A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can ...markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.
Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.
Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size ES = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.
A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.
The Southeastern University Research Association (SURA) Coastal Ocean Observing and Prediction (SCOOP) program includes university, government, and private sector partners working together to ...implement information technology solutions. The SCOOP program goal is a modular and distributed system for predicting and visualizing the coastal response to extreme atmospheric events, including the damaging and catastrophic effects of storm surge, inundation and wind waves. SCOOP program partners are creating the "IT glue" for this interoperable system of systems by modularizing critical components and standardizing the interfaces between the modules. SCOOP emphasizes the transition of "pre-operational" research activities to operational status, and uses the real-time prediction system as an innovative research tool. SCOOP partners are turning environmental measurement and prediction into a community effort and a real-time collaboration between research institutions and operational agencies.
Optical mapping is a single molecule methodology for the rapid production of ordered restriction maps from single DNA molecules. This is the first practical non-electrophoretic genomic physical ...mapping approach.
All metazoan cells are able to make decisions about cell division or cellular differentiation based, in part, on environmental cues. Accordingly, cells express receptor systems that allow them to ...detect the presence of hormones, growth factors and other signals that manipulate the regulatory processes of the cell. In plants, an unusual signal - light - is required for the induction and regulation of many developmental processes. Past physiological and molecular studies have revealed the variety and complexity of plant responses to light but until recently very little was known about the mechanisms of those responses. Two major breakthroughs have allowed the identification of some photoreceptor signalling intermediates: the identification of photoreceptor and signal transduction mutants in Arabidopsis, and the development of single-cell microinjection assays in which outcomes of photoreceptor signalling can be visualized. Here, we review recent genetic advances which support the notion that light responses are not simply endpoints of linear signal transduction pathways, but are the result of the integration of a variety of input signals through a complex network of interacting signalling components.
All metazoan cells are able to make decisions about cell division or cellular differentiation based, in part, on environmental cues. Accordingly, cells express receptor systems that allow them to ...detect the presence of hormones, growth factors and other signals that manipulate the regulatory processes of the cell. In plants, an unusual signal - light - is required for the induction and regulation of many developmental processes. Past physiological and molecular studies have revealed the variety and complexity of plant responses to light but until recently very little was known about the mechanisms of those responses. Two major breakthroughs have allowed the identification of some photoreceptor signalling intermediates: the identification of photoreceptor and signal transduction mutants in Arabidopsis, and the development of single-cell microinjection assays in which outcomes of photoreceptor signalling can be visualized. Here, we review recent genetic advances which support the notion that light responses are not simply endpoints of linear signal transduction pathways, but are the result of the integration of a variety of input signals through a complex network of interacting signalling components.
Objective
To describe the health state preferences of patients with osteoarthritis (OA) according to the level of pain and disability and the extent of gastrointestinal side effects from nonsteroidal ...antiinflammatory drugs (NSAIDs).
Methods
Using combinations of 5 OA health states (4 specifying medication use) and 6 gastrointestinal side effect profiles, we developed 25 scenarios. In an Internet survey, adults with OA evaluated 5 randomly chosen health state–side effect scenarios (in addition to scenarios for congestive heart failure and wearing dentures, as benchmarks). They rated the scenarios on a 0–100 scale, in which 100 corresponds to best imaginable health. Unadjusted mean ratings were calculated using a difference‐in‐difference approach. A generalized linear model was used to estimate the effects of disease severity and side effect severity on the ratings, after controlling for patient characteristics.
Results
A total of 4,386 respondents whose mean age was 55.3 years, of whom 3,107 (70.8%) were women and 4,007 (91.4%) were white, completed the survey. Mean adjusted ratings for health state–side effect scenarios ranged from 94.9 for the mildest scenario to 25.3 for the most severe scenario. Severity of NSAID side effects had a greater negative influence on the ratings in milder OA states than in more severe OA states. Ratings were lower among men (P < 0.001) and among respondents with OA pain in the previous 24 hours (P < 0.001). Disease severity had a greater effect on ratings than did side effect severity.
Conclusion
Patients consider pain and functional limitations associated with OA to be important determinants of well‐being. Future research should attempt to determine whether patients prefer reductions in their OA‐related pain and disability over improvements in treatment side effect profiles.
Encouraging Americans to eat more fruits and vegetables has been a central theme of Federal dietary guidance for more than a decade. Still, despite conditions that would appear to favor higher US ...consumption of fruits and vegetables, Americans are eating far fewer servings than recommended. Marketers and nutritionists alike have puzzled over the reasons for Americans' fruit and vegetable shortfalls. To shed light on the persistent difficulty in increasing US produce consumption, USDA Economic Research Service researchers have examined how economic, social, and behavioral factors influence consumers' fruit and vegetable choices. The cost of fruits and vegetables is a commonly cited reason why consumers don't eat more of these healthy foods. More educated households bought a slightly more varied mix of vegetables. In addition, a household's ethnic background plays a role.
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