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"do not resuscitate"

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https://www.readbyqxmd.com/read/29664875/do-not-resuscitate-orders-in-the-neonatal-icu-experiences-and-beliefs-among-staff
#1
Bonnie H Arzuaga, C Lydia Wraight, Christy L Cummings, Wenyang Mao, David Miedema, Dara D Brodsky
OBJECTIVES: Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown. DESIGN: Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders. SETTING: Four academic neonatal ICUs. SUBJECTS: Clinical staff members working in each neonatal ICU...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29657179/the-dilemma-of-the-doctor-in-the-family
#2
Joanna K Weinberg
The twelve narratives written by physicians for this symposium address the same question: "What happens when I wear a white physician's coat at the bedside of an ill or dying family member or friend?" This commentary addresses several key themes, which emerged as the author reacted to these narratives: (1) the physicians did not mention policy issues affecting the public inherent in a health system regulated by statutes and paid for by insurers; (2) the physicians did not follow the ethical rule against treating family members; (3) there was no discussion of whether hospital ethics committees or similar advisory bodies might have helped address conflicts as they arose; and (4) there was minimal discussion of Advance Medical Directives and Do Not Resuscitate Orders...
2018: Narrative Inquiry in Bioethics
https://www.readbyqxmd.com/read/29651270/disparities-in-functional-outcome-after-intracerebral-hemorrhage-among-asians-and-pacific-islanders
#3
Kazuma Nakagawa, Sage L King, Todd B Seto, Marjorie K L M Mau
Background: Disparities in outcome after intracerebral hemorrhage (ICH) among Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have been inadequately studied. We sought to assess differences in functional outcome between Asians and NHOPI after ICH. Methods: A multiracial prospective cohort study of ICH patients was conducted from 2011 to 2016 at a tertiary center in Honolulu, HI, USA to assess racial disparities in outcome after ICH. Favorable outcome was defined as 3-month modified Rankin Scale (mRS) score ≤2...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29629982/end-of-life-care-in-icus-in-east-asia-a-comparison-among-china-korea-and-japan
#4
So Young Park, Jason Phua, Masaji Nishimura, Yiyun Deng, Yan Kang, Keiichi Tada, Younsuck Koh
OBJECTIVES: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. DESIGN: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. SETTING: ICUs in China, Korea, and Japan. SUBJECTS: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan)...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29614148/clinical-inquiries-how-well-do-polst-forms-assure-that-patients-get-the-end-of-life-care-they-requested
#5
Jordan Collier, Gary Kelsberg, Sarah Safranek
Quite well, for cardiopulmonary resuscitation (CPR). Most patients (91%-100%) who select "do not resuscitate" (DNR) on their physician's orders for life-sustaining treatment (POLST) forms are allowed a natural death without attempted CPR across a variety of settings (community, skilled nursing facilities, emergency medical services, and hospice). Few patients (6%) who select "comfort measures only" die in the hospital, whereas more (22%) who choose "limited interventions," and still more (34%) without a POLST form, die in the hospital (strength of recommendation [SOR]: B, large, consistent cross-sectional and cohort studies)...
April 2018: Journal of Family Practice
https://www.readbyqxmd.com/read/29611241/the-interactive-effect-of-advanced-cancer-patient-and-caregiver-prognostic-understanding-on-patients-completion-of-do-not-resuscitate-orders
#6
Megan Johnson Shen, Kelly M Trevino, Holly G Prigerson
OBJECTIVE: Advanced cancer patients' prognostic understanding is associated with completion of Do Not Resuscitate (DNR) orders, which often represent engagement in advance care planning (ACP). Given caregivers' critical roles in patient decision-making about ACP and end-of-life care, caregivers' prognostic understanding may have a large additive effect. The present study examined the association between the main and interactive effects of advanced cancer patient and caregiver prognostic understanding on DNR order completion...
April 2, 2018: Psycho-oncology
https://www.readbyqxmd.com/read/29590187/is-endotracheal-intubation-a-non-beneficial-treatment-in-patients-with-respiratory-failure-due-to-paraquat-poisoning
#7
Meng-Ruey Wu, Chia-Ying Hsiao, Chun-Han Cheng, Feng-Ching Liao, Chuan-Lei Chao, Chun-Yen Chen, Hung-I Yeh, Min-I Su
INTRODUCTION: Paraquat poisoning can result in dysfunction of multiple organs, and pulmonary fibrosis with respiratory failure is the major cause of mortality. For terminally ill patients, some life-prolonging treatments can be non-beneficial treatments (NBT). The objective of this study was to determine if intubation is a NBT for patients with respiratory failure due to paraquat poisoning. METHODS: The study included 68 patients with respiratory failure due to paraquat poisoning...
2018: PloS One
https://www.readbyqxmd.com/read/29518439/sex-race-and-insurance-status-differences-in-hospital-treatment-and-outcomes-following-out-of-hospital-cardiac-arrest
#8
Scott D Casey, Bryn E Mumma
BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427...
March 5, 2018: Resuscitation
https://www.readbyqxmd.com/read/29489814/reversals-and-limitations-on-high-intensity-life-sustaining-treatments
#9
Gustavo Chavez, Ilana B Richman, Rajani Kaimal, Jason Bentley, Lee Ann Yasukawa, Russ B Altman, Vyjeyanthi S Periyakoil, Jonathan H Chen
IMPORTANCE: Critically ill patients often receive high-intensity life sustaining treatments (LST) in the intensive care unit (ICU), although they can be ineffective and eventually undesired. Determining the risk factors associated with reversals in LST goals can improve patient and provider appreciation for the natural history and epidemiology of critical care and inform decision making around the (continued) use of LSTs. METHODS: This is a single institution retrospective cohort study of patients receiving life sustaining treatment in an academic tertiary hospital from 2009 to 2013...
2018: PloS One
https://www.readbyqxmd.com/read/29479534/do-not-resuscitate-orders-as-part-of-advance-care-planning-in-patients-with-copd
#10
Jo Raskin, Kristina Vermeersch, Stephanie Everaerts, Pascal Van Bleyenbergh, Wim Janssens
There is growing awareness of the need for advance care planning in patients with chronic obstructive pulmonary disease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice. We retrospectively analysed an observational cohort of 569 COPD patients with 2.5-8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance of DNR order implementation and specification. 345 patients (61%) had no DNR order, of whom 27% died during a median (interquartile range (IQR)) follow-up of 1935 (1290-2448) days...
January 2018: ERJ Open Research
https://www.readbyqxmd.com/read/29465539/different-utilization-of-intensive-care-services-icss-for-patients-dying-of-hemorrhagic-and-ischemic-stroke-a-hospital-based-survey
#11
Vinchi Wang, Chieh-Chao Hsieh, Yen-Ling Huang, Chia-Ping Chen, Yi-Ting Hsieh, Tzu-Hao Chao
The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records...
February 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29457686/viable-but-non-culturable-and-persistence-describe-the-same-bacterial-stress-state
#12
Jun-Seob Kim, Nityananda Chowdhury, Ryota Yamasaki, Thomas K Wood
Bacteria are often thought of as having two dormant phenotypes: the viable but non-culturable (VBNC) state and the persister state. Here we investigate the relatedness of the two stress-induced phenotypes at the single-cell level and examine cell morphology and quantify cell resuscitation. Using the classic starvation conditions to create VBNC cells, we found that the majority of the remaining Escherichia coli population are spherical, have empty cytosol, and fail to resuscitate; however, some of the spherical cells resuscitate immediately (most probably those with dense cytosol)...
February 19, 2018: Environmental Microbiology
https://www.readbyqxmd.com/read/29443114/causes-and-circumstances-of-death-in-a-neonatal-unit-over-20-years
#13
Marissa C Michel, Tarah T Colaizy, Jonathan M Klein, Jeffrey L Segar, Edward F Bell
BackgroundWe examined changes in the causes and circumstances of death in our neonatal intensive care unit (NICU) over 20 years.MethodsFor 551 infants who died between 1993 and 2013, the principal cause of death was recorded. Circumstances of death were assigned to one of the following four categories: death following cardiopulmonary resuscitation (CPR), death while being mechanically ventilated without CPR, death after withholding life-support interventions, and death after withdrawal of life support. Data were compared across four 5-year epochs...
February 14, 2018: Pediatric Research
https://www.readbyqxmd.com/read/29420142/the-surprise-question-and-identification-of-palliative-care-needs-among-hospitalized-patients-with-advanced-hematologic-or-solid-malignancies
#14
Kathryn Elizabeth Hudson, Steven Paul Wolf, Gregory P Samsa, Arif H Kamal, Amy Pickar Abernethy, Thomas William LeBlanc
BACKGROUND: Little is known about quality of life (QOL), depression, and end-of-life (EOL) outcomes among hospitalized patients with advanced cancer. OBJECTIVE: To assess whether the surprise question identifies inpatients with advanced cancer likely to have unmet palliative care needs. DESIGN: Prospective cohort study and long-term follow-up. SETTING/SUBJECTS: From 2008 to 2010, we enrolled 150 inpatients at Duke University with stage III/IV solid tumors or lymphoma/acute leukemia and whose physician would not be surprised if they died in less than one year...
February 8, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29417395/islamic-considerations-on-the-application-of-patient-s-autonomy-in-end-of-life-decision
#15
Mohammad Mustaqim Malek, Noor Naemah Abdul Rahman, Mohd Shahnaz Hasan, Luqman Haji Abdullah
In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate...
February 7, 2018: Journal of Religion and Health
https://www.readbyqxmd.com/read/29397521/end-of-life-care-of-children-with-diffuse-intrinsic-pontine-glioma
#16
Fyeza Hasan, Kevin Weingarten, Adam Rapoport, Eric Bouffet, Ute Bartels
The end-of-life management of children with diffuse intrinsic pontine glioma (DIPG) is challenging. Families cope with debilitating symptoms and make complex decisions regarding their child's care. However, there is little evidence guiding palliative care provision for these children. Our objective was to describe the dying trajectory of children with DIPG, their symptoms, the care they require and the end-of-life decisions made for them. This retrospective cohort study analyzed the end-of-life care of 41 consecutive patients with DIPG who died between January 2001 and June 2010...
February 3, 2018: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29378423/receipt-of-vasopressors-is-positively-associated-with-the-length-of-the-actively-dying-process-in-hospitalization
#17
Hsiao-Chen Chou, Hsien-Liang Huang, Chiang-Yi Chen, Chuan-Lan Wang, Chin-Chung Shu, Nin-Chieh Hsu, Yu-Feng Lin, Jin-Shing Chen, Wang-Huei Sheng
BACKGROUND: End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS: We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29372125/dilated-thoracic-esophagus-presenting-with-painful-progressive-persistent-dysphagia-and-leukocytosis-of-unknown-origin
#18
Kyawzaw Lin, Jamil Shah, Emmanuel Ofori, Vahe Shahnazarian, Madhavi Reddy
Esophageal cancer is the eighth-most common cause of cancer-related mortality worldwide. The most common presenting symptom in advanced distal esophageal cancer is the sensation of sticking food, but it may sometimes present with bleeding and related complications, or asymptomatic leukocytosis. We present the case of a 77-year-old afebrile man with chronic alcoholism and a dilated thoracic esophagus with painful, progressive, and persistent dysphagia and leukocytosis of unknown origin. A 77-year-old man with a past medical history of hypertension and colonic cancer status post right hemicolectomy (surveillance negative) presented to the emergency department with painful, progressive, persistent, and worsening dysphagia for the past three weeks...
November 16, 2017: Curēus
https://www.readbyqxmd.com/read/29368644/differences-in-do-not-resuscitate-orders-hospice-care-utilization-and-late-referral-to-hospice-care-between-cancer-and-non-cancer-decedents-in-a-tertiary-hospital-in-taiwan-between-2010-and-2015-a-hospital-based-observational-study
#19
Tzu-Chien Shih, Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Tzeng-Ji Chen, Shinn-Jang Hwang
BACKGROUND: In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change. METHODS: Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan...
January 24, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29351327/a-novel-risk-classification-system-for-30-day-mortality-in-children-undergoing-surgery
#20
Oguz Akbilgic, Max R Langham, Arianne I Walter, Tamekia L Jones, Eunice Y Huang, Robert L Davis
A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012-2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30)...
2018: PloS One
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