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https://www.readbyqxmd.com/read/29045241/taking-assent-to-new-heights-a-case-report-on-do-not-resuscitate-status-in-pediatric-palliative-care-procedures
#1
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
#2
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...
October 17, 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
#3
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...
September 27, 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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28839364/omega-3-fish-oil-reduces-mortality-due-to-severe-sepsis-with-acute-gastrointestinal-injury-grade-iii
#12
Huaisheng Chen, Wei Wang, Chengying Hong, Ming Zhang, Yingcai Hong, Su Wang, Huadong Zhang
BACKGROUND: Sepsis plays an important role in acute gastrointestinal injury (AGI). Our research was designed to determine the effects of omega-3 fish oil (FO) in patients suffering from severe sepsis combined with AGI III, and the ability of FO to modulate immune function. METHODS: Seventy-eight patients diagnosed with severe sepsis with AGI III and a need for mechanical ventilation were randomized to two groups. In the FO group, 50 g of long chain fatty acid soybean oil (n = 6) and 10 g of FO (n = 3) were administered as total parenteral nutrition (TPN)...
July 2017: Pharmacognosy Magazine
https://www.readbyqxmd.com/read/28832795/cardiopulmonary-resuscitation-in-an-average-brazilian-intensive-care-unit-should-we-perform-less-or-better
#13
Leonardo Augusto Miana, Marcella Mendes Moraes, Bernardo Mendes Moraes, Pedro Guilherme Ponte, Eduardo Venturelli, Rodrigo Urbano Mallosto, Alexander Moreira-Almeida
Introduction: Few data can be found about cardiac arrest in the intensive care unit outside reference centers in third world countries. Objective: To study epidemiology and prognostic factors associated with cardiac arrest in the intensive care unit (ICU) in an average Brazilian center. Methods: Between June 2011 and July 2014, 302 cases of cardiac arrest in the intensive care unit were prospectively evaluated in 273 patients (age: 68.9 ± 15 years) admitted in three mixed units...
May 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28822393/identifying-futile-interfacility-surgical-transfers
#14
Kristy Kummerow Broman, Sharon E Phillips, Jesse M Ehrenfeld, Mayur B Patel, Oscar M Guillamondegui, Kenneth W Sharp, Richard A Pierce, Benjamin K Poulose, Michael D Holzman
Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28802543/outcomes-and-predictors-of-failure-of-non-invasive-ventilation-in-patients-with-community-acquired-pneumonia-in-the-emergency-department
#15
Amjad Al-Rajhi, Anwar Murad, P Z Li, Jason Shahin
OBJECTIVE: We set out to describe the use and analyze the predictors of non-invasive ventilation failure in patients with community-acquired pneumonia who receive non-invasive ventilation as first line ventilatory therapy in the emergency department. METHODS: A retrospective cohort study was conducted among consecutive patients with community acquired pneumonia requiring ventilator support presenting to two tertiary care university-affiliated emergency departments...
August 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28797376/advance-care-planning-in-the-outpatient-geriatric-medicine-setting
#16
REVIEW
Bryan David Struck, Elizabeth Aubrey Brown, Stefani Madison
This article describes how to perform advance care planning in the outpatient geriatric medicine setting. The article defines advance care planning and discusses components of advance care planning, such as advance directives, do-not-resuscitate orders, and Physician Orders for Life-Sustaining Treatment. The article describes how to document advance care planning discussions in the clinic and bill Medicare and ways for clinicians to improve their skill at leading these conversations.
September 2017: Primary Care
https://www.readbyqxmd.com/read/28796532/hospital-variation-in-do-not-resuscitate-orders-and-end-of-life-healthcare-use-in-the-united-states
#17
Allan J Walkey, Amber E Barnato, Seppo T Rinne, Colin R Cooke, Meng-Shiou Shieh, Penelope S Pekow, Peter K Lindenauer
N/A.
August 10, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28789562/patient-outcomes-after-palliative-care-consultation-among-patients-undergoing-therapeutic-hypothermia
#18
Priya Pinto, Tartania Brown, Michael Khilkin, Elizabeth Chuang
OBJECTIVES: To compare the clinical outcomes of patients who did and did not receive palliative care consultation among those who experienced out-of-hospital cardiac arrest and underwent therapeutic hypothermia. METHODS: We identified patients at a single academic medical center who had undergone therapeutic hypothermia after out-of-hospital cardiac arrest between 2009 and 2013. We performed a retrospective chart review for demographic data, hospital and critical care length of stay, and clinical outcomes of care...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28772095/advance-directives-among-nursing-home-residents-with-mild-moderate-and-advanced-dementia
#19
Jennifer Tjia, Marisa Dharmawardene, Jane L Givens
OBJECTIVE: To describe prevalence and content of AD documentation among NH residents by dementia stage. BACKGROUND: The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. METHODS: Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2...
August 3, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28769583/association-of-code-status-discussion-with-invasive-procedures-among-advanced-stage-cancer-and-noncancer-patients
#20
Akinori Sasaki, Eiji Hiraoka, Yosuke Homma, Osamu Takahashi, Yasuhiro Norisue, Koji Kawai, Shigeki Fujitani
BACKGROUND: Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR), and opioid use among inpatients with advanced stages of cancer and noncancer diseases. METHODS: We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer...
2017: International Journal of General Medicine
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