Right time for ‘end-of-life’ talk

first_imgThe vast majority of patients with incurable lung or colorectal cancer talk with a physician about their options for care at the end of life, but often not until late in the course of their illness, according to a new study by Harvard-affiliated Dana-Farber Cancer Institute investigators published in the Feb. 7 issue of the Annals of Internal Medicine.The researchers found that such belated conversations tend to occur under particularly stressful conditions — when patients have been admitted to a hospital for acute care. And the doctor who shares in the end-of-life care talk is often a hospital physician rather than an oncologist who has treated the patient for much of his or her illness.Together, these circumstances may deprive patients of the opportunity for extended reflection and deliberation that would have been possible months earlier, when the conversation also could have occurred under less trying and hectic conditions, the authors suggest.“Previous studies have shown that patients who discuss their end-of-life care preferences with a physician are more likely to choose palliative, comfort-focused care over aggressive measures, and [to] receive hospice or other care consistent with their wishes. But studies haven’t looked at the timing of these discussions, or where and with whom they occur,” says the study’s lead author, Jennifer Mack of Dana-Farber/Children’s Hospital Cancer Center. Mack is also an assistant professor of pediatrics at Harvard Medical School (HMS).The new study, which involved 2,155 patients with stage IV (highly advanced) lung or colorectal cancer, found that 73 percent of the patients had a conversation about end-of-life care with a physician, according to medical records or an interview with the patient or a companion. Among the nearly 1,000 patients who passed away and whose records document an end-of-life care discussion with a physician, the median time of those discussions was 33 days before death.Other findings pertain to the location of those discussions and the type of physician involved. Of the more than 1,000 end-of-life care discussions in medical records, 55 percent occurred in the hospital. Oncologists documented end-of-life care talks with only 27 percent of their terminally ill patients in the study.Data for the study was provided by the Cancer Outcomes Research and Surveillance Consortium (CanCORS), a multi-region, population- and health system-based study of more than 10,000 patients with lung or colorectal cancer. Researchers interviewed patients at two time points and analyzed their medical records 15 months after diagnosis.“It’s encouraging to see such a high percentage of patients had end-of-life care conversations with a physician,” Mack says. “There’s a concern, though, that so many of these talks are taking place late in the trajectory of the disease.”Previous studies had estimated that fewer than 40 percent of patients with advanced cancer had end-of-life care discussions. Mack theorizes that this lower figure may reflect that earlier studies didn’t record end-of-life talks that took place shortly before patients’ death.Other research has suggested that physicians may delay end-of-life care discussions because of a natural reluctance to broach the subject, or because it conflicts with physicians’ problem-solving, hope-giving image. While such motivations are understandable, Mack says, they may work to patients’ detriment if they postpone the conversations too long.Mack and her colleagues are planning future studies to examine the quality and content of end-of-life care conversations, and then explore whether having such talks earlier in the course of illness can benefit patients.The study’s senior author is HMS Professor of Medicine Jane Weeks of Dana-Farber. Co-authors include Angel Cronin and Nathan Taback of Dana-Farber; Haiden Huskamp and Nancy Keating of Harvard Medical School; Jennifer Malin of the University of California, Los Angeles; and Craig Earle of the Ontario Institute for Cancer Research.The study was funded by grants from the National Cancer Institute, the U.S. Department of Veterans Affairs, the American Cancer Society, and the National Palliative Care Research Center.last_img read more

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Saipem’s 3Q revenue and profit rise

first_imgItalian energy services provider Saipem reported a rise in 2019 Q3 revenue and profit. The company’s revenue for the quarter grew to 2,36 billion euros, up from 2,22 billion a year ago. Net profit was 30 million euros, compared to a net loss of 34 million a year ago.Illustration: Saipem’s Scarabeo 8 drilling rig; Image by SP Mac/Flickr – shared with permission from the photographerSaipem’s offshore and engineering and construction division reported a slight decline in revenue from EUR 1,06 billion in 3Q last year to EUR 998 million in Q3 2019.New contracts in the division came in at 661 million euros in the third quarter, down from 1,04 billion in the corresponding quarter of 2018.Saipem said that most significant awards for offshore E&C in the third quarter of 2019 related to three new contracts for BP, in consortium with Boshelf LLC and STAR GULF FZCO, for the development of the gas and oil field Azeri Chirag-Gunashli (ACG) off the coast of Azerbaijan.Saudi Aramco offshore fields boost onshore E&C order intakeWorth noting, Saipem’s Onshore Engineering & Construction saw a substantial increase in new contracts for the quarter, boosted by Saudi Aramco’s awards related to Berri and Marjan offshore gas fields.Namely, Saipem reported 3,57 billion euros in new contracts for the quarter for its Onshore E&C business. This is compared to $1.04 billion in the third quarter of 2018. What is more, new contract intake for the division in this single quarter surpassed the value of new contracts awarded to Saipem’s Onshore E&C division in the first nine months of 2018, during which Saipem had secured 3.3 billion euros in new contracts.“The most significant awards [to the Onshore E&C division] in the third quarter of 2019 relate to two new contracts for Saudi Arabian Oil Company, encompassing engineering, construction, and installation for the development of onshore facilities of the Berri and Marjan gas fields, both located in the Arabian Gulf,” Saipem said.The onshore E&C division’s revenue in 3Q 2019 slightly rose to 974 million euros vs last year 3Q’s 958 million euros.Offshore drilling revenue up Saipem’s offshore drilling business, operating 4 semi-submersible rigs, 2 drillships, 7 jack-ups and one tender assisted drilling barge, saw its revenue rise to 121 million euros, up from 115 million in q3 last year, with new contracts in the quarter valued at 128 million, up from 29 million secured in q3 2018.For this division, the most significant awards in the third quarter of 2019 relate to a new four-year contract for ADNOC in the United Arab Emirates, continuing ongoing operations utilizing the jack-up rig Perro Negro 8.Onshore drilling revenue and contract intake also grew in the quarter. Revenue was 136 million, up from 124 million, and new contracts valued at 42 million euros were secured, an increase versus 18 million euros awarded in Q3 2018Overall, in the first nine months of 2019, Saipem was awarded new contracts amounting to €13,9 billion compared to €6,1 billion in the first nine months of 2018).The backlog at September 30, 2019, amounted to €19,8 billion of which €4,7 billion in Offshore Engineering & Construction, €13,745 billion in Onshore Engineering & Construction, €821 million in Offshore Drilling and €492 million in Onshore Drilling), of which €1,9 billion is to be realized in 2019.Looking ahead, Saipem said that high volatility in the oil price and the persistently low level of new investments by the oil companies will continue to characterize the last part of this year.“In the first nine months, some important Final Investment Decisions (FIDs) in the gas segment contributed significantly to the high level of contract awards. The backlog at the end of September 2019, combined with forecasts for current commercial tenders, allows us to forecast revenues of around €9 billion for 2019, with adjusted EBITDA margin above 10%,” Saipem said.Offshore Energy Today StaffSpotted a typo? Have something more to add to the story? Maybe a nice photo? Contact our editorial team via email.Also, if you’re interested in showcasing your company, product, or technology on Offshore Energy Today, please contact us via our advertising form, where you can also see our media kit.last_img read more

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Lampard demands for ‘fair’ treatment for tired Chelsea

first_imgFrank Lampard has called on the Premier League to give Chelsea a fair start to next season, saying the September 12 launch date is “too early” for his players. The Blues lost Saturday’s FA Cup final 2-1 to London rivals Arsenal but are still not finished with the current campaign. Lampard’s side take on Bayern Munich on Saturday in the rescheduled second leg of their Champions League round-of-16 tie, trailing 3-0 from the first leg. Even if they exit the competition, Chelsea will have just 35 days before the new season is due to begin. Manchester City are also still in the Champions League, the final of which is scheduled for August 23, while Manchester United and Wolves are involved in the Europa League, which ends on August 21. It is understood that when Premier League clubs agreed a September 12 start date, it was also clear there would need to be at least a 30-day break for Chelsea and any of the other teams playing in the end-of-season European competitions. Lampard lost Willian and Ruben Loftus-Cheek on the eve of the FA Cup final to injury and Cesar Azpilicueta and goalscorer Christian Pulisic during the game to hamstring problems.Advertisement Loading… Promoted Content7 Things That Actually Ruin Your PhoneNothing Compares To Stargazing Places Around The World8 Things That Will Happen If An Asteroid Hits Earth7 Mind-Boggling Facts About Black Holes8 Fascinating Facts About CoffeeCouples Who Celebrated Their Union In A Unique, Unforgettable Way2020 Tattoo Trends: Here’s What You’ll See This YearThe Highest Paid Football Players In The World6 Extreme Facts About HurricanesThe 10 Best Secondary Education Systems In The WorldWorld’s Most Delicious Foods6 Incredibly Strange Facts About Hurricanescenter_img “Even in a worst-case scenario, we don’t go through against Bayern, the 12th feels too early for me for the players to start playing again,” said the Chelsea boss. “The players need a break. That is why we have pulled two hamstrings and had players pull out of the game before this.” Lampard implored the Premier League to make sure clubs start the next season with a level playing field. Read Also: UEFA Champions League ready to restart, at long last “I would like to think the Premier League would look seriously at that,” he said. “Hopefully they give us a fair start next season. We deserve to be (given a fair start) as a Premier League club competing in the Champions League.” FacebookTwitterWhatsAppEmail分享 last_img read more

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Man Utd among ‘four giants’ looking to prise Barcelona’s Ivan Rakitic

first_imgManchester United ‘face a battle with three other European giants’ for the signature of Barcelona midfielder Ivan Rakitic. Rakitic, 31, will have two years left on his contract come the summer and is expected to have limited game time next season after the Catalan giants signed Frenkie de Jong from Ajax.The Red Devils are now looking to pounce on the opportunity in a bid to bolster their midfield.PSG are also interested having made a spectacular offer to sign Rakitic last summer according to Mundo Deportivo.Inter Milan have also entered the bidding war with reports that the Serie A side have met Ivan’s brother Dejan.Rakitic could also be heading back to the Bundesliga where he spent four years with Schalke as Bayern Munich are also interested.United will be hoping they can offer Champions League football to Rakitic with a top-four finish this season.Ole Gunnar Solskjaer’s side face rivals Liverpool on Sunday hoping to strengthen their grip on the Champions League qualification places. –center_img Source: Dailymail Footballlast_img read more

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Lakers’ Metta World Peace believes he’s in better shape than in his first Lakers stint

first_imgHe mentioned reporters often asked about his shooting accuracy (40.2 percent). So did former Lakers coach Phil Jackson when he coached the former Artest his first two seasons here.“I love Phil. But it’s not easy for people to adjust,” World Peace said. “I wanted to finish my career off strong.”The Lakers have noticed. “You have to give him a lot of credit for somebody who was out of the league for a couple of years,” Scott said of World Peace. “He worked as hard as he worked to get back into the league and be able to be a vital part of what we’re trying to do. It’s been great.” World Peace also argued he “absolutely” is in better shape than in his first stint with the Lakers (2009-2013).“I feel way better. I can do whatever I want,” the 36-year-old World Peace told Los Angeles News Group. “Essentially, I’m a wild card.”World Peace, a 15-year NBA veteran, insisted he’s “not trying to prove anybody wrong” after playing overseas last year in China and Italy. Still, World Peace acknowledged his limited time in New York became “frustrating.” He also argued he “wasn’t getting the credit I felt I should have been getting” during his first Lakers stint.“The Lakers were great,” World Peace said. “I’m talking about the outside and national [media].” Newsroom GuidelinesNews TipsContact UsReport an Errorcenter_img PHOENIX >> The respect Lakers coach Byron Scott held for Metta World Peace’s defense stayed as sturdy as his physical frame. Like anyone connected to the Lakers, Scott also appreciates the former Ron Artest’s role in securing the franchise’s last championship five years ago.But after the Lakers signed World Peace to a non-guaranteed contract, Scott “felt real leery if he was going to be able to get through training camp.” World Peace last played in the NBA with the New York Knicks in the 2013-14 season, but he played only 29 games before accepting a buyout. He also entered training camp with a back and left calf injury that sidelined him through most of the first week. “That’s when I thought he’s not going to make it,” Scott said.Two months later, World Peace started against the Phoenix Suns on Monday at Talking Stick Resort Arena while Kobe Bryant sat out for the third time in the past five contests. Scott gushed that World Peace is “playing a major role for us,” including starts in two games and mentoring the team’s young players. Though he entered Monday’s game against Phoenix averaging a modest 6.5 points on 39.4 percent shooting in 18.8 minutes, World Peace posted 11 points on 4-of-4 shooting, 2-of-2 from 3-point range and two rebounds in the first half versus the Suns.last_img read more

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