliable prediction of certain human disorders as a function of the lineage and/or genetic makeup of an individual or of any two parents or potential parents.Nanoparticles: Nanometer-sized particles that are nanoscale in three dimensions. They include nanocrystaline materials; NANOCAPSULES; METAL NANOPARTICLES; DENDRIMERS, and QUANTUM DOTS. The uses of nanoparticles include DRUG DELIVERY SYSTEMS and cancer targeting and imaging.Biological Evolution: The process of cumulative change over successive generations through which organisms acquire their distinguishing morphological and physiological characteristics.Drug Therapy: The use of DRUGS to treat a DISEASE or its symptoms. One example is the use of ANTINEOPLASTIC AGENTS to treat CANCER.Mass Spectrometry: An analytical method used in determining the identity of a chemical based on its mass using mass analyzers/mass spectrometers.Terminology as Topic: The terms, expressions, designations, or symbols used in a particular science, discipline, or specialized subject area.Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system.Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function that leads to the formation of specialized cells, tissues, and organs.Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system.Imaging, Three-Dimensional: The process of generating three-dimensional images by electronic, photographic, or other methods. For example, three-dimensional images can be generated by assembling multiple tomographic images with the aid of a computer, while photographic 3-D images (HOLOGRAPHY) can be made by exposing film to the interference pattern created when two laser light sources shine on an object.Models, Theoretical: Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Patient Rights: Fundamental claims of patients, as expressed in statutes, declarations, or generally accepted moral principles. (Bioethics Thesaurus) The term is used for discussions of patient rights as a group of many rights, as in a hospital's posting of a list of patient rights.Proteome: The protein complement of an organism coded for by its genome.Nervous System Diseases: Diseases of the central and peripheral nervous system. This includes disorders of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscle.Biomedical Technology: The application of technology to the solution of medical problems.Biological Therapy: Treatment of diseases with biological materials or biological response modifiers, such as the use of GENES; CELLS; TISSUES; organs; SERUM; VACCINES; and humoral agents.Suprachiasmatic Nucleus: An ovoid densely packed collection of small cells of the anterior hypothalamus lying close to the midline in a shallow impression of the OPTIC CHIASM.Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the NERVOUS SYSTEM.Technology, Dental: The field of dentistry involved in procedures for designing and constructing dental appliances. It includes also the application of any technology to the field of dentistry.Biological Products: Complex pharmaceutical substances, preparations, or matter derived from organisms usually obtained by biological methods or assay.Drugs, Investigational: Drugs which have received FDA approval for human testing but have yet to be approved for commercial marketing. This includes drugs used for treatment while they still are undergoing clinical trials (Treatment IND). The main heading includes drugs under investigation in foreign countries.Evidence-Based Medicine: An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006)User-Computer Interface: The portion of an interactive computer program that issues messages to and receives commands from a user.Immunity, Innate: The capacity of a normal organism to remain unaffected by microorganisms and their toxins. It results from the presence of naturally occurring ANTI-INFECTIVE AGENTS, constitutional factors such as BODY TEMPERATURE and immediate acting immune cells such as NATURAL KILLER CELLS.Genetic Techniques: Chromosomal, biochemical, intracellular, and other methods used in the study of genetics.Third-Party Consent: Informed consent given by someone other than the patient or research subject.Host-Pathogen Interactions: The interactions between a host and a pathogen, usually resulting in disease.National Institutes of Health (U.S.): An operating division of the US Department of Health and Human Services. It is concerned with the overall planning, promoting, and administering of programs pertaining to health and medical research. Until 1995, it was an agency of the United States PUBLIC HEALTH SERVICE.Infant, Newborn: An infant during the first month after birth.Internet: A loose confederation of computer communication networks around the world. The networks that make up the Internet are connected through several backbone networks. The Internet grew out of the US Government ARPAnet project and was designed to facilitate information exchange.Allergy and Immunology: A medical specialty concerned with the hypersensitivity of the individual to foreign substances and protection from the resultant infection or disorder.Stem Cells: Relatively undifferentiated cells that retain the ability to divide and proliferate throughout postnatal life to provide progenitor cells that can differentiate into specialized cells.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Regeneration: The physiological renewal, repair, or replacement of tissue.Euthanasia: The act or practice of killing or allowing death from natural causes, for reasons of mercy, i.e., in order to release a person from incurable disease, intolerable suffering, or undignified death. (from Beauchamp and Walters, Contemporary Issues in Bioethics, 5th ed)Communicable DiseasesBiomedical Engineering: Application of principles and practices of engineering science to biomedical research and health care.Photoperiod: The time period of daily exposure that an organism receives from daylight or artificial light. It is believed that photoperiodic responses may affect the control of energy balance and thermoregulation.Cardiology: The study of the heart, its physiology, and its functions.Oligonucleotide Array Sequence Analysis: Hybridization of a nucleic acid sample to a very large set of OLIGONUCLEOTIDE PROBES, which have been attached individually in columns and rows to a solid support, to determine a BASE SEQUENCE, or to detect variations in a gene sequence, GENE EXPRESSION, or for GENE MAPPING.Microfluidics: The study of fluid channels and chambers of tiny dimensions of tens to hundreds of micrometers and volumes of nanoliters or picoliters. This is of interest in biological MICROCIRCULATION and used in MICROCHEMISTRY and INVESTIGATIVE TECHNIQUES.Positron-Emission Tomography: An imaging technique using compounds labelled with short-lived positron-emitting radionuclides (such as carbon-11, nitrogen-13, oxygen-15 and fluorine-18) to measure cell metabolism. It has been useful in study of soft tissues such as CANCER; CARDIOVASCULAR SYSTEM; and brain. SINGLE-PHOTON EMISSION-COMPUTED TOMOGRAPHY is closely related to positron emission tomography, but uses isotopes with longer half-lives and resolution is lower.Cell- and Tissue-Based Therapy: Therapies that involve the TRANSPLANTATION of CELLS or TISSUES developed for the purpose of restoring the function of diseased or dysfunctional cells or tissues.Immune System: The body's defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components.Lab-On-A-Chip Devices: Microdevices that combine microfluidics technology with electrical and/or mechanical functions for analyzing very small fluid volumes. They consist of microchannels etched into substrates made of silicon, glass, or polymer using processes similar to photolithography. The test fluids in the channels can then interact with different elements such as electrodes, photodetectors, chemical sensors, pumps, and valves.High-Throughput Screening Assays: Rapid methods of measuring the effects of an agent in a biological or chemical assay. The assay usually involves some form of automation or a way to conduct multiple assays at the same time using sample arrays.Medical Futility: The absence of a useful purpose or useful result in a diagnostic procedure or therapeutic intervention. The situation of a patient whose condition will not be improved by treatment or instances in which treatment preserves permanent unconsciousness or cannot end dependence on intensive medical care. (From Ann Intern Med 1990 Jun 15;112(12):949)Informed Consent: Voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment.Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level.Epigenomics: The systematic study of the global gene expression changes due to EPIGENETIC PROCESSES and not due to DNA base sequence changes.Patient Preference: Individual's expression of desirability or value of one course of action, outcome, or selection in contrast to others.Societies, Scientific: Societies whose membership is limited to scientists.Synthetic Biology: A field of biological research combining engineering in the formulation, design, and building (synthesis) of novel biological structures, functions, and systems.World Health: The concept pertaining to the health status of inhabitants of the world.Aging: The gradual irreversible changes in structure and function of an organism that occur as a result of the passage of time.Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form.Toxicology: The science concerned with the detection, chemical composition, and biological action of toxic substances or poisons and the treatment and prevention of toxic manifestations.Drug Evaluation, Preclinical: Preclinical testing of drugs in experimental animals or in vitro for their biological and toxic effects and potential clinical applications.Radiobiology: Study of the scientific principles, mechanisms, and effects of the interaction of ionizing radiation with living matter. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)Microscopy: The use of instrumentation and techniques for visualizing material and details that cannot be seen by the unaided eye. It is usually done by enlarging images, transmitted by light or electron beams, with optical or magnetic lenses that magnify the entire image field. With scanning microscopy, images are generated by collecting output from the specimen in a point-by-point fashion, on a magnified scale, as it is scanned by a narrow beam of light or electrons, a laser, a conductive probe, or a topographical probe.Nanostructures: Materials which have structured components with at least one dimension in the range of 1 to 100 nanometers. These include NANOCOMPOSITES; NANOPARTICLES; NANOTUBES; and NANOWIRES.Bacteria: One of the three domains of life (the others being Eukarya and ARCHAEA), also called Eubacteria. They are unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. Bacteria can be classified by their response to OXYGEN: aerobic, anaerobic, or facultatively anaerobic; by the mode by which they obtain their energy: chemotrophy (via chemical reaction) or PHOTOTROPHY (via light reaction); for chemotrophs by their source of chemical energy: CHEMOLITHOTROPHY (from inorganic compounds) or chemoorganotrophy (from organic compounds); and by their source for CARBON; NITROGEN; etc.; HETEROTROPHY (from organic sources) or AUTOTROPHY (from CARBON DIOXIDE). They can also be classified by whether or not they stain (based on the structure of their CELL WALLS) with CRYSTAL VIOLET dye: gram-negative or gram-positive.Right to Die: The right of the patient or the patient's representative to make decisions with regard to the patient's dying.History, 17th Century: Time period from 1601 through 1700 of the common era.Phylogeny: The relationships of groups of organisms as reflected by their genetic makeup.Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas).Human Genome Project: A coordinated effort of researchers to map (CHROMOSOME MAPPING) and sequence (SEQUENCE ANALYSIS, DNA) the human GENOME.Urogenital Neoplasms: Tumors or cancer of the UROGENITAL SYSTEM in either the male or the female.Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form.Diagnostic Techniques, Digestive System: Methods and procedures for the diagnosis of diseases or dysfunction of the digestive system or its organs or demonstration of their physiological processes.Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the ENDOCRINE SYSTEM.Genome-Wide Association Study: An analysis comparing the allele frequencies of all available (or a whole GENOME representative set of) polymorphic markers in unrelated patients with a specific symptom or disease condition, and those of healthy controls to identify markers associated with a specific disease or condition.Research Support as Topic: Financial support of research activities.Randomized Controlled Trials as Topic: Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.Environment: The external elements and conditions which surround, influence, and affect the life and development of an organism or population.Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function.Biosensing Techniques: Any of a variety of procedures which use biomolecular probes to measure the presence or concentration of biological molecules, biological structures, microorganisms, etc., by translating a biochemical interaction at the probe surface into a quantifiable physical signal.Tumor Markers, Biological: Molecular products metabolized and secreted by neoplastic tissue and characterized biochemically in cells or body fluids. They are indicators of tumor stage and grade as well as useful for monitoring responses to treatment and predicting recurrence. Many chemical groups are represented including hormones, antigens, amino and nucleic acids, enzymes, polyamines, and specific cell membrane proteins and lipids.Genetic Vectors: DNA molecules capable of autonomous replication within a host cell and into which other DNA sequences can be inserted and thus amplified. Many are derived from PLASMIDS; BACTERIOPHAGES; or VIRUSES. They are used for transporting foreign genes into recipient cells. Genetic vectors possess a functional replicator site and contain GENETIC MARKERS to facilitate their selective recognition.Biocompatible Materials: Synthetic or natural materials, other than DRUGS, that are used to replace or repair any body TISSUES or bodily function.Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining PROTEIN CONFORMATION.Genotype: The genetic constitution of the individual, comprising the ALLELES present at each GENETIC LOCUS.Patient Care Planning: Usually a written medical and nursing care program designed for a particular patient.MicroRNAs: Small double-stranded, non-protein coding RNAs, 21-25 nucleotides in length generated from single-stranded microRNA gene transcripts by the same RIBONUCLEASE III, Dicer, that produces small interfering RNAs (RNA, SMALL INTERFERING). They become part of the RNA-INDUCED SILENCING COMPLEX and repress the translation (TRANSLATION, GENETIC) of target RNA by binding to homologous 3'UTR region as an imperfect match. The small temporal RNAs (stRNAs), let-7 and lin-4, from C. elegans, are the first 2 miRNAs discovered, and are from a class of miRNAs involved in developmental timing.Gastrointestinal Tract: Generally refers to the digestive structures stretching from the MOUTH to ANUS, but does not include the accessory glandular organs (LIVER; BILIARY TRACT; PANCREAS).Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells.Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis.Personhood: The state or condition of being a human individual accorded moral and/or legal rights. Criteria to be used to determine this status are subject to debate, and range from the requirement of simply being a human organism to such requirements as that the individual be self-aware and capable of rational thought and moral agency.Patient Self-Determination Act: The purpose of this 1990 federal act is to assure that individuals receiving health care services will be given an opportunity to participate in and direct health care decisions affecting themselves. Under this act, hospitals, health care agencies, and health maintenance organizations are responsible for developing patient information for distribution. The information must include patients' rights, advance directives, living wills, ethics committees' consultation and education functions, limited medical treatment (support/comfort care only), mental health treatment, resuscitation, restraints, surrogate decision making and transfer of care. (from JCAHO, Lexicon, 1994)DNA: A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine).Databases, Genetic: Databases devoted to knowledge about specific genes and gene products.Practice Guidelines as Topic: Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.Evolution, Molecular: The process of cumulative change at the level of DNA; RNA; and PROTEINS, over successive generations.Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., BIOPOLYMERS; PLASTICS).Animal Experimentation: The use of animals as investigational subjects.Single-Cell Analysis: Assaying the products of or monitoring various biochemical processes and reactions in an individual cell.Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa), antigenic proteins, synthetic constructs, or other bio-molecular derivatives, administered for the prevention, amelioration, or treatment of infectious and other diseases.Models, Statistical: Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc.Virus Diseases: A general term for diseases produced by viruses.Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process.
(1/172) Autonomy, liberalism and advance care planning.

The justification for advance directives is grounded in the notion that they extend patient autonomy into future states of incompetency through patient participation in decision making about end-of-life care. Four objections challenge the necessity and sufficiency of individual autonomy, perceived to be a defining feature of liberal philosophical theory, as a basis of advance care planning. These objections are that the liberal concept of autonomy (i) implies a misconception of the individual self, (ii) entails the denial of values of social justice, (iii) does not account for justifiable acts of paternalism, and (iv) does not account for the importance of personal relationships in the advance care planning process. The last objection is especially pertinent in light of recent empirical research highlighting the importance of personal relationships in advance care planning. This article examines these four objections to autonomy, and the liberal theoretical framework with which it is associated, in order to re-evaluate the philosophical basis of advance care planning. We argue that liberal autonomy (i) is not a misconceived concept as critics assume, (ii) does not entail the denial of values of social justice, (iii) can account for justifiable acts of paternalism, though it (iv) is not the best account of the value of personal relationships that arise in advance care planning. In conclusion, we suggest that liberalism is a necessary component of a theoretical framework for advance care planning but that it needs to be supplemented with theories that focus explicitly on the significance of personal relationships.  (+info)

(2/172) The value of taking an 'ethics history'.

OBJECTIVES: To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement. DESIGN: Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds. SETTING: A large district general hospital in the United Kingdom. MAIN MEASURES: To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives. RESULTS: Twenty-four (43%) were inadequately informed of their illness. Forty-six (82%) said they would want to know were something serious to be found. Twenty-eight (50%) wanted to make their own decision if requiring risky treatment and 11 (20%) wanted family members involved. Thirty-one (55%) wanted to make a cardiopulmonary resuscitation (CPR) decision and five of these decisions differed from those made by the doctors. Twenty-five (45%) preferred the doctors to decide. Eleven (20%) of the patients had heard of living wills but only one had executed such a will. Seven (13%) of the patients wished to provide advance directives. Three (5%) did not find the history taking helpful but none were discomforted. CONCLUSION: Taking an ethics history is a simple means of obtaining useful information about patients' preferences.  (+info)

(3/172) Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients.

BACKGROUND: There has been little research on the potential value of palliative care for dialysis patients. In this pilot study, we sought (i) to identify symptom burden, health-related quality of life (HRQoL) and advance directives in extremely ill haemodialysis patients to determine their suitability for palliative care and (ii) to determine the acceptability of palliative care to patients and nephrologists. METHODS: Nineteen haemodialysis patients with modified Charlson co-morbidity scores of > or =8 were recruited. Each completed surveys to assess symptom burden, HRQoL and prior advance care planning. Palliative care specialists then visited patients twice and generated recommendations. Patients again completed the surveys, and dialysis charts were reviewed to assess nephrologists' (i) compliance with recommendations and (ii) documentation of symptoms reported by patients on the symptom assessment survey. Patients and nephrologists then completed surveys assessing their satisfaction with palliative care. RESULTS: Patients reported 10.5 symptoms, 40% of which were noted by nephrologists in patients' charts. HRQoL was significantly impaired. Thirty-two percent of patients had living wills. No differences were observed in symptoms, HRQoL or number of patients establishing advance directives as a result of the intervention. Sixty-eight percent of patients and 76% of nephrologists rated the intervention worthwhile. CONCLUSIONS: Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population.  (+info)

(4/172) Advance care planning in nursing homes: correlates of capacity and possession of advance directives.

PURPOSE: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. DESIGN AND METHODS: The authors used cross-sectional, cohort study between 1997 and 1999. Seventy-eight residents (M age = 83.97, SD = 8.2) and their proxies (M age = 59.23, SD = 11.77) were included across five nursing homes. The authors obtained data via chart review, proxy interviews, resident assessments, survey completion by certified nursing assistants, and direct observation of residents' daily behaviors. RESULTS: Capacity assessments revealed that most residents could state a simple treatment preference (82.4%), but a sizable number did not retain capacity to understand treatment alternatives or appreciate the consequences of their choice. Global cognitive ability (Mini-Mental State Examination score) was related to understanding and appreciation. When the authors removed the effects of global cognitive ability, understanding and appreciation were related to time spent by residents in verbal interaction with others. Residents were more likely to possess advance directives when proxies possessed advance directives, proxies were less religious, and residents were socially engaged. IMPLICATIONS: Assessment of proxy beliefs and direct determination of residents' decisional capacity and social engagement may help nursing home staff identify families who may participate in advance planning for end-of-life medical care. Measures of global cognitive ability offer limited information about resident capacity for decision making. Decisional capacity assessments should enhance the verbal ability of individuals with dementia by reducing reliance on memory in the assessment process. Interventions to engage residents and families in structured discussions for end-of-life planning are needed.  (+info)

(5/172) Chronic obstructive pulmonary disease: the last year of life.

Nearly one quarter million Americans die with or of advanced chronic obstructive pulmonary disease (COPD) each year. Many patients die after a prolonged functional decline that is accompanied by much suffering. Though difficult prognostically and emotionally, anticipation of death opens the door to planning and preparing for terminal care. Epidemiologists have begun to identify characteristics of COPD patients who are most likely to die within 6-12 months, including severe, irreversible airflow obstruction, severely impaired and declining exercise capacity and performance status, older age, concomitant cardiovascular or other co-morbid disease, and a history of recent hospitalizations for acute care. Clinicians are encouraged to raise the difficult subject of planning for death when many of these characteristics apply. Patients with far-advanced disease are often receptive to the recommendation of a dual agenda: "Hope for and expect the best, and prepare for the worst." Medical advance planning is best pursued in an out-patient office during a prescheduled, 3-way conversation between patient, health care proxy, and physician. An advance directive can be written after the meeting to summarize the conversation. Clinicians should consider recommending hospice care when a COPD patient is at high risk of respiratory failure from the next chest infection and in need of frequent or specialized home care. Preparation for death should include a realistic appraisal of the prospects for dying peacefully at home and a contingency plan for terminal hospitalization, should the need arise.  (+info)

(6/172) Patient-physician communication about end-of-life care for patients with severe COPD.

Since patients with chronic obstructive pulmonary disease (COPD) infrequently discuss treatment preferences about end-of-life care with physicians, the goal of the present study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians, and how patients rate the quality of this communication. A total of 115 patients with oxygen-dependent COPD, identified in pulmonary clinics in three hospitals and through an oxygen delivery company, were enrolled in this study. A 17-item quality of communication questionnaire (QOC) was administered to patients, along with other measures, including satisfaction with care. The patients reported that most physicians do not discuss how long the patients have to live, what dying might be like or patients' spirituality. Patients rated physicians highly at listening and answering questions. Areas patients rated relatively low included discussing prognosis, what dying might be like and spirituality/religion. Patients' assessments of physicians' overall communication and communication about treatment correlated well with the QOC. Patients' overall satisfaction with care also correlated significantly with the QOC. In conclusion, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with chronic obstructive pulmonary disease. Future studies should determine the responsiveness of these items to interventions, and the effect such interventions have on patient satisfaction and quality of care.  (+info)

(7/172) Relatives' knowledge of decision making in intensive care.

BACKGROUND/AIM: The law on consent has changed in Scotland with the introduction of the Adults with Incapacity (Scotland) Act 2000. This Act introduces the concept of proxy consent in Scotland. Many patients in intensive care are unable to participate in the decision making process because of their illness and its treatment. It is normal practice to provide relatives with information on the patient's condition, treatment, and prognosis as a substitute for discussion directly with the patient. The relatives of intensive care patients appeared to believe that they already had the right to consent on behalf of an incapacitated adult. The authors' aim was to assess the level of knowledge among relatives of intensive care patients of both the old and new law using a structured questionnaire. METHODS: The next of kin of 100 consecutive patients completed a structured questionnaire. Each participant had the questions read to them and their answers recorded. Patients were not involved in the study. RESULTS: Few (10%) were aware of the changes. Most (88%) thought that they previously could give consent on behalf of an incapacitated adult. Only 13% have ever discussed the preferences for life sustaining treatment with the patient but 84% felt that they could accurately represent the patient's wishes. CONCLUSIONS: There appeared to be a lack of public awareness of the impending changes. The effectiveness of the Act at improving the care of the mentally incapacitated adult will depend largely on how successful it is at encouraging communication and decision making in advance of incapacity occurring.  (+info)

(8/172) Advance care planning and end of life decision making.

BACKGROUND: Aging populations with greater rates of cognitive decline demand increased attention to the issues of end of life decision making and advance care planning (ACP). Legislatures have passed statutes that recognise the necessity for both substitute decision making and the declaration in advance of wishes relating to health care. OBJECTIVE: This article discusses ACP and the role of the general practitioner. DISCUSSION: Advance care planning provides patients, relatives and doctors with greater confidence about the future. There is good evidence that patients desire to discuss end of life care, and GPs are in a good position to engage their patients in considering the issues. They have a responsibility to confirm the decision making capacity of patients who write advance health directive documents, to inform and educate their patients about future health care, and to keep the ACP conversation going.  (+info)

*  Advance healthcare directive
... advancecareplanning.org.au/advance-care-planning/for-professionals/the-law-of-advance-care-planning "Health Canada- Minister's ... However, the same polls show that only about 13% have actually done so, or have created an advance care plan for themselves. A ... "National Framework for advance care planning". SpeakUp. 2014. Archived from the original on 2014-11-28. Retrieved 2014-11-18. " ... Much of the current focus in Canada is on advance care planning which involves encouraging individuals to reflect on and ...
*  Advance care planning
... is a process that enables individuals to make plans about their future health care. Advance care plans ... Advance care planning is applicable to all adults in all stages of life. Advance care planning aims to allow people to live ... Advance care planning is applicable to adults at all stages of life. Participation in advance care planning has been shown to ... "The benefits of advance care planning". Advance Care Planning Australia. Archived from the original on 2014-01-26. Retrieved 16 ...
*  Physician Orders for Life-Sustaining Treatment
"Improving Advanced Illness Care: The Evolution of State POLST Programs"" (PDF). April 2011. "AAHPM: Advance Care Planning". ... To designate a health care surrogate, patients must use an advance directive. An advance directive allows you to generally ... represents a significant paradigm change in advance care policy by standardizing provider communications through a plan of care ... An advance directive is a legal document that allows you to share your wishes with your health care team if you can't speak for ...
*  America's Affordable Health Choices Act of 2009
This Advance Care Planning Consultation section was criticized by some Republicans and conservatives such as Betsy McCaughey, a ... 1] "Section 1233 - Advance Care Planning Consultation". En.wikisource.org. Retrieved 2009-09-20. "Social Security Act §1861". ... "America's Health Insurance Plans", a lobbyist group, opposed the bill. 'Americans for Stable Quality Care' is an activist group ... Text of S. 466 110th: Medicare End-of-Life Care Planning Act of 2007 Ezra Klein, August 10, 2009, The Washington Post, Is the ...
*  Robert Staddon (swimmer)
"Advance Care Planning - A Family's Journey" (PDF). Planning Ahead Tools. Retrieved 17 July 2012. Results for Staddon from the ... He became the first quadriplegic in Australia to gain an advanced open water diving certificate and a coxwain's certificate. At ...
*  Patient Self-Determination Act
Advance Care Planning in Health Care Reform Legislation. National Hospice and Paliative Care Organization. Robert Pear ( ... Facilities must provide education to their staff and affiliates about advance health care directives. Health care providers are ... to make an advance health care directive Facilities must inquire as to whether the patient already has an advance health care ... and other health care institutions to provide information about advance health care directives to adult patients upon their ...
*  Life Matters Media
"Advance care planning among seniors of a diverse city". Journal of Clinical Oncology. ISSN 0732-183X. "Death and beer: ... and advance health care planning. According to the organization, end of life decisions should be considered carefully, and ... sometimes accompanied by other end of life care experts, help seniors consider their own end of life care preferences and ... He came into the care of Mulcahy, a medical oncologist at Northwestern Memorial Hospital in Chicago. Though Mulcahy always told ...
*  MyDirectives
... and Coordinated Care Oklahoma have partnered with MyDirectives as the chosen advance care plan platform for their members. ... The app makes a user's advance care plan accessible to healthcare providers even when an iPhone is locked, ensuring the user's ... partners with advance care planning company ADVault Inc. for living will app - Louisville - Louisville Business First". ... MyDirectives.com offers conversation starters and guidance for users on how to discuss advance care planning wishes with family ...
*  Partnership HealthPlan of California
Offering and Honoring Choices, promoting advance care planning and palliative care. Telehealth EConsult Social determinants of ... California portal Health portal Health care L.A. Care Health Plan Association for Community Affiliated Plans Kevin Green (July ... "DHCS selects health plans for rural expansion of Medi-Cal managed care". California Medical Association. Retrieved 21 February ... It began operations as a County Organized Health System in 1994, and is currently the largest Medi-Cal Managed Care Plan in ...
*  Julian Gardner (lawyer)
Director, Advance Care Planning and End of Life Care Ltd, since 2011. Chair, National Reference Group, Respecting Patients ...
*  Health care reforms proposed during the Obama administration
Advance care planning for serious illness," Health Affairs Policy Brief, August 20, 2009. President Barack Obama, President's ... who provide universal health care including preventative care, found that they could lower their total health care expenditures ... Beam, Christopher (October 14, 2009). "Do I have a "Cadillac Plan"? An Explainer health care FAQ". Slate. Jon Gabel, Jeremy ... Under the new health care reform, Latinos were expected to be major beneficiaries of the new health care law. Gallup found that ...
*  Gundersen Health System
Community Advance Care Planning Course. Today, it uses an evidence-based model to communicate patient's wishes for care, ... 2005-2006) Gundersen Health System Gundersen Medical Foundation Respecting Choices® Advance Care Planning. ... Pulmonary Care, General Surgery Gastrointestinal (GI) Care, and Critical Care. In 1991, leaders of Gundersen pioneered the ... of Medical Humanities and Respecting Choices at Gundersen Health System and one of the inventors of the advance-care planning ...
*  Percutaneous endoscopic gastrostomy
"White Paper on Surrogate Decision-Making and Advance Care Planning in Long-Term Care". American Medical Directors Association ... In advanced dementia, studies show that PEG placement does not in fact prolong life. Instead, oral assisted feedings are ... As with other types of feeding tubes, care must be made to place PEGs into an appropriate population. The following are ... AMDA - The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should ...
*  Do not resuscitate
The correlation between preferences against life-prolonging care and the increased likelihood of advance care planning is ... It does not apply to palliative care (reasonable pain relief; food and drink). An Advanced Care Directive legally defines the ... A key to reducing ethnic/racial disparities in advance care planning?. Cancer (0008543X) [serial online]. December 15, 2014;120 ... and the decision to move to purely palliative care. Medicine portal Advance Health Care Directive Cardiac arrest Power of ...
*  Chuck Grassley
... and advising the beneficiary regarding advanced care planning." In December 2009, he voted against the Patient Protection and ... including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care ... Grassley has been critical of the Affordable Care Act but does not believe the law can be completely repealed. He believes some ... Charles Grassley plans new whistleblower-protection caucus". Washington Post. Archived from the original on April 16, 2014. ...
*  Helen Polley
... which is possible with advance care planning and a first-rate palliative care system. Polley believes that body image and the ... better palliative care services across Tasmania so that Tasmanians who receive palliative care receive the best possible care. ... Women who are not psychologically, emotionally or financially equipped to take care of their babies. Government must act to ... and then as Parliamentary Secretary for Aged Care from 2013 to 2016. Polley has been a staunch advocate for the initial rollout ...
*  Karen Ann Quinlan
... Hospice Karen Ann Quinlan at Find a Grave Sabatino, Charles P. "Advance Directives and Advance Care Planning ...
*  Ira Byock
Data-driven, community-based quality improvement in advance care planning, health care and social services Volunteer and ... Fins JJ, Maltby BS, Friedmann E, Greene MG, Norris K, Adelman R, Byock I: Contracts, covenants and advance care planning: An ... End-of-life care: A public health crisis and an opportunity for managed care. Am J Manage Care 2001 Dec;7(12):1123-1132. Byock ... Improving palliative care in intensive care units: Identifying strategies and interventions that work. Crit Care Med 2006 ...
*  Nephrology
... health education and advanced care planning play key roles in nephrology. Chronic kidney disease is typically managed with ... The ISN is the largest global society representing medical professionals engaged in advancing kidney care worldwide. In the USA ... Nephrology requires additional training to become an expert with advanced skills. Nephrologists may provide care to people ... "Homepage". Kidney Care UK. Retrieved 2017-12-12. American Kidney Fund International Society of Nephrology, a global ...
*  Mark Siegler
Advance Care Planning and Outcomes. Chest 1996; 110:249-55. Singer PA, Siegler M. Clinical ethics in the practice of medicine. ... Intimacy and caring: The legacy of Karen Ann Quinlan. Trends in Health Care, Law, and Ethics. 1993; 8(1):28-30. Daugherty C, ... Advances in Internal Medicine. 1991; 57-79. Siegler M. A medicine of strangers or a medicine of intimates: The two legacies of ... Responsibility in Health Care. Boston and Dordrecht, Holland: D. Reidel, 1982; 141-62. Childress JF, Siegler M. Metaphors and ...
*  Terminal illness
"Advance Care Planning, Preferences for Care at the End of Life , AHRQ Archive". archive.ahrq.gov. Retrieved 2017-10-24. Qaseem ... "Advance Care Planning, Preferences for Care at the End of Life , AHRQ Archive". archive.ahrq.gov. Retrieved 2017-10-24. Qaseem ... "Advance Care Planning, Preferences for Care at the End of Life , AHRQ Archive". archive.ahrq.gov. Retrieved 2017-10-24. Qaseem ... they have more time to prepare advance care planning, such as advance directives and living wills, which have been shown to ...
*  Society for the Promotion of Hospice Care
... educate and empower the public about the importance of advance care planning Raise public awareness of issues relating to death ... dying and end-of-life care Provide the highest quality patient-and-family centred care to those with life-limiting illnesses, ... The Society for the Promotion of Hospice Care ('SPHC') believes that everyone has the right to live with dignity at every turn ... Established in 1986, the Society for the Promotion of Hospice Care (Chinese: 善寧會) is a non-profit organisation in Hong Kong ...
*  Allina Health
Provides services including Care Navigation Help Desk, Advance care planning, Palliative care, Hospice care, & SeniorCare ... Allina Home Care provides support, knowledge and assistance to help keep patients independent in the comfort of home. ... Allina Health is a not-for-profit health care system based in Minneapolis, Minnesota. Allina owns or operates 13 hospitals and ... Clinic Aspen Medical Group and Quello Clinic are now Allina Health Clinics Abbott Northwestern Center for Outpatient Care Edina ...
*  University of Toronto Joint Centre for Bioethics
... patient-centered model of quality end-of-life care, developing a new model of advance care planning, including living wills, ... The goal of this program is to create a national network of health care providers trained to care for terminally ill patients. ... Temmy Latner Centre for Palliative Care) that aimed to train 10,000 physicians in end-of-life care. Although the program is no ... Error is not uncommon in health care and can have adverse outcomes. The response to error can be in the terms of disclosure and ...
*  Caregiver
Advance care planning should note if a patient is using a implantable cardioverter-defibrillator (ICD) and give instructions ... Without this home-care, most of these cared for loved ones would require permanent placement in institutions or health care ... A fundamental part of giving care is being a good communicator with the person getting care. Care is given with respect for the ... Godfrey, C.M., Harrison, M.B., Lysaght, R., Lamb, M., Graham, I., & Oakley, P. (2011). Care of self - care by other - care of ...
*  New Melones Dam
... he had written letters to the Corps and Governor Jerry Brown telling them of his plans in advance. Ultimately, dam operators ... Wyatt, Dennis (2016-06-14). "Deal avoids water war: Farms, fish & cities taken care of for year". Manteca Bulletin. ,access- ... This plan has been met with outcry from local cities and irrigation districts, which contend that it would heavily damage the ... Originally, Reclamation had planned to extend the water supply to other users, but even from the start, the Melones Project was ...
The Mental Capacity Act and Advanced Care Planning Discussions Tickets, Thu, 5 Jul 2018 at 09:30 | Eventbrite  The Mental Capacity Act and Advanced Care Planning Discussions Tickets, Thu, 5 Jul 2018 at 09:30 | Eventbrite
North Devon Hospice presents The Mental Capacity Act and Advanced Care Planning Discussions - Thursday, 5 July 2018 at North ... The Mental Capacity Act and Advanced Care Planning Discussions at North Devon Hospice Deer Park Rumsam Road, Barnstaple, EX32 ... The Mental Capacity Act and Advanced Care Planning Discussions. by North Devon Hospice ... recognise and know how to use the Code of Practice and Advance Care Planning documentation, as well as develop skills to open ...
more infohttps://www.eventbrite.co.uk/e/the-mental-capacity-act-and-advanced-care-planning-discussions-tickets-41577019986
Advance Directives | FirstHealth  Advance Directives | FirstHealth
Advance Care Planning Choices: Make them yours, and make them known.. An advance directive gives your family direction on what ... The time to think about and communicate your advance care planning wishes is while you and your loved ones are able to discuss ... What are Advance Directives?. Advance Directives are planning documents that legally ensure your wishes are carried out and ... Advance directives DO NOT sign away your right to medical treatment or put you at risk of being denied medical care. ...
more infohttps://www.firsthealth.org/reference/patient-education/advance-directives
Superseding Psychiatric Advance Directives: Ethical and Legal Considerations | Journal of the American Academy of Psychiatry...  Superseding Psychiatric Advance Directives: Ethical and Legal Considerations | Journal of the American Academy of Psychiatry...
Prendergast TJ: Advance care planning: pitfalls, progress, promise. Crit Care Med 29(suppl):N34-N39, 2001. ... Danis M, Southerland LI, Garrett JM, et al: A prospective study of advance directives for life-sustaining care. N Engl J Med ... to expend scarce medical resources on futile care for one patient merely because that patient requests such care in advance, ... were to pass a statute denying funds for inpatient care of nondangerous persons who competently refuse medication in advance of ...
more infohttp://jaapl.org/content/34/3/385.long
Website Increases Advance Care Planning  Website Increases Advance Care Planning
A simple website on advance care planning can spur patients to become engaged in important discussions and physicians to enter ... Barriers to advance care planning - specifically, physician time and lack of healthcare resources - can be overcome with this ... SAN ANTONIO - A simple website that walks users through a five-step process to answer questions about advance care planning led ... Videos depict different elements of advance care planning, such as one person asking another to be a medical decision maker. ...
more infohttps://www.medscape.com/viewarticle/880252
Advance Care Planning | University Hospitals  Advance Care Planning | University Hospitals
UH has prepared advance care planning materials that may be useful for patients. ... Plan ahead so that your family and loved ones understand your wishes for care when you can no longer make those decisions for ... Advance directives are legal documents that provide direction and instruction for your future health care in the event you are ... Plan ahead so you can receive the care that is important to you and in accordance with your wishes. ...
more infohttps://www.uhhospitals.org/rainbow/patients-and-visitors/your-visit/patient-rights/advance-care-planning
Advance Care Planning | HealthLink BC  Advance Care Planning | HealthLink BC
Get information about how you can plan for and document your wishes and instructions for present and future health care ... Advance Care Planning - Making Future Health Care Decisions For information on advance care planning information and resources ... Advance Care Planning - Making Future Health Care Decisions *Advance Care Planning Frequently Asked Questions (PDF) ... Advance Care Planning. Advance care planning is the process of thinking about and writing down your wishes or instructions for ...
more infohttps://www.healthlinkbc.ca/health-feature/advance-care-planning
Free advance care planning session offered  Free advance care planning session offered
What: Advance Care Planning Session - hosted by St. Mary's Hospital and Hospice and Palliative Care of Western Colorado When ... Free advance care planning session offered. Grand Junction Free Press ^ , Friday, April 8, 2011 , Sharon Sullivan Posted on 04/ ... urging all citizens to make their health care wishes known through advance care planning for managing a serious illness, or end ... The Mesa County Advance Care Planning Task Force, a group of local organizations, is offering Medical Decision Making in ...
more infohttp://www.freerepublic.com/focus/f-news/2702496/posts?page=17
Advance care planning - Wikipedia  Advance care planning - Wikipedia
Advance care planning is a process that enables individuals to make plans about their future health care. Advance care plans ... Advance care planning is applicable to all adults in all stages of life. Advance care planning aims to allow people to live ... Advance care planning is applicable to adults at all stages of life. Participation in advance care planning has been shown to ... "The benefits of advance care planning". Advance Care Planning Australia. Archived from the original on 2014-01-26. Retrieved 16 ...
more infohttps://en.wikipedia.org/wiki/Advance_care_planning
Advance Care Planning  Advance Care Planning
Texas hospitals encourage you to know your options for accepting or refusing care. Decide what's right for you. Talk with your ... An advance directive is your life on your terms. Whether you're 18 or 80, documenting your wishes today means your family won't ... What are "advance directives"? Advance directives are documents that state your choices for health care, or name someone to ... Advance care planning is a process of communication between individuals, families and others who are important to the ...
more infohttps://www.tha.org/AdvanceCarePlanning
Project MUSE - Advance Care Planning in Pakistan: Unexplored Frontiers  Project MUSE - Advance Care Planning in Pakistan: Unexplored Frontiers
Advance Care Planning, of which Advance directive is only a part, is a process of planning for future medical care under ... In other words, Advance Care Planning should be raised before an acute crisis.7 Primary care physicians are in the best ... The premise of advance directives may have been patient autonomy, but the process of Advance Care Planning does not evolve in ... Advance care planning involves a structured discussion between patient and ideally their primary care physician to explore the ...
more infohttp://muse.jhu.edu/article/530691
Advance care planning | Seattle Cancer Care Alliance  Advance care planning | Seattle Cancer Care Alliance
Advance care planning can help you document decisions about your health care in case you become ill or injured and can no ... Advance care planning A serious illness or accident can happen to anyone at any age. Advance care planning is a communication ... Advance care planning can also inform how you complete your health care directive, living will or power of attorney for health ... If you have questions or need guidance in preparing your advance care planning documents, please call our SCCA Supportive Care ...
more infohttps://www.seattlecca.org/advance-care-planning
Advance Care Planning - Atlantic Health System, NJ  Advance Care Planning - Atlantic Health System, NJ
... living will or designate a health care proxy. Learn more about our advance care planning services. ... Atlantic Health System offers programs and events that can help you create an advance directive, ... An advance care plan ensures that you get the care you need and want in the event that you become seriously ill or injured. ... Local Advance Care Planning Support Resources. *New Jersey Hospital Association - Practitioner Orders for Life-Sustaining ...
more infohttps://www.atlantichealth.org/patients-visitors/education-support/support-resources/advance-care-planning.html
Advance care plans - Better Health Channel  Advance care plans - Better Health Channel
Advance care planning can help the people close to you and those caring for you to know what is important to you about the ... In an advance care directive, you can document your wishes for future medical care. Advance care directives are legally ... Reviewing your advance care directive. You can review and change your advance care directive at any time. You may be prompted ... Give your advance care directive to others. Keep the original copy of your advance care directive and medical treatment ...
more infohttps://www.betterhealth.vic.gov.au/havetheconversation
David Oliver: Should advance care planning enter the mainstream? | The BMJ  David Oliver: Should advance care planning enter the mainstream? | The BMJ
... that this would open the way for specific decisions about end-of-life care and its limits. Yet such advance care planning is ... They used documentation of the preferred place of death as the indicator of advance care planning. Patients with an advance ... We know that advance care planning has benefits. In 2016 Dixon and colleagues reported an analysis of the national survey of ... David Oliver: Should advance care planning enter the mainstream? BMJ 2018; 361 :k2123 ...
more infohttps://www.bmj.com/content/361/bmj.k2123
Cancers | Free Full-Text | Advance Care Planning in Glioblastoma Patients  Cancers | Free Full-Text | Advance Care Planning in Glioblastoma Patients
... care, which can be achieved with Advance Care Planning (ACP). Although ACP, by definition, aims at timely involvement of ... patients and proxies in decision-making on future care, the optimal moment to initiate ACP discussions in the disease ... warranted to involve glioblastoma patients early in the disease trajectory in treatment decision-making on their future care, ... advance care planning; decision-making; end-of-life; palliative care glioblastoma; advance care planning; decision-making; end- ...
more infohttp://www.mdpi.com/2072-6694/8/11/102
Comprehensive advanced care planning  Comprehensive advanced care planning
Hospice of the Western Reserve offers a full scope of services including home visits and inpatient care. We offer 24/7 ... Compassionate care for the seriously ill, support for loved ones and comfort for the bereaved. ... Advance Care Planning Tools Advance Care Planning, when done effectively, significantly improves quality of life for patients ... Advance care planning is important to all adults. Younger, healthier adults should focus on identifying a proxy to make ...
more infohttp://hospicewr.org/western-reserve-carelink/Pages/Comprehensive-advanced-care-planning.aspx
Advance Care Planning - Community Medical Centers  Advance Care Planning - Community Medical Centers
Advance Care Planning Advance care planning helps you communicate your wishes for medical treatment should you become unable to ... Advance care planning communicates, clarifies and puts your wishes in writing.. There are several ways you can put your wishes ... Our trained facilitators are available to meet with you and guide you through the advance care planning process as part of our ... Advance Healthcare Directives. An advance healthcare directive allows you to state your preferences for medical treatments and ...
more infohttps://www.communitymedical.org/for-patients-families/Advance-Care-Planning
Advance Care Planning - British Geriatrics Society  Advance Care Planning - British Geriatrics Society
Good Practice Guide on Advance Care Planning National Guidelines. This is an executive summary. The full guideline is on the ... Advance care planning (including end of life discussions, advance statements and advance decisions to refuse treatment) are ... One specific area of controversy related to advance care planning is the use of advance decisions to refuse treatment (ADRTs). ... have prepared evidence based guidelines on advance care planning with special reference to older people. The key ...
more infohttp://www.bgs.org.uk/good-practice-guides/resources/goodpractice/gpgadvancecare
Advance Care Planning and Chronic Disease Management | Alzheimers Disease and Healthy Aging | CDC  Advance Care Planning and Chronic Disease Management | Alzheimer's Disease and Healthy Aging | CDC
It is about doing what you can to ensure that your wishes and preferences are consistent with the health care treatment you ... Advance care planning can be a gift you give yourself and your family. ... National Institute on Aging - Advance Care Planning. *Advance Care Planning: Ensuring Your Wishes Are Known and Honored If You ... While many of us do not like to think that we will ever need such a plan, too often the lack of advance care planning can ...
more infohttps://www.cdc.gov/aging/advancecareplanning/index.htm
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		47 of Advance care planning and advance directives  Medline ® Abstract for Reference 47 of 'Advance care planning and advance directives'
Critical Care, Sleep Medicine, Rheumatology, Surgery, and more. ... and patients that provides information on Adult Primary Care ... BACKGROUND: Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little ... Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was ... Future work needs to explore the generalizability of these findings and examine how strictly patients desire their advance ...
more infohttp://www.uptodate.com/contents/advance-care-planning-and-advance-directives/abstract/47
Advance Care Planning: Should I Stop Kidney Dialysis? | Cigna  Advance Care Planning: Should I Stop Kidney Dialysis? | Cigna
Advance Care Planning: Should I Stop Kidney Dialysis? ... Advance Care Planning: Should I Stop Kidney Dialysis?. 1. Get ... Advance Care Planning: Should I Stop Kidney Dialysis?. Here's a record of your answers. You can use it to talk with your doctor ... Advance Care Planning: Should I Stop Kidney Dialysis?. Skip to the navigation ... This may be done through hospice care . Hospice offers the chance to think about personal goals, relieve pain, and take care of ...
more infohttps://www.cigna.com/individuals-families/health-wellness/hw/medical-topics/advance-care-planning-tu6095
Advance Care Planning | Community Hospice & Palliative Care  Advance Care Planning | Community Hospice & Palliative Care
The Advance Care Planning program helps you plan so future health care challenges don't create difficult questions and ... What is Advance Care Planning?. Advance care planning (ACP) is a process of understanding, reflecting on and discussing your ... Our advance care planning document (advance directive) was developed and approved by area hospitals and is available at no cost ... Advance Care Planning. Honoring Choices Florida: A conversation today for the care you want tomorrow. ...
more infohttps://www.communityhospice.com/services/advance-care-planning/
Advance care planning codes not being used | The Hospitalist  Advance care planning codes not being used | The Hospitalist
Doctors are not taking advantage of Medicare codes designed to compensate them for time spent with discussing end-of-life plans ... Advance care planning benefit presents challenges Low usage of the ACP codes may be associated with lack of awareness, ... "Many people over age 65 are not ready to deal with advance care planning in their day-to-day lives, and it may not be what they ... "If we have a short conversation about advance care planning, it gets folded into our evaluation and management visit. It's not ...
more infohttps://www.the-hospitalist.org/hospitalist/article/196380/practice-management/advance-care-planning-codes-not-being-used
Power of Attorney (Scotland) - Advance care planning in Scotland - Macmillan Cancer Support  Power of Attorney (Scotland) - Advance care planning in Scotland - Macmillan Cancer Support
Back to Advance care planning in Scotland. Planning ahead. Making a will. Your wishes for your care. Advance Directives. Organ ... Funeral planning. Managing your care if you haven't planned ahead. Mental capacity. ... Welfare PoA and Advance Directives. If you make an Advance Directive, your welfare attorney will need to follow your decisions ... This is only if your Advance Directive is up to date, relevant to your situation at the time and is known to still reflect your ...
more infohttps://www.macmillan.org.uk/information-and-support/bladder-cancer/non-invasive-bladder-cancer/organising/planning-for-the-future-with-advanced-cancer/advance-care-planning-scotland/power-of-attorney.html
Healthcare | Free Full-Text | Advance Care Planning among People Living with Dialysis  Healthcare | Free Full-Text | Advance Care Planning among People Living with Dialysis
Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will ... Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance ... and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members ... and planning for the future. Interviews were recorded, transcribed and analyzed. ...
more infohttp://www.mdpi.com/2227-9032/4/1/17
  • Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated. (wikipedia.org)
  • This led to the development of what some have called "second generation" advance directives - the "health care proxy appointment" or "medical power of attorney. (wikipedia.org)
  • In the U.S., The Patient Self-Determination Act (PSDA) went into effect in December 1991, and required healthcare providers (primarily hospitals, nursing homes and home health agencies) to give patients information about their rights to make advance directives under state law. (wikipedia.org)
  • People are often encouraged to complete both documents to provide comprehensive guidance regarding their care, although they may be combined into a single form. (wikipedia.org)
  • However, by the late 1980s, public advocacy groups became aware that many people remained unaware of advance directives and even fewer actually completed them. (wikipedia.org)
  • Advance Instruction for Mental Health Treatment is a legal document that tells physicians and mental health providers what mental health treatments you would want and what treatments you would not want if you are unable to decide for yourself. (firsthealth.org)
  • Even if you're not nor have ever been a patient at a FirstHealth hospital, you CAN have your Advance Directives on file for easy access if needed. (firsthealth.org)
  • The most recent result was the Patient Self-Determination Act of 1990, which attempted to address this awareness problem by requiring health care institutions to better promote and support the use of advance directives. (wikipedia.org)
  • In part, this was seen as a failure of health care providers and medical organizations to promote and support the use of these documents. (wikipedia.org)
  • This study day enables all Health Care Professionals to fulfil their duty of care, understand, recognise and know how to use the Code of Practice and Advance Care Planning documentation, as well as develop skills to open and maintain facilitative discussions. (eventbrite.co.uk)
  • After your Advance Directives are on file at the hospital you CAN change them anytime you want by simply sending a letter to the hospital Health Information Management Department or by sending in new documents. (firsthealth.org)
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