Preferred Medical Treatment Research Articles

Interdependence of Anti-Inflammatory and Antioxidant Properties of Squalene-Implication for Cardiovascular Health.

Cardiovascular diseases (CVD) have been recognized as the leading cause of mortality worldwide, accounting for 31% of global mortality. Among the risk factors of CVD, hyperlipidemia has been established as the most potent risk factor. Statins, a class of drug that reduces lower-density lipoprotein cholesterol (LDL-C), are the preferred medical treatment. However, due to the development of statin-associated muscle symptoms, statins are associated with patients’ discontinuation and nonadherence. Other statin-induced side effects, such as hepatotoxicity and gastrointestinal upset, all contribute to patients choosing alternative medicines. Squalene (SQ), an unsaturated hydrocarbon naturally synthesized in plants and animals, could become the alternative treatment or supplementary agent for cardiovascular health. SQ has been shown to exert cardioprotective effect via its antioxidant activity. Oxidative stress and inflammatory responses are closely related to each other, which proposes an interdependence relation between antioxidant and anti-inflammatory. Therefore, this review explores the interdependence between the antioxidant and anti-inflammatory effects of SQ implicated on cardiovascular health.

Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial.

Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. ISRCTN registry ISRCTN63110516.

Acceptance and Influencing Factors of Social Virtual Reality in the Urban Elderly

In the stage of aging society and population aging, the social needs of the elderly are widely discussed by researchers. Especially driven by the demand of tele-medical treatment and tele-rehabilitation therapy, it is vital for the elderly to integrate into virtual communities by combining social virtual reality (VR) with different medical services and entertainment needs. In addition, affected by the COVID-19 epidemic, it is more difficult for people to have face-to-face contacts. With more remote consultation, entertainment and virtual social connectivity, the application of social VR is more urgent and valuable. However, there is little discussion on the acceptability and influencing factors of social VR among the elderly at present. Therefore, in order to get further data, we used (1) early stage semi-structured interviews and then (2) Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaires for investigation. One hundred fourteen elderly people aged 60–89 living in the metropolitan area of Taipei were taken as the subjects. To help them understand the situation and state of using social VR, these elderly people were asked to use a head-mounted display (HMD) to experience social VR games. The preliminary results showed that the elderly had obvious preference for entertainment (32.4%) and medical treatment (31.3%). The interview showed that this was related to the physiological condition or medical needs of the age range. In order to further understand how social VR would affect the social life of the elderly, we proposed the further demand structure of UTAUT Model based on the interview of both experts and the elderly. The model structures include (1) Performance Expectancy, (2) Perceived Enjoyment, (3) Social Influence, (4) User Attitude, (5) Behavioral Intention, and so on. These structures were applied to conduct interviews and questionnaires to find out the influence extent and relevance of the elderly on different structural needs, and suggestions were given accordingly. The results of the above interviews showed that (1) the elderly thought that the functions of entertaining and interacting of social VR could increase their social opportunities, and also meet medical needs (teleconference, cognitive decline, etc.), (2) the closeness of social relations (between family members, friends, doctors, and places), and also affect the relevance of Perceived Enjoyment (β = 0.77, p = 0.000 &lt; 0.05). The results of these phenomena and interviews showed the interplay between the demand structures and their special relevance. They also indicated that as to social VR technologies, various demands and functional issues of the elderly need to be considered, and these demands would appear in the subtle usage, and different social VR interfaces and functions would emerge based on their special living ways and physical and psychological demands.

Intrapersonal Factors Impact Advance Care Planning Among Cancer Patients.

Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.

Severe mental illness and palliative care: patient semistructured interviews

ObjectivesTo explore perceptions, experiences and expectations with respect to palliative care of patients with severe mental illness (SMI) and an incurable, life-limiting chronic illness.MethodsFace-to-face semistructured interviews were conducted with 12...

A comparative study of patients\u2019 satisfaction with different levels of hospitals in Beijing: why do patients prefer high-level hospitals?

BackgroundTo promote the integration of medical resources, Beijing has built medical alliances since 2012, but this reform has not changed the state of disordered medical treatment. Patients are still willing to go to high-level hospitals for medical treatment. What causes patients to prefer high-level hospitals? To explore the reasons behind this preference for high-level medical treatment among patients and to guide patients to make visits in an orderly manner, we conducted this study and compared patients’ satisfaction with hospitals of different levels in the context of medical resource integration.MethodsThis study conducted a questionnaire survey among 1250 patients who were selected in 18 medical alliances in Beijing from October to December 2016. The study type is a comparative study based on cross-sectional data. Patient satisfaction was the main outcome, and descriptive analysis, chi-square tests, nonparametric tests and binary logistic regression analysis were used. The level of statistical significance was set at p < 0.05.ResultsThe overall satisfaction score of the medical alliances was 3.375, and the satisfaction scores of core hospitals and cooperative hospitals were 2.77 and 3.07, respectively. The overall patient satisfaction rate was 44.62%, and the satisfaction rates of core hospitals and cooperative hospitals were 34.34 and 50.43%, respectively. The type of hospital and understanding of medical alliance policy were the factors associated with patient satisfaction with the medical alliance.ConclusionsThe patients’ satisfaction with cooperative hospitals was higher than their satisfaction with core hospitals. Although the patients were more satisfied with the service attitude of the cooperative hospitals, they still preferred core hospitals due to their higher expectations for their medical treatment and greater trust in their medical technology. It is necessary to explore the establishment of closed medical alliances under the unified management of human and financial resources to enable medical alliances to become a community of common interests and provide integrated medical services for patients.

Effectiveness of a medical student-led, advanced care planning intervention in an inpatient cancer population.

e24010 Background: In an effort to provide patients with care that aligns with their values and goals, patients are encouraged to complete advance directives (ADs). While research has shown the benefits of advanced care planning (ACP) sessions, few studies have examined the thematic content of ACP discussions in an inpatient hematology or oncology population. Methods: We enrolled patients admitted to the hematology and oncology unit of an academic medical center who had never completed a power-of-attorney for healthcare form. One medical student 1) helped patients complete a power-of-attorney for healthcare form and 2) performed semi-structured interviews that explored patient's values, beliefs about end-of-life care, and preferences for medical treatments. Interviews were audio-recorded, transcribed, and analyzed through thematic analysis. Subjects completed pre- and post- surveys assessing their knowledge and attitudes about ACP. Results: All 48 patients enrolled in the study completed an advance directive. There was no significant change between pre- and post- intervention surveys evaluating patients’ trust in their physicians or family members to choose the right treatments for them in a life-threatening situation. Similarly, there was no change in patients’ comfort level discussing advance care planning after the interview. 79.2% of patients agreed or strongly agreed that they would recommend this ACP conversation to family and friends. 35.5% of patients agreed or strongly agreed that having this ACP conversation made them anxious. In the qualitative arm of the study, analysis suggests that cancer patients are willing to undergo further treatment unless it burdens their loved ones or interferes with quality time spent with family and friends. Motivating factors for patients included their spirituality and ability to fulfill a responsibility in a defined role. Conclusions: An ACP intervention performed by a medical student can increase the number of advance directives among patients admitted to inpatient hematology and oncology units. While this intervention may be anxiety-provoking for patients, it can illuminate the relative value patients place on the quality of their life versus their longevity.

End-of-life communication in advanced cancer: international trends (2009–2014)

ObjectiveTo examine trends in end-of-life communication with people with cancer in general practice.MethodsMortality follow-back survey among general practitioners (GPs) in representative epidemiological surveillance networks in Belgium (BE), the Netherlands (NL)...

The Feasibility and Effectiveness of Web-Based Advance Care Planning Programs: Scoping Review.

BackgroundAdvance care planning (ACP) is a process with the overall aim to enhance care in concordance with patients’ preferences. Key elements of ACP are to enable persons to define goals and preferences for future medical treatment and care, to discuss these with family and health care professionals, and to document and review these if appropriate. ACP is usually conducted through personal conversations between a health care professional, a patient, and—if appropriate—family members. Although Web-based ACP programs have the potential to support patients in ACP, their effectiveness is unknown.ObjectiveThis study aimed to assess the feasibility and effectiveness of Web-based, interactive, and person-centered ACP programs.MethodsWe systematically searched for quantitative and qualitative studies evaluating Web-based, interactive, and person-centered ACP programs in seven databases including EMBASE, Web of Science, Cochrane Central and Google Scholar. Data on the characteristics of the ACP programs’ content (using a predefined list of 10 key elements of ACP), feasibility, and effectiveness were extracted using a predesigned form.ResultsOf 3434 titles and abstracts, 27 studies met the inclusion criteria, evaluating 11 Web-based ACP programs—10 were developed in the United States and one in Ireland. Studied populations ranged from healthy adults to patients with serious conditions. Programs typically contained the exploration of goals and values (8 programs), exploration of preferences for treatment and care (11 programs), guidance for communication about these preferences with health care professionals or relatives (10 programs), and the possibility to generate a document in which preferences can be recorded (8 programs). Reportedly, participants were satisfied with the ACP programs (11/11 studies), considering them as easy to use (8/8 studies) and not burdensome (7/8 studies). Designs of 13 studies allowed evaluating the effectiveness of five programs. They showed that ACP programs significantly increased ACP knowledge (8/8 studies), improved communication between patients and their relatives or health care professionals (6/6 studies), increased ACP documentation (6/6 studies), and improved concordance between care as preferred by the patients and the decisions of clinicians and health care representatives (2/3 studies).ConclusionsWeb-based, interactive, and person-centered ACP programs were mainly developed and evaluated in the United States. They contained the key elements of ACP, such as discussing and documenting goals and preferences for future care. As participants considered programs as easy to use and not burdensome, they appeared to be feasible. Among the 13 studies that measured the effectiveness of programs, improvement in ACP knowledge, communication, and documentation was reported. The concordance between preferred and received care is yet understudied. Studies with high-quality study designs in different health care settings are warranted to further establish the feasibility and effectiveness of Web-based ACP programs.

The surgical intervention of thoracic aortic aneurysm among octogenarians and over: A Single center study

Background: Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure to repair the major blood vessel in the body i.e. aorta. This minimally invasive approach is considered as a better option in comparison to the open-heart surgery by among octogenarians. Therefore, the aim of this study was to examine the trends of postoperative complications among octogenarians and nonagenarians with arch, descending, or thoracoabdominal aortic aneurysms.&#x0D; Methodology: This interventional, single center study initially included a total of 329 consecutive patients with arch, descending, or thoracoabdominal aortic aneurysms. The study was conducted at Matsubara Tokushukai Hospital, Japan between May 2005 to November 2018. Of the total, 129 patients met the inclusion criteria and were enrolled. 32 patients were excluded as they didn’t provide consent for the surgical intervention and preferred conservative medical treatment only. While the remaining 97 patients had operative indications, 64 of these were treated with TEVAR (SG group) and 33 were treated with open surgery (OS group). Early and late outcomes and the relation with bedridden status were examined retrospectively. Data was analyzed using JMP 9.0 software (SAS Institute, Inc., Cary, NC).&#x0D; Results: Among the enrolled patients 49.5% were males and 50.5% were females. Decreased complications were observed among the patients of SG group as compared to the OS group. The highest mortality 69% was noted among the group treated with medical therapy alone with the confidence of interval of 95%. Furthermore, most of the patients in the OS group developed a complication of cerebral infarction and also needed tracheotomy during long-term hospital stay. Moreover, deaths occurring in bedridden patients were more common in the OS group than the SG group respectively.&#x0D; Conclusion: It is concluded that SG is a better therapeutic approach as compared to the OS and the conservative therapy alone.

Quality of life and patient preferences among Danish patients with ulcerative colitis – results from a survey study

Objective: To explore health-related quality of life (HRQoL) and assess preferences for medical treatment attributes to obtain information of the relative importance of the different attributes in a Danish population with ulcerative colitis (UC).Methods: We used data from an online survey collected in March 2018 among people with self-reported UC. A total of 302 eligible respondents answered the HRQoL questionnaires (EuroQol-5 Dimensions (EQ-5D-5L) and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ)), and 212 also completed the discrete choice experiment (DCE). The probability of choosing an alternative from a number of choices in the DCE was estimated using a conditional logit model.Results: The respondents had an average SIBDQ score of 4.5 and an HRQoL score of 0.77, applying the EQ-5D-5L questionnaire. HRQoL correlated with disease severity, and the respondents had lower HRQoL than did a gender- and age-matched subset of the Danish population. The most important medical treatment attribute was efficacy within eight weeks. Additionally, respondents stated a preference for avoiding taking steroids, for fast onset of effect and for oral formulations.Conclusions: HRQoL correlates with disease severity, and patients with UC have lower HRQoL than the general population. The most important treatment attribute was efficacy, but patients also would like to avoid steroids, value fast onset of effect and prefer oral formulations.

Selected aspects of advance care planning according to Polish legal regulations — physician’s requirements

In 2017, the group of 109 experts from various countries developed the international consensus definition of advance care planning (ACP), which is defined as enabling individuals to define objectives and preferences for future medical treatment and care, to discuss these goals and preferences with family and healthcare providers, and to record and review these preferences if appropriate. ACP plays a significant role in the care of patients with chronic diseases, and especially may have an impact on the situation of palliative care patients, their families and healthcare professionals who look after them. This article analyses the legal constraints of ACP in Poland, and presents legal regulations related to some selected issues of ACP. One of the essential features of ACP is disclosing information to the patient and taking into account the patient’s decisions concerning the treatment and medical care. This is provided for in Polish law and healthcare professionals are obliged to observe it. Moreover, the Polish law includes broad principles applying to providing the patient’s family with information about diagnosis and prognosis of the disease. However, advance directives and health care proxy have not been regulated by national law yet. Therefore, it seems that the incorporation of ACP into Polish healthcare system requires the development of new legal regulations.

Successful Medical Treatment of Hyperinsulinemic Hypoglycemia in the Adult: A Case Report and Brief Literature Review

Hyperinsulinemic hypoglycemia is characterized by inappropriate insulin secretion from the pancreatic beta cells causing low blood glucose levels. Nesidioblastosis is a very rare cause of hyperinsulinemic hypoglycemia in adults. Medical therapy can effectively improve disease symptoms. In 2014, a 45-year-old man presented with recurrent severe fasting and postprandial symptomatic hypoglycemia. The symptoms resolved after glucose ingestion. Fasting test was positive after only 4 h but imaging methods (abdominal computerized tomography, magnetic resonance imaging, endoscopic ultrasonography and octreotide scintigraphy) failed to identify pancreatic lesions. Hypoglycemia in face of endogenous hyperinsulinemia and lack of focal lesions in the pancreas in multiple imaging exams suggested the diagnosis of adult nesidioblastosis. The patient preferred conservative medical treatment in association with dietary recommendations. Nifedipine (30 mg/day) did not improve the glycemic profile and was poorly tolerated by the patient. Diazoxide 150 mg/day was started, with progressive increase to 400 mg/day over 6 weeks. Patient has been successfully treated with medical treatment for 5 years, with no events of severe hypoglycemia, no significant side effects and with marked improvement in quality of life. This clinical case demonstrates that adult hyperinsulinemic hypoglycemia can be effectively controlled with medical treatment, which is a viable alternative to pancreatic surgery. J Endocrinol Metab. 2019;9(6):199-202 doi: https://doi.org/10.14740/jem617

Comparison of Perceived Requirements for Maternal Delivery between Medical versus Nursing Students

Purpose: The aim of this study was to investigate the perceptions of intervention and levels of care required for maternal delivery between medical and nursing students. The differences in perceived practices were then considered in relation to health care approaches explored in either the medical or nursing professions. Methods: The number of individuals surveyed in this study included 98 (6th year) medical students and 78 (4th year) nursing students in the Oita University’s Faculty of Medicine. Out of the total 98 medical students recruited to participate in the study, 20 of them did not agree the survey. On the other hand, among the total 78 nursing students recruited, like their peers in medicine, 10 did not agree, whereby, only 68 nursing students were participated. As a result, the final rate of valid responses is 82.9% (78+68/98+78=146/176) as shown in (Table 1). The survey questionnaires were completed anonymously during the three months from August to October in 2014. The topics surveyed included the necessity or not of procedures used in delivery and types of care extended on delivery for mothers or their partners, or awareness for natural childbirth. The ethics committee of the university approved the study. Results: In the survey of medical care and treatment for delivery, the number of medical students who desired lithotomy position and the use of oxytocin under the direction of obstetricians were significantly larger than that of nursing students (Table 2. Question No.9, No. 13, P=0.0001). As for the importance of the quality of the delivery experience in relation to the decision of birth place (P=0.0001, Table 2, Question No 2, Table 7, Question No. 2), and comfortable labor position using a location other than the childbirth table (P=0.0001, Table 2, Question No. 4), the number of nursing students was significantly higher than that of medical students. In accordance with the effective and recommended guidelines in “Care in normal birth: A practical guide (WHO1996)”, the authors highlighted survey questions that included consideration of “Planning of childbirth together with a partner”. This survey approach also included “Information for choice of birth place”, Respect for decisions as to who should be accompanying on childbirth and “Comfortable labor position or favorite birth or delivery places other than the childbirth delivery table.” (1) The ratio of medical students significantly supports that birth plan should be decided with partner was higher when compared with nursing students (Table 7. P=0.017). (2) As for information for choice of birthplace, more nursing students significantly support that birth place should be consented as compared with medical students (Table 7. P=0.0001). (3) More nursing students significantly support the person accompanying on delivery (Table 7. P=0.048). (4) Both nursing students and medical students agree with “Comfortable labor position or favorite delivery or birth places other than the childbirth delivery table” (Table 7. P=0.006) Table 8 has shown no recommendation by WHO such as enema, shaving, preventive vascular access, conventional lithotomy position. No such difference could be seen between both the medical students and nursing students as in Table 4. Consequently, the medical students indicated that higher preference for more medical treatment including promotion of delivery due to oxytocin treatment and lithotomy position was necessary compared to the nursing students’ expression of such desirability of the approach. Conclusion: The study showed a significant difference in the perceived requirements for child birth or delivery between medical students and nursing students. The main differences are suspected to be due to differences in the educational programs and backgrounds which both the medical students or nursing students received while studying and training for their respective professions.

End of life decision making - Advance care planning/requests for hastened death

This paper discusses end-of-life decision making, focusing on advance care planning (ACP) which may enable patients with neurodegenerative conditions to express their preferences and wishes. In some countries where this is legally permitted, this may involve requests for hastened death. All neurodegenerative illnesses are marked by progressive difficulties with cognition and/or communication. While ACP is recommended, there is no consensus on definitions or implementation. Several methods for undertaking ACP have been developed in North America and Australia. Hastened death may involve various types of assisted dying and is permitted in very few countries. We conducted a five round international Delphi study to develop consensus on ACP. A total of 109 experts (82 from Europe, 16 from North America, and 11 from Australia) rated ACP definitions and 41 recommendations. The recommendations concern five domains of ACP: elements (12 recommendations), roles and tasks (6 recommendations), timing (3 recommendations), policy and regulation (5 recommendations), and evaluation (15 recommendations). The panel’s agreement per definition or recommendation ranged from 74%-100%. ACP was defined as “enabling individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and healthcare providers, and to record and review these preferences if appropriate”. The scope of ACP was defined to be broader than the physical domain alone, and may include psychological, social and spiritual domains. ACP enables patients to define, discuss, record and review goals and preferences for future medical treatment and care, including advance directives.

Advance care planning with chronically ill patients: A relational autonomy approach.

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%). Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process.

Oxidative stress and neurobehavioural changes in rats following copper exposure and their response to MiADMSA andd-penicillamine

An increase in copper concentration in body may lead to hepatolenticular degeneration which is considered as one clinical feature of Wilson’s disease. Chelation therapy using d-penicillamine is the preferred medical treatment for reducing the toxic effects of copper. However, a few shortcomings associated with d-penicillamine led us to search of an alternative antidote for copper toxicity. Monoisoamyl-2, 3-dimercaptosuccinic acid (MiADMSA), a potent arsenic chelator under clinical trial, has been reported to reduce system copper level. Thus, the present study was envisaged to explore the ameliorative effect of MiADMSA against copper toxicity. Copper pre-exposed animals (CuSO4.5H2O; 100 mg/kg; p.o., for 6 weeks) were segregated in different groups and were administered equimolar dose (0.3 mEq/kg/day; p.o.) of d-penicillamine and MiADMSA for 5 days. The effect of different treatments on spontaneous locomotor activity, muscle coordination, depression like behaviour and contextual fear memory was analysed using neurobehavioural battery test. Biochemical variables related to oxidative stress, zinc and copper concentration were determined in liver, kidney and brain. The results suggested that copper exposure led to oxidative stress in liver, kidney and blood, along with moderate effects in brain. Treatment with d-penicillamine and MiADMSA reduced liver copper load. MiADMSA produced more pronounced beneficial effect compared to d-penicillamine by increasing brain GPx activity. Our study suggests that MiADMSA might be equally effective as d-penicillamine in depleting body copper load. More detailed studies using different doses are required to suggest whether MiADMSA could be an alternative for d-penicillamine in reducing oxidative injury, neurobehavioural changes and depleting body copper burden.

Correction: Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study.

[This corrects the article DOI: 10.1371/journal.pone.0201191.].

NATIONAL QUESTIONNAIRE SURVEY ON ADVANCE CARE PLANNING IN JAPAN

AbstractThe Japanese Ministry of Health, Labor and Welfare conducts a national questionnaire survey on end-of-life care every five years. The subjects were among general population, doctors, nurses, and administrators in long-term care institutions. The survey focuses on preferences for future medical treatment and one’s desired place to receive care when becoming terminally ill. The latest survey, conducted in December 2017, defined the concept of advance care planning (ACP) for the first time and included questions related to ACP. The preliminary analysis found that people who are 65 years and older, who are female, and who have experience of caring for someone are more likely to have engaged in ACP. I will present the summary findings from the survey including the current status of ACP, factors associated with ACP, and perspectives toward ACP among the general population and health care providers in Japan.

Advanced care planning and selection of therapy: Influence on hospitalization for patients with metastatic lung cancer.

130 Background: Advanced care planning (ACP) allows patients to express preferences for medical treatment toward the end of life. Reduced healthcare resource utilization has been observed with ACP. The association of ACP and hospitalization was assessed among patients who initiated second line (2L) therapy for metastatic non-small cell lung cancer (mNSCLC). Methods: Adults who received 2L treatment for mNSCLC were identified in a retrospective study of claims from Humana Medicare Advantage, following its launch of ACP programs in 2015. In this cohort, patients who participated in ACP programs and patients who did not were matched 2:1 by age, sex, race, population density of residence, and year of 2L termination. Categories of 2L therapy were chemotherapy, immuno-oncology (IO), and targeted therapy. Extent of comorbidity was assessed using the Deyo-Charlson Comorbidity Index (DCCI). The odds of hospitalization in the 12 months following initiation of 2L therapy for patients who participated in ACP programs and patients who did not were assessed with a logistic regression model, offset for patient months of follow-up, and considering therapy category and DCCI. Results: Ninety-eight patients who participated in ACP programs were matched to 196 patients who did not. More than half the cohort was male; median age was 71. There was no difference in therapy category or DCCI by ACP program participation. A greater proportion of patients with no ACP were hospitalized post-2L treatment, 57.7% vs 42.9%, P&lt; 0.001. ACP was associated with a 52.1% decreased odds of hospitalization. Patients treated with IO or targeted therapy had reduced odds of hospitalization, 54.8% and 75.4% respectively, relative to patients treated with chemotherapy. Conclusions: This early assessment of ACP programs in patients with mNSCLC suggests ACP program participants may have fewer hospitalizations near the end of life. Possibly, ACP program participation presents opportunities for staff to identify changes in health status and prevent escalation to hospitalization. Also, because of its potential to reduce hospitalizations, selection of therapy should be considered as a part of ACP.