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"do not resuscitate"

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https://www.readbyqxmd.com/read/29219759/does-the-obesity-paradox-predict-functional-outcome-in-intracerebral-hemorrhage
#1
Neha S Dangayach, Harpreet Singh Grewal, Gian Marco De Marchis, Roberta K Sefcik, Rachel Bruce, Aarti Chhatlani, E Sander Connolly, M Cristina Falo, Sachin Agarwal, Jan Claassen, J Michael Schmidt, Stephan A Mayer
OBJECTIVE Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29189091/dnr-do-not-resuscitate-or-death-not-reversible
#2
Kieran Quinn, Stephen Workman
Allowing physicians to write a do not resuscitate (DNR) or do not administer cardiopulmonary resuscitation order after properly informing patients and their families that death would be irreversible offers a more rational and compassionate approach than traditional shared decision making in establishing a DNR status for some hospitalized patients.
November 30, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29159371/care-planning-for-inpatients-referred-for-palliative-care-consultation
#3
Kara Bischoff, David L O'Riordan, Angela K Marks, Rebecca Sudore, Steven Z Pantilat
Importance: Care planning is a critical function of palliative care teams, but the impact of advance care planning and goals of care discussions by palliative care teams has not been well characterized. Objective: To describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. Design, Setting, and Participants: This was a prospective cohort study conducted between January 1, 2013, and December 31, 2016...
November 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29129249/association-between-hospital-rates-of-early-do-not-resuscitate-orders-and-favorable-neurological-survival-among-survivors-of-inhospital-cardiac-arrest
#4
Timothy J Fendler, John A Spertus, Kevin F Kennedy, Paul S Chan
BACKGROUND: Current guidelines recommend deferring prognostication for 48 to 72 hours after resuscitation from inhospital cardiac arrest. It is unknown whether hospitals vary in making patients who survive an arrest Do-Not-Resuscitate (DNR) early after resuscitation and whether a hospital's rate of early DNR is associated with its rate of favorable neurological survival. METHODS: Within Get With the Guidelines-Resuscitation, we identified 24,899 patients from 236 hospitals who achieved return of spontaneous circulation (ROSC) after inhospital cardiac arrest between 2006 and 2012...
November 2017: American Heart Journal
https://www.readbyqxmd.com/read/29118858/characteristics-and-predictors-of-mortality-of-patients-with-hematologic-malignancies-requiring-invasive-mechanical-ventilation
#5
Hasan M Al-Dorzi, Haya Al Orainni, Faten Al Eid, Haytham Tlayjeh, Abedalrahman Itani, Ayman Al Hejazi, Yaseen M Arabi
RATIONALE: Acute respiratory failure (ARF) may complicate the course of hematologic malignancies (HMs). Our objective was to study the characteristics, outcomes and predictors of mortality of patients with HMs who required intubation for ARF. METHODS: This retrospective cohort study evaluated all patients with HMs who were admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City-Riyadh between 2008 and 2013 and required invasive mechanical ventilation...
October 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/29101301/do-not-attempt-resuscitation-dnar-orders-understanding-and-interpretation-of-their-use-in-the-hospitalised-patient-in-ireland-a-brief-report
#6
Helen O'Brien, Siobhan Scarlett, Anne Brady, Kieran Harkin, Rose Anne Kenny, Jeanne Moriarty
Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014...
November 3, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29068859/racial-and-geographic-disparities-in-interhospital-icu-transfers
#7
Patrick D Tyler, David J Stone, Benjamin P Geisler, Stuart McLennan, Leo Anthony Celi, Barret Rush
OBJECTIVES: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN: Retrospective cohort study. SETTING: Nationwide Inpatient Sample, 2006-2012. PATIENTS: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation...
October 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29068858/outcomes-of-ventilated-patients-with-sepsis-who-undergo-interhospital-transfer-a-nationwide-linked-analysis
#8
Barret Rush, Patrick D Tyler, David J Stone, Benjamin P Geisler, Keith R Walley, Leo Anthony Celi
OBJECTIVES: The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit...
October 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29049106/do-not-resuscitate-and-the-surgical-patient-not-a-contradiction-in-terms
#9
Elizabeth L Whitlock, Rondall K Lane
No abstract text is available yet for this article.
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29045241/taking-assent-to-new-heights-a-case-report-on-do-not-resuscitate-status-in-pediatric-palliative-care-procedures
#10
Heather A Ballard, Santhanam Suresh
Dying adolescents presenting for palliative procedures have complicated developmental and ethical issues, especially when reconsidering do-not-resuscitate orders. Though the American Academy of Pediatrics has guidelines, there is limited information in the literature on how to take care of these patients. We describe the case of a 14-year-old patient presenting to the interventional radiology suite for management of superior vena cava syndrome. The patient's goals of treatment were elucidated through a comprehensive care team consisting of the procedural and oncology teams...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29044457/secondary-prevention-medication-use-after-myocardial-infarction-in-u-s-nursing-home-residents
#11
Andrew R Zullo, Sadia Sharmin, Yoojin Lee, Lori A Daiello, Nishant R Shah, W John Boscardin, David D Dore, Sei J Lee, Michael A Steinman
BACKGROUND/OBJECTIVES: Secondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. The objective was to evaluate new use of secondary prevention medications after AMI in NH residents who were previously nonusers and to evaluate what factors were associated with use. DESIGN: Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims...
November 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28985622/outcomes-and-changes-in-code-status-of-patients-with-acute-myeloid-leukemia-undergoing-induction-chemotherapy-who-were-transferred-to-the-intensive-care-unit
#12
Tamjeed Ahmed, Abby L Koch, Scott Isom, Heidi D Klepin, Jonathan M Bishop, Leslie R Ellis, Dmitriy Berenzon, Dianna Howard, Susan Lyerly, Bayard L Powell, Timothy S Pardee
Patients with Acute Myeloid Leukemia (AML) have compromised marrow function and chemotherapy causes further suppression. As a result complications are frequent, and patients may require admission to the intensive care unit (ICU). How codes status changes when these events occur and how those changes influence outcome are largely unknown. Outcomes for adult patients with AML, undergoing induction chemotherapy, and transferred to the ICU between January 2000 and December 2013 were analyzed. 94 patients were included...
November 2017: Leukemia Research
https://www.readbyqxmd.com/read/28968619/balancing-patient-autonomy-surrogate-decision-making-and-physician-non-maleficence-when-considering-do-not-resuscitate-orders-an-ethics-case-analysis
#13
Nabil Mehta, Samantha Roche, Elisabeth Wong, Abass Noor, Kathryn DeCarli
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
October 2, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28958349/variation-in-do-not-resuscitate-orders-and%C3%A2-implications-for-heart-failure-risk-adjusted-hospital-mortality-metrics
#14
Jeffrey Bruckel, Anuj Mehta, Steven M Bradley, Sabu Thomas, Charles J Lowenstein, Brahmajee K Nallamothu, Allan J Walkey
OBJECTIVES: This study evaluated the effect of patient do-not-resuscitate (DNR) status on hospital risk-adjusted heart failure mortality metrics. BACKGROUND: Do-not-resuscitate orders limit the use of life-sustaining therapies. Patients with DNR orders have increased in-hospital mortality, and DNR rates vary among hospitals. Variations in DNR rates could strongly confound risk-adjusted hospital mortality rates for heart failure. METHODS: We identified a cohort of adults with primary diagnosis of heart failure by using the 2011 California State Inpatient Database, a claims database that captures "early DNR," within 24 h of admission...
October 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#15
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
September 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28914272/a-randomized-controlled-trial-of-a-cpr-decision-support-video-for-patients-admitted-to-the-general-medicine-service
#16
Aimee M Merino, Ryan Greiner, Kristopher Hartwig
BACKGROUND: Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process. OBJECTIVE: We examined the effect of an informational video about CPR on hospitalized patients' code status choices. DESIGN: This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28904011/continuation-of-non-essential-medications-in-actively-dying-hospitalised-patients
#17
Beverly Rosa Williams, F Amos Bailey, Elizabeth Kvale, Neal Steil, Patricia S Goode, Richard E Kennedy, Kathryn L Burgio
OBJECTIVE: The objective of this analysis was to examine the use of 11 non-essential medications in actively dying patients. METHODS: This was a planned secondary analysis of data from the Best Practices for End-of-Life Care for Our Nation's Veterans trial, a multicentre implementation trial of an intervention to improve processes of end-of-life care in inpatient settings. Supported with an electronic comfort care decision support tool, intervention included training hospital staff to identify actively dying patients, communicate the prognosis to patients/families and implement best practices of traditionally home-based hospice care...
September 13, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28881383/processes-of-code-status-transitions-in-hospitalized-patients-with-advanced-cancer
#18
Areej El-Jawahri, Kelsey Lau-Min, Ryan D Nipp, Joseph A Greer, Lara N Traeger, Samantha M Moran, Sara M D'Arpino, Ephraim P Hochberg, Vicki A Jackson, Barbara J Cashavelly, Holly S Martinson, David P Ryan, Jennifer S Temel
BACKGROUND: Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. METHODS: We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR...
September 7, 2017: Cancer
https://www.readbyqxmd.com/read/28872978/electing-full-code-in-hospice-patient-characteristics-and-live-discharge-rates
#19
Claire K Ankuda, Evan Fonger, Thomas O'Neil
BACKGROUND: It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. OBJECTIVE: To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. DESIGN: Retrospective cohort study of electronic medical record data. SETTING/SUBJECTS: A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014...
September 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28861039/intracerebral-hemorrhage-with-intraventricular-extension-getting-the-prognosis-right-early
#20
Christoph Stretz, Catherine Gao, David M Greer, Caitlin Loomis, Emily J Gilmore, Adam J Kundishora, Charles C Matouk, David Y Hwang
BACKGROUND: Early accurate outcome prognostication for patients with intracerebral hemorrhage (ICH) and accompanying intraventricular hemorrhage (IVH) is often challenging (1). Acute hydrocephalus often contributes to a poor clinical exam (2) and can portend significant morbidity and mortality (3). Accordingly, the inpatient neurologist may feel inclined to recommend limitations of care for an ICH patient admitted with a large IVH burden and poor exam. CASE PRESENTATION: We present a patient with significant IVH and minimal ICH who deteriorated rapidly to coma after presentation...
2017: Frontiers in Neurology
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