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https://www.readbyqxmd.com/read/29443114/causes-and-circumstances-of-death-in-a-neonatal-unit-over-20-years
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/29339056/do-not-resuscitate-tattoos
#9
EDITORIAL
Gordon A Ewy
No abstract text is available yet for this article.
January 12, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29331091/terminal-spreading-depolarization-and-electric-silence-in-death-of-human-cortex
#10
Jens P Dreier, Sebastian Major, Brandon Foreman, Maren K L Winkler, Eun-Jeung Kang, Denny Milakara, Coline L Lemale, Vince DiNapoli, Jason M Hinzman, Johannes Woitzik, Norberto Andaluz, Andrew Carlson, Jed A Hartings
OBJECTIVE: Restoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could inform the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2-5 min after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury...
January 13, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29312849/do-not-resuscitate-status-as-an-independent-risk-factor-for-patients-undergoing-surgery-for-hip-fracture
#11
Ethan Y Brovman, Andrew J Pisansky, Anair Beverly, Angela M Bader, Richard D Urman
AIM: To determine morbidity and mortality in hip fracture patients and also to assess for any independent associations between Do-Not-Resuscitate (DNR) status and increased post-operative morbidity and mortality in patients undergoing surgical repair of hip fractures. METHODS: We conducted a propensity score matched retrospective analysis using de-identified data from the American College of Surgeons' National Surgical Quality Improvement Project (ACS NSQIP) for all patients undergoing hip fracture surgery over a 7 year period in hospitals across the United States enrolled in the ACS NSQIP with and without DNR status...
December 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/29287932/legislating-how-critical-care-physicians-discuss-and-implement-do-not-resuscitate-orders
#12
EDITORIAL
Courtenay R Bruce, Trevor Bibler, Andrew Childress, Savitri Fedson
A few weeks ago, Texas took an unprecedented position on unilateral DNRs by passing Senate Bill (SB) 11, which requires patient/surrogate consent for writing DNR orders. The motivation behind the bill was based on the drafters' beliefs that physicians frequently write unilateral DNR orders. SB 11, however, does not stop at requiring physicians to seek consent for DNR orders. Instead, the legislation uncharacteristically exceeds what is typically within the scope and role boundaries for lawmakers by legislating how physicians discuss and implement DNR orders...
December 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29241382/causes-of-mortality-in-icu-acquired-weakness
#13
Linda van Wagenberg, Esther Witteveen, Luuk Wieske, Janneke Horn
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a common complication of critical illness and is associated with increased mortality, longer mechanical ventilation and longer hospital stay. Little is known about the causes of mortality in patients with ICU-AW. In this study, we aimed to give an overview of the causes of death in a population diagnosed with ICU-AW during hospital admission. METHODS: Data from a prospective cohort study in the mixed medical-surgical ICU of the Academic Medical Center in Amsterdam were used...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29219759/does-the-obesity-paradox-predict-functional-outcome-in-intracerebral-hemorrhage
#14
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
#15
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
#16
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...
January 1, 2018: 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
#17
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
#18
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
#19
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
#20
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
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