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The Patient Self-Determination Act 548 ; to seek and record information regarding advance directives at the time of admission. Yet, when these have not been addressed in advance, forced contemplation of resuscitation options at the time of admission for worsening HF may heighten patient and family anxiety without revealing true preferences 549 ; . The majority of patients with HF who had not discussed resuscitation during hospitalization indicated that they had not desired such an interaction 546 ; . Furthermore, in one study, the impact of resuscitation preferences on in-hospital outcome was minimal even for patients with HF in intensive care, of whom only 4% experienced cardiac arrests, compared with more than 25% of patients in intensive care units who had other chronic illnesses 550 ; . When the limitations imposed by HF alone or in combination with other severe conditions become intolerable, however, resuscitation may no longer be desired by the patient. At this time, it is important to understand which aspects of further care the patient wishes to forego. In some cases, the patient may want full care other than actual resuscitation; in other circumstances, hospitalization may no longer be desired for any intervention. Any decision to forego resuscitation should lead to possible deactivation of the life-saving function of an implanted debfibrillation device; the poor functional status of any patient should also influence the decision regarding implantation of such a device in the first place 551 ; . To observe both the intent and the directives of the patient and family, it is highly desirable that outpatient, inpatient, and crisis management be supervised by the same team to diminish the hazards of fragmented care during this period. Rapid communications with this team will reduce the conflicts and uncertainties that may arise when patients are first seen in an emergent setting by physicians not normally involved in their care. The standing care plans for each patient need to be quickly accessible to all personnel likely to be involved in the patient's care. Hospice services have only recently been extended to patients dying of HF. Originally developed for patients with end-stage cancer, the focus of hospice care has now been expanded to the relief of symptoms other than pain 552 ; . This is appropriate, because the suffering of patients with HF is characteristically linked to symptoms of breathlessness, and thus, compassionate care may require the frequent administration of intravenous diuretics and in some cases ; the continuous infusion of positive inotropic agents, rather than the use of potent analgesics. Physicians caring for these patients, however, are becoming more comfortable with the prescription of anxiolytics and narcotics to ease distress during the last days. Traditionally, the utilization of hospice care has required a prediction by a physician of death within 6 months, but this operational policy may be difficult to apply because health care providers are generally unable to accurately predict the end of life in patients with HF. In a large US experience of patients hospitalized in intensive care units with terminal stages of disease, the majority of patients who were identified by broad criteria for hospice care survived the next 6. I Can See Tomorrow, Patricia L. Owen, 1995 - Examines new antidepressants, provides concise information on how to find a therapist, discusses how depression affects an individual's family and career, explores the relationship between depression and chemical dependency. Depression: What Your Body's Trying to Tell You, Susan Skog & the Editors of Healthy Living Magazine, 1999 - Explores how depression can be a natural gateway to unparalleled physical, emotional and spiritual strength. Shares depression's intimate link to our emotions, past trauma, toxic thinking, nutritional deficiency, etc. Treating Depressed Children, Charma D. Dudley, 1997 - Children and adolescents have symptoms of depression similar to those experienced by adults. The author presents the theory of cognitive therapy, taking into account the development of the child and giving examples for clinicians who work with depressed youth. Lonely, Sad and Angry, Barbara D. Ingersoll & Sam Goldstein, 1995 - A parent's guide to depression in children and adolescents. How depression differs from the normal "ups and downs" of life, what kinds of behavior signal depression in children and adolescents, the causes of childhood depression, where to turn for help, etc. Gift of the Dark Angel, Ann Keiffer, 1991 - The author tells of her devastating experience: her struggle with the Dark Angel of depression as she lost health, hope, and finally all reason to live . and her discovery of the unexpected gifts buried in her depression and journey toward recovery. "Help Me, I'm Sad", David G. Fassler & Synne S. Dumas, 1997 How to tell if your child is at risk, spotting symptoms, teen suicide, depression's link with other problems and its impact on the family, finding the right diagnosis, therapist and treatment, what you can do to help, etc. Treating Depression in the Medically Ill: A Clinician's Guide, Lori Stevic-Rust & Anita Maximin, 2000 A comprehensive scholarly treatment of depression in the medically ill in a clear, straightforward style. A good summary of research findings as well as clinical recommendations for the diagnosis and treatment of depression. Women and Sadness A Sane Approach to Depression, M. Sara Rosenthal, 2000 This is a book for women living in difficult circumstances to help you figure out what you need, and who can help. The Depression Book, Cheri Huber, 1999 This book suggests that resisting depression or anything else we don't want actually maintains it, and that compassionate acceptance of our feelings and ourselves leads us to freedom. Wrestling with Depression, William & Lucy Hulme, 1995 Writing from his own battles with depression and his experience as a pastoral counselor, the author helps depressed persons and their families understand depression and its treatments. Woven into his story are his wife's struggles as a caregiver. What To Do If You're Burned Out & Blue, Dr. Kristina Downing-Orr, 2000 If you are suffering from clinical depression, the author provides the advice and information to help.
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