The aim of this study was two-fold; to examine patient-proxy agreement on the impact of MS on daily life at different points in time and to get more insight in patient-proxy agreement on change over time.. The positive mean differences that were found at baseline and follow-up indicated a tendency for proxy respondents to report more disease impact of MS than the patient did themselves. This tendency of reporting more symptoms and lower levels of functioning by proxy respondents compared to the patients themselves, is in line with other studies on this topic [10, 35]. In contrast to some of the other longitudinal proxy studies [13, 14, 19] we did not see an improvement in agreement over time. Mean directional differences at follow-up were actually statistically significant for both the physical and the psychological scale, which points towards systematic overestimation by proxy respondents. Effect sizes showed that the magnitude of this bias was moderate for both scales.. At both time points, ...

Ms. Whiting described how among patients with chronic conditions, the patient voice and the caregiver voice are often thought to be interchangeable. But, patient and caregiver perspectives can be very different. She described research demonstrating that if the caregiving relationship is strained, a caregiver may overstate the amount of pain a patient is facing. So there is a clear need for a more nuanced approach to identify where caregivers can help and to what degree their voice should be included in data collection.. She highlighted how the caregiver role evolves over time. For example, among young patients who may be unable to self-report, the caregiver voice may be more prominent. But, as the patient matures, they may be able to report on their own signs and symptoms, indicating that at that point a patient-reported outcome should be used. Similarly, among patients with dementia, the patient has a more prominent voice in the beginning. But, as the disease progresses, their ability to report ...

Similar to the previous situation, ethics consults are occasionally obtained when its not clear to the treating team who the surrogate decision maker is or how to navigate conflicts between decision makers. In California and by our policy, a surrogate decision maker can be anyone who knows the patient and his values well enough to make decisions on his behalf. There is no predetermined hierarchy of relationship; a neighbor may be a better surrogate than an estranged spouse who hasnt seen the patient in a decade. Its not uncommon that we find ourselves in complex family and friend relationships with multiple spouses, children, cousins, friends, and parents who all want a say in medical decision making. We hope that all the stakeholders are on the same page and work together to determine whats best for a patient, but this is rare. Especially in the intensive care unit, situations can be emotionally-laden and challenging to achieve a consensus. Furthermore, its quite important to identify a ...

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Prevalence and determinants of misreporting among European children in proxy-reported 24 h dietary recalls.. Börnhorst C, Huybrechts I, Ahrens W, Eiben G, Michels N, Pala V, Molnár D, Russo P, Barba G, Bel-Serrat S, Moreno LA, Papoutsou S, Veidebaum T, Loit H-M, Lissner L, Pigeot I, on behalf of the IDEFICS consortium ...

This study assessed associations between preschoolers objectively measured leisure-time PA and a comprehensive set of subjective (i.e. by parent proxy-report) and objective potential PA correlates across the behavioral, social and physical environmental domains on both family- and community-level (Fig. 1) in a large sample of German preschoolers.. None of the objective community-level social and physical environmental potential correlates were associated with objectively assessed leisure-time PA. In contrast, for the family-level behavioral domain (child participation in organized sports) as well as the subjective (i.e. by parent proxy-report) family-level physical environmental domain (parental perception of neighborhood traffic safety) significant associations with MVPA and TPA were observed. These main findings were consistently seen in both the weekend and weekday afternoon samples.. No associations between PA and the objective community-level social and physical environmental factors from ...

This data collection is comprised of responses from two sets of survey questionnaires, the basic Current Population Survey (CPS) and a survey administered as a supplement to the June 2008 CPS questionnaire on the topic of Fertility.The CPS, administered monthly, collects labor force data about the civilian noninstitutional population living in the United States. Moreover, the CPS provides current estimates of the economic status and activities of this population which includes estimates of total employment (both farm and nonfarm), nonfarm self-employed persons, domestics, and unpaid helpers in nonfarm family enterprises, wage and salaried employees, and estimates of total unemployment. Data from the CPS are provided for the week prior to the administration of the survey.All females 15-44 years old that were eligible for the basic CPS survey were also eligible for the supplement survey, as applicable. Self or proxy responses were allowed for the supplement, that is a single respondent could ...

One in five deaths in the U.S. occurs in or shortly after discharge from an intensive care unit (ICU), typically following decisions made by surrogate decision makers to forego life prolonging treatment. A large body of empirical research has identified deficiencies in care processes that contribute to three important problems: 1) family members often experience poor quality communication with ICU clinicians, leading to lasting psychological distress associated with the ICU experience; 2) patients near the end of life frequently receive invasive, expensive treatment that is inconsistent with their values and preferences, and 3) end-of-life care is a major contributor to health care costs.[8, 9] Although advance care planning can prevent some unwanted treatment, many patients wish for a trial of intensive treatment when the prognosis is uncertain, and therefore it seems likely that the need for interventions to improve in-the-moment decisions by surrogates will persist.[10, 11]. In a pilot ...

Hers what I find troubling and ultimately depressing about the drinking and driving problem.. We know, without a doubt, that alcohol consumption impairs and inhibits normal human mental abilities, to which we would generically refer as judgement capacity or the ability to make rational, well-informed decisions. This is the main reason that in the medical profession (in which I work) a patients right to decide about his/her medical treatment becomes null and void if he/she is intoxicated, barring a legally-recognized surrogate decision maker that is at the bedside to accept that responsibility or a legal document stating the same (an advanced directive, etc). Thus every day in ERs across this country we are doing things (invasive things, painful things, risky things) to patients against their will because we determine that they are either intoxicated or have sustained a brain injury or are acutely psychotic (etc) and are therefore not competent to decide for themselves. Granted, what we ...

1. Majesko A, Darby J. Etomidate and adrenal insufficiency: the controversy continues. Critical Care. 2010; 14:338 2. Majesko A, Hong SY, Weissfeld L, White DB. Identifying family members who may struggle in the role of surrogate decision maker*.Crit Care Med. 2012; Aug;40(8):2281-6. 3. Majesko A, Palliative Care: More than Natural Talent and Good Communication. Critical Care Connections. 2012; Aug/Sept; 11(4):8. 4. Zachary O Binney, Tammie E Quest, Paul L Feingold, Timothy Buchman, Alyssa A Majesko. Feasibility and economic impact of dedicated hospice inpatient units for terminally ill ICU patients. Crit Care Med. 2014 May;42(5):1074-80.. ...

This study provides evidence regarding the relatedness of multi-informant agreement and perceived observability of internalizing and externalizing problem behaviors. Based on 2 distinct but comparable samples of children/adolescents (Sample 1: 58.2% female and mean age of 12.51 years; Sample 2: 56.4% female and mean age of 12.35 years) and their mothers, cross-sectional as well as longitudinal analyses were conducted. Although often suggested in the literature, the results of the study do not indicate that-in general-internalizing behavior is less observable than externalizing behavior. Moreover, the results do not corroborate the suggestion that multi-informant agreement regarding internalizing behavior is lower than that of externalizing behavior. However, apart from the broad distinction of internalizing versus externalizing behavior, observability and multi-informant agreement are positively correlated with respect to reports on actual state (cross-sectional) as well as change (longitudinal) ...

Representatives with Voting Privileges (shown in the table below as Voting = Yes) may vote and count towards quorum. Voting Privileges are based on the Roster Role and attendance of the Member Organization for this committee. Attendance is recorded for the last three meetings. + Present, - Absent, p Proxy (Report errors to the Secretary and/or Cochairs) ...

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Carstensen, Bendix; Read, Stephanie H; Friis, Soren; Sund, Reino; Keskimäki, Ilmo; Svensson, Ann-Marie; Lung, Richard; Wild, Sarah H; Kerssens, Joannes; Harding, Jessica L; Magliano, Dianna J; Gudbjörnsdottir, Soffia; on behalf of the Diabetes and Cancer Research Consortium (2016) ...

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The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other persons best interests and that the new legislation introduces only an advisor, not a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other peoples desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other peoples thought processes indicates that we are unlikely ever to achieve accurate simulations of others ...

Internal Medicine Module 2: Informed Consent - Surrogate Decision Making. This case explores the best course of action when a surrogate decision maker refuses bypass surgery for her husband even when the primary care physician, cardiologist, and cardiac surgeon all recommend it as the best treatment option. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

One of the hardest things veterinarians have to do is to counsel owners about assessing a pets quality of life as it begins to decline. Because our animals cant verbalize their specific desires when it comes to end of life care, owners and, to a lesser extent, veterinarians are forced into the role of proxy decision makers. We have the ability to extend or end a sick or injured pets life, and deciding what he or she would want under the circumstances is never easy.. Quality of life (QoL) surveys are helpful during this difficult time. They can focus our attention on the most important aspects of what the patient is experiencing. A single QoL survey provides some information, particularly at the extremes of the contentment - suffering continuum, but these tools really shine when they are performed on a frequent and regular basis. In this way, current scores can be compared to those taken in the past. Owners and veterinarians can then more easily pick up trends and address problems before they ...

Clawson AH, Jurbergs N, Lindwall J, Phipps S. Concordance of parent proxy report and child self-report of posttraumatic stress in children with cancer and healthy children: influence of parental posttraumatic stress. Psychooncology. 2013 Nov;22(11):2593-600. PubMed PMID: 23723147 ...

The law allows for different ways to handle the finances of the person under tutorship depending on the state of the persons illness and the extent of his/her personal fortune. For example, if there is a close relative who is willing to accept the responsibility, the judge can designate him/her as legal administrator under judicial control without appointing a surrogate tutor or family council (article 497). A family council is not usually necessary unless the fortune is particularly large or there are serious problems between family members.. Depending on the type of marriage contract that a married person previously drew up, it might not be necessary to appoint the spouse as tutor as s/he would already have the authority to take care of the persons interests (article 498).. Another option is to appoint a manager (gérant de la tutelle) instead of a surrogate tutor or family council. This solution is often used if the person has no family or if the family is disinterested or unsuitable to ...

When patients lack the capacity for medical decision, making the responsibility lies with an appointed Health Care Proxy (HCP) or, in the absence of a HCP, a surrogate decision maker. A Health Care Proxy can only be selected by the patient and must include a legal form specific to the state in which the patient lives. The form requires a patient with capacity who designates a person to make decisions on their behalf only at times when the patient is unable to make their wishes known. The form requires two witnesses (none of whom can be the HCP), but does not require a lawyer, doctor or notary. In the absence of a designated HCP, New York State law outlines a hierarchy for surrogate decision making. Highest on the list is a legal guardian followed by: spouse/domestic partner, child if over 18, parent, extended family and, last, a close friend.. A Health Care Proxy or surrogate must be willing to make decisions, be available at a reasonable time to make decisions and act, not as they wish, but as ...

The Dementia Risk Assessment (DRA) is an online tool consisting of questions about known risk factors for dementia, a novel verbal memory test, and an informant report of cognitive decline. Its primary goal is to educate the public about dementia risk factors and encourage clinical evaluation where appropriate. In Study 1, more than 3,000 anonymous persons over age 50 completed the DRA about themselves; 1,000 people also completed proxy reports about another person. Advanced age, lower education, male sex, complaints of severe memory impairment, and histories of cerebrovascular disease, Parkinsons disease, and brain tumor all contributed significantly to poor memory performance. A high correlation was obtained between proxy-reported decline and actual memory test performance. In Study 2, 52 persons seeking first-time evaluation at dementia clinics completed the DRA prior to their visits. Their responses (and those of their proxy informants) were compared to the results of independent evaluation by

Advance care planning (ACP) is a process of discussing an individuals values, life goals, and preferences of future medical care between individuals, their family members/surrogate decision makers and healthcare providers.1 The American Heart Association has highlighted the importance of implementing ACP for people with heart failure.2 However, the clinical course in heart failure is often unpredictable and it is thus challenging to predict the precise trajectory of the condition.2 This prognostic uncertainty together with the difficulties with identifying appropriate timing to initiate ACP as well as the general fear of depriving a persons hope are just some of the barriers to implementing ACP.2 3 It is known that ACP could increase the likelihood of receiving end-of-life care according to an individuals wishes and improve quality of communication among people with cancers or chronic diseases; however, the effects of ACP for people with heart failure are yet to be determined. Consequently, ...

Objective: The Actifcare (Access to timely formal care) study investigated needs of people With dementia and their families during the phase in which formal care is being considered, and examined whether higher need levels are related to lower quality of life (QOL).. Method: From eight European countries 451 people with dementia and their carers participated. Needs were measured with the Camberwell Assessment of Need for the Elderly. QOL was measured with the QOL-AD, and carer quality of life was measured with the CarerQol. The relationship between needs and QOL was analysed with multiple regression analyses.. Results: Needs were expressed in the domains of psychological distress, daytime activities, company and information. People with dementia rated their unmet needs significantly lower than their carers: the mean number of self-rated unmet needs was 0.95, whereas the mean proxy ratings were 1.66. For met needs, the self-rated mean was 5.5 and was 8 when proxy-rated. The level of needs ...

A secondary analysis of prospective data pooled from five placebo-controlled randomised trials for smoking reduction conducted in Europe, USA and Australia. This article is intended to give an overview of the current status of MCE. Characterization of Fluorescent Proteins for Three- and Four-Color Live-Cell Imaging in S. We conclude that lipase A and B are distinctly different enzymes and that they are probably viagra without prescription not related polymorphic forms of one another. We undertook to describe the genetic and protein composition of subglottic stenosis (SGS) by measuring an array of protein expression and messenger RNA levels within human SGS tissue. Prednisone was administered at a median starting dosage of 1.8 mg/kg/d (0.82 mg/lb/d), PO, with dosage tapered during the first month of treatment. Comparison of self and proxy ratings for motor performance of individuals with Parkinson generic cialis tadalafil disease. CT by three-dimensional reconstruction can provide more special ...

Assess and compare the patient reported and parent proxy cognitive problems (child + teen) quality of life across multiple time points using the Peds Quality of Life version 3. Assessment was performed across all risk groups. The QL scoring is a 5-point Likert scale from 0 (never) to 4 (almost always). Scores are transformed on a scale from 0 to 100. Items are reverse scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25, and 4=0. Total score is the sum of all items over the number of items answered on all scales. The higher the score, the better the quality of life ...

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即係代表某人的意思 另外送上常用片語四十個 1. first of all 首先 First of all, a warm welcome to cour company. 首先，誠摯地歡迎你加入我們公司。 2. in the meantime 同時 In the meantime, can you give me some thoughts and come up with any recommendations? 同時，你能給我一些想法與建議嗎？ 3. from ones point of view 從某人的觀點來看 I would like to agree with Marketings suggestion as this…

I have made your name known to those whom you gave me from the world. They were yours, and you gave them to me, and they have kept your word. Now they know that everything you have given me is from you; for the words that you gave to me I have given to them, and they have received them and know in truth that I came from you; and they have believed that you sent me. I am asking on their behalf; I am not asking on behalf of the world, but on behalf of those whom you gave me, because they are yours. All mine are yours, and yours are mine; and I have been glorified in them. And now I am no longer in the world, but they are in the world, and I am coming to you. Holy Father, protect them in your name that you have given me, so that they may be one, as we are one. ...

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Infoblox Inc. is pleased to provide the Community Website (the Site), and associated content for fostering interest and custom application development around Infoblox products. To support this environment, Infoblox provides the Site under the following terms and conditions. Please read these terms and conditions carefully before accessing the Site, or any software and other content available for download on the Site (collectively, the Content).. BY USING THE SITE, REGISTERING AS A USER, CONTRIBUTING ANY CONTENT OR DOWNLOADING ANY CONTENT, YOU AGREE TO BE BOUND BY THESE TERMS AND CONDITIONS. This is a legal agreement between you and Infoblox. You refers to the person using the Site. If the Site is being used on behalf of an entity by a representative using the Site or Content on behalf of such entity, then you also refers to such entity. You must be at least 18 years of age to use the Site. These Terms and Conditions apply to all use of the Site and Content available on the Site. Infoblox ...

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