Friday, April 14, 2006
Proxy decision makers & dialysis; end of life care in cystic fibrosis; PVS; transdermal methylphenidate
Some digest entries from my back-log of PubMed updates...
There was a recent Gerontologist article about the (lack of) agreement between patients and their spouses about continuing dialysis in a variety of situations. It is from a survey of dialysis patients and their spouses; they were asked a variety of questions about continuing dialysis in a variety of situations (mild stroke, severe stroke, terminal illness, etc.). The spouses were asked what they would want for themselves as well as what they thought the patients would want. Essentially they found that the spouses' substituted decisions were more like what they would want for themselves, and less like what the patients wanted. Of note, across the board, the spouses chose to continue dialysis more often than the patients themselves did. All of this is pretty consistent with what has been shown before: proxy decision makers aren't right all of the time, and tend to want more 'aggressive' care than the patients.
The Journal of Cystic Fibrosis has an article on end of life care for adult cystic fibrosis patients. It is based on qualitative interviews of patients, families, and CF care providers about what is important in end of life care for these patients.
Lancet has a review of 'chronic disorders of consciousness' (persistent vegetative state, minimally conscious state, etc.) It's a good primer.
The FDA has just approved a methylphenidate transdermal system (for ADHD). This is the extent of my knowledge of the product. Duragesic on one forearm and Daytrana on the other?