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Chantilly, VA, United States

An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.A living will is one form of advance directive, leaving instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone to make decisions on their behalf when they are incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care. An example of combination documents includes the Five Wishes in the United States. The term living will is also the commonly recognised vernacular in many countries, especially the U.K. Wikipedia.

Jeffery D.R.,Advance Health
Therapeutic Advances in Chronic Disease | Year: 2013

The development of new pharmacologic agents for the treatment of multiple sclerosis (MS) and advances in testing for exposure to the JC virus have led to changes in the treatment of MS. In addition several new agents are in late stage development for MS and their entry onto the market will provide additional treatment options. In 2012 and in early 2013, it is likely that both terifunomide and BG-12 will be approved by the United States Food and Drug Administration (FDA) for the treatment of relapsing forms of MS. The therapeutic environment has already changed and is likely to change rapidly over the next several years. Fingolimod was the first oral agent approved for the treatment of MS and this agent is now widely used in patients intolerant of injections and the side effects associated with the older platform therapies. In many settings it is also used a first-line agent. Owing to the risk of progressive multifocal leukoencephalopathy, natalizumab had previously been reserved for patients with active disease who were intolerant of first-line agents or patients who were worsening despite standard therapy. With the availability of JC virus antibody testing, natalizumab is now being used as a first-line agent in patients negative for JC virus antibodies. Teriflunomide and BG-12 will become available in the next year. Both agents have suitable efficacy and a favorable safety and tolerability profile. There are advantages and disadvantages associated with all of the oral agents. In this article we summarize the clinical trial results regarding the efficacy and safety of the oral agents and discuss the changes that are already taking place in the therapeutic landscape for MS. © The Author(s), 2012. Source

Hopp F.P.,Wayne State University | Martin L.,Wayne State University | Zalenski R.,Advance Health
Social Work in Health Care | Year: 2012

This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness. © 2012 Copyright Taylor and Francis Group, LLC. Source

Veredas F.,University of Malaga | Mesa H.,Advance Health | Morente L.,Area de Enfermeria Comunitaria
IEEE Transactions on Medical Imaging | Year: 2010

A pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear, or friction. Diagnosis, treatment, and care of pressure ulcers are costly for health services. Accurate wound evaluation is a critical task for optimizing the efficacy of treatment and care. Clinicians usually evaluate each pressure ulcer by visual inspection of the damaged tissues, which is an imprecise manner of assessing the wound state. Current computer vision approaches do not offer a global solution to this particular problem. In this paper, a hybrid approach based on neural networks and Bayesian classifiers is used in the design of a computational system for automatic tissue identification in wound images. A mean shift procedure and a region-growing strategy are implemented for effective region segmentation. Color and texture features are extracted from these segmented regions. A set of κ multilayer perceptrons is trained with inputs consisting of color and texture patterns, and outputs consisting of categorical tissue classes which are determined by clinical experts. This training procedure is driven by a κ-fold cross-validation method. Finally, a Bayesian committee machine is formed by training a Bayesian classifier to combine the classifications of the κ neural networks. Specific heuristics based on the wound topology are designed to significantly improve the results of the classification. We obtain high efficiency rates from a binary cascade approach for tissue identification. Results are compared with other similar machine-learning approaches, including multiclass Bayesian committee machine classifiers and support vector machines. The different techniques analyzed in this paper show high global classification accuracy rates. Our binary cascade approach gives high global performance rates (average sensitivity =78.7\%, specificity =94.7\%, and accuracy =91.5\%) and shows the highest average sensitivity score (=86.3%) when detecting necrotic tissue in the wound. © 2010 IEEE. Source

Rivera V.M.,Baylor College of Medicine | Jeffery D.R.,Advance Health | Weinstock-Guttman B.,State University of New York at Buffalo | Bock D.,EMD Serono, Inc. | Dangond F.,EMD Serono, Inc.
BMC Neurology | Year: 2013

Background: Registry to Evaluate Novantrone Effects in Worsening Multiple Sclerosis (RENEW) was a 5-year, phase IV study in which the safety of Mitoxantrone was monitored in a patient cohort from the United States (US). The objective of the study was to evaluate the long-term safety profile of Mitoxantrone in patients with secondary progressive multiple sclerosis (SPMS), progressive relapsing multiple sclerosis (PRMS), and worsening relapsing-remitting multiple sclerosis (RRMS).Methods: Overall, 509 patients (395 SPMS, 81 worsening RRMS, 33 PRMS) were enrolled and treated at 46 multiple sclerosis (MS) treatment centers located in the US. Patients received Mitoxantrone in accordance with the package insert every 3 months. During the treatment phase, patients received laboratory workups and cardiac monitoring every 3 months and then annually for a total of 5 years.Results: Five hundred and nine subjects were enrolled in this trial and received at least one infusion of Mitoxantrone. Overall, 172 (33.8%) completed the 5-year trial (i.e., participated for 5 years ± 3 months [treatment + follow-up]); 337 (66.2%) did not complete the 5-year trial. Annual follow-up data were available for 250 of 509 enrolled patients. Left ventricular ejection fraction reduction under 50% was reported in 27 (5.3%) patients during the treatment phase (n = 509) and 14 (5.6%) patients during the annual follow-up phase (n = 250). Signs and symptoms of congestive heart failure were observed in 10 (2.0%) patients (six during treatment phase and four during the annual follow-up phase). Post-hoc analyses of the risk for cardiotoxicity outcomes revealed that cumulative dose exposure is the primary risk factor associated with the risk of cardiac toxicity with Mitoxantrone. Therapy-related leukemia was reported in three (0.6%) patients who received total cumulative Mitoxantrone doses of 73.5 mg/m2, 107.3 mg/m2, and 97.1 mg/m2 respectively. During the treatment phase, persistent amenorrhea developed in 22% (28/128) of women with regular menses and 51% (25/49) of women with irregular menses at baseline. During the annual follow-up phase, persistent amenorrhea developed in 5% (4/73) of women with regular menses at baseline.Conclusion: RENEW results are consistent with the known safety profile of Mitoxantrone, and provide additional long-term safety data for Mitoxantrone in MS patients. © 2013 Rivera et al.; licensee BioMed Central Ltd. Source

Advance Health | Date: 2013-12-30

A medical screening system includes: a mobile device including: a user interface embodied in an input/output system; a processor; and a memory in communication with the processor, including stored instructions that, when executed by the processor, cause the processor to: provide a medical screening intake system that receives objective medical data, subjective medical data, and medical test results for a person as input through the user interface; receive the objective medical data, subjective medical data, and medical test results for the person as input through the user interface; automatically process the objective medical data, subjective medical data, and medical test results to generate one or more plans of care specifically adapted for the person; and communicate the one or more plans of care specifically adapted for the person to the person as a report embodied in a structured data output.

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