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Futile Care

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https://www.readbyqxmd.com/read/28922791/targeting-hypoxia-to-improve-non-small-cell-lung-cancer-outcome
#1
Ahmed Salem, Marie-Claude Asselin, Bart Reymen, Alan Jackson, Philippe Lambin, Catharine M L West, James P B O'Connor, Corinne Faivre-Finn
Oxygen deprivation (hypoxia) in non-small cell lung cancer (NSCLC) is an important factor in treatment resistance and poor survival. Hypoxia is an attractive therapeutic target, particularly in the context of radiotherapy, which is delivered to more than half of NSCLC patients. However, NSCLC hypoxia-targeted therapy trials have not yet translated into patient benefit. Recently, early termination of promising evofosfamide and tarloxotinib bromide studies due to futility highlighted the need for a paradigm shift in our approach to avoid disappointments in future trials...
January 1, 2018: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/28914279/blood-products-provided-to-patients-receiving-futile-critical-care
#2
Thanh H Neville, Alyssa Ziman, Neil S Wenger
The number of hospitalized patients receiving treatment perceived to be futile is not insignificant. Blood products are valuable resources that are donated to help others in need. We aimed to quantify the amount of blood transfused into patients who were receiving treatment that the critical care physician treating them perceived to be futile. During a 3-month period, critical care physicians in 5 adult intensive care units completed a daily questionnaire to identify patients perceived as receiving futile treatment...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28892278/reflection-on-stroke-deaths-and-end-of-life-stroke-care
#3
Syed Zujajuddin Quadri, Thang Huynh, Cecilia Cappelen-Smith, Nirupama Wijesuriya, Abul Mamun, Roy Beran, Alan Mcdougall, Dennis Cordato
BACKGROUND: The benefit of palliative care referral for severe stroke patients on end-of-life care pathways (EOLCP) is increasingly recognised. Palliative care provides assistance with symptom management and transition to end-of-life care. Advance care planning (ACP) may help accommodate patient/family expectations and guide management. METHOD: Retrospective study of all stroke deaths (2014-2015) at Liverpool Hospital, Sydney, Australia. Data examined included age, co-morbidities, living arrangements, pre-existing ACP, palliative care referral rates and 'survival time'...
September 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28885062/out-of-hospital-cardiac-arrest-always-coronary-angiography
#4
Andrea Rognoni, Chiara Cavallino, Marco Giovanni Mennuni, Lucia Barbieri, Roberta Rosso, Francesco Rametta, Federico Nardi, Alessandro Lupi, Angelo Sante Bongo
Out-of-hospital cardiac arrest (OHCA) remains one of the principle challenges in the setting of critical care medicine and emergency cardiology. Areas covered: Long-term survival rates even after successful resuscitation are variable but increasing in the recent years; due to the improvement of base and advanced cardiac life support techniques an increasing number of resuscitated patients are admitted to the hospital. Some recent data have suggested that patients surviving to hospital discharge after OHCA presented long-term outcome similar to patients with ST-elevation myocardial infarction...
September 8, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28877748/a-pilot-clinical-trial-of-recombinant-human-angiotensin-converting-enzyme-2-in-acute-respiratory-distress-syndrome
#5
Akram Khan, Cody Benthin, Brian Zeno, Timothy E Albertson, John Boyd, Jason D Christie, Richard Hall, Germain Poirier, Juan J Ronco, Mark Tidswell, Kelly Hardes, William M Powley, Tracey J Wright, Sarah K Siederer, David A Fairman, David A Lipson, Andrew I Bayliffe, Aili L Lazaar
BACKGROUND: Renin-angiotensin system (RAS) signaling and angiotensin-converting enzyme 2 (ACE2) have been implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). We postulated that repleting ACE2 using GSK2586881, a recombinant form of human angiotensin-converting enzyme 2 (rhACE2), could attenuate acute lung injury. METHODS: We conducted a two-part phase II trial comprising an open-label intrapatient dose escalation and a randomized, double-blind, placebo-controlled phase in ten intensive care units in North America...
September 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28876621/the-absolute-number-of-repeat-operations-for-complex-intra-abdominal-sepsis-is-not-a-useful-predictor-of-non-survival
#6
M F Scriba, G L Laing, J L Bruce, D L Clarke
BACKGROUND: When multiple repeat laparotomies are required to manage intra-abdominal sepsis, questions about futility of treatment frequently arise. This study focuses specifically on patients who required two or more repeat laparotomies and describes the spectrum of disease necessitating multiple repeat laparotomies and the associated outcomes in the hope of clarifying the issue. METHOD: This study was conducted over a 20-month period (December 2012 - July 2014) at Greys Hospital in Pietermaritzburg, South Africa...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28872748/30-day-mortality-after-systemic-anticancer-treatment-as-a-real-world-quality-of-care-indicator-the-northland-experience
#7
Edmond Ang, Los Vincent Newton
BACKGROUND: Systemic Anticancer Treatment (SACT) at the end of life is considered poor practice due to futility and associated toxicities. Consequently, 30-Day Mortality after SACT is increasingly recognised as a potential real world quality of care indicator in medical oncology. AIMS: Whangarei Base Hospital (WBH) provides outpatient SACT treatment to all patients living in the Northland region of New Zealand. The goal of this study is to report our 30 Day mortality after SACT and to contribute to the experience of its use in Australasia...
September 5, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28864854/time-resolved-ct-assessment-of-collaterals-as-imaging-biomarkers-to-predict-clinical-outcomes-in-acute-ischemic-stroke
#8
Elizabeth Tong, Jim Patrie, Sara Tong, Avery Evans, Patrik Michel, Ashraf Eskandari, Max Wintermark
PURPOSE: Collateral circulation plays a pivotal role in the pathophysiology of acute ischemic stroke and is increasingly recognized as a promising biomarker for predicting the clinical outcome. However, there is no single established grading system. We designed a novel machine-learning software that allows non-invasive, objective, and quantitative assessment of collaterals according to their vascular territories. Our goal is to investigate the prognostic and predictive value of this collateral score for the prediction of acute stroke outcome...
September 1, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28843407/the-feasibility-of-cold-atmospheric-plasma-in-the-treatment-of-complicated-wounds-in-cranio-maxillo-facial-surgery
#9
Stefan Hartwig, Saskia Preissner, Jan Oliver Voss, Moritz Hertel, Christian Doll, Richard Waluga, Jan Dirk Raguse
BACKGROUND: Compromised wound healing in cranio-maxillo-facial surgery is a threat to the patient's rehabilitation. Therapy of chronic and/or infected wounds is time- and cost-consuming, burdensome and occasionally futile. Cold atmospheric plasma is a new approach that promises to overcome these limitations. The aim of this proof-of-concept study was to evaluate the clinical outcome of cold plasma irradiation in patients with impaired wound healing who are refractory to conservative wound therapy and/or revision surgery...
July 27, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28843370/a-phase-ii-study-of-preoperative-capecitabine-and-concomitant-radiation-in-women-with-advanced-breast-cancer
#10
Wendy A Woodward, Penny Fang, Lisa Arriaga, Hui Gao, Evan N Cohen, James M Reuben, Vicente Valero, Huong Le-Petross, Lavinia P Middleton, Gildy V Babiera, Eric A Strom, Welela Tereffe, Karen Hoffman, Benjamin D Smith, Thomas A Buchholz, George H Perkins
PURPOSE: To examine the response rate of gross chemo-refractory breast cancer treated with concurrent capecitabine (CAP) and radiation therapy in a prospective Phase II study. METHODS AND MATERIALS: Breast cancer patients with inoperable disease after chemotherapy, residual nodal disease after definitive surgical resection, unresectable chest wall or nodal recurrence after a prior mastectomy, or oligometastatic disease were eligible. Response by RECIST criteria was assessed after 45 Gy...
May 3, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28837429/severe-burnout-is-common-among-critical-care-physician-assistants
#11
Muneer Bhatt, Danny Lizano, Anthony Carlese, Vladimir Kvetan, Hayley Beth Gershengorn
OBJECTIVES: To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants. DESIGN: Online survey. SETTINGS: U.S. ICUs. SUBJECTS: Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement...
August 23, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28829876/effect-of-natriuretic-peptide-guided-therapy-on-hospitalization-or-cardiovascular-mortality-in-high-risk-patients-with-heart-failure-and-reduced-ejection-fraction-a-randomized-clinical-trial
#12
RANDOMIZED CONTROLLED TRIAL
G Michael Felker, Kevin J Anstrom, Kirkwood F Adams, Justin A Ezekowitz, Mona Fiuzat, Nancy Houston-Miller, James L Januzzi, Daniel B Mark, Ileana L Piña, Gayle Passmore, David J Whellan, Hongqiu Yang, Lawton S Cooper, Eric S Leifer, Patrice Desvigne-Nickens, Christopher M O'Connor
Importance: The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results. Objective: To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF)...
August 22, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28822393/identifying-futile-interfacility-surgical-transfers
#13
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/28821336/a-randomized-clinical-trial-of-red-blood-cell-transfusion-triggers-in-cardiac-surgery
#14
Colleen G Koch, Daniel I Sessler, Edward J Mascha, Joseph F Sabik, Liang Li, Andra I Duncan, Nicole M Zimmerman, Eugene H Blackstone
BACKGROUND: Class I evidence supporting a threshold for transfusion in the cardiac surgical setting is scarce. We randomly allocated patients to a transfusion hematocrit trigger of 24% versus 28% to compare morbidity, mortality, and resource use. METHODS: From March 2007 to August 2014, two centers randomly assigned 722 adults undergoing coronary artery bypass graft surgery or valve procedures to a 24% hematocrit trigger (n = 363, low group) or 28% trigger (n = 354, high group)...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28777877/timely-access-to-care-in-the-treatment-of-rectal-cancer-and-the-effect-on-quality-of-life
#15
Sofie Walming, Mattias Block, David Bock, Eva Angenete
AIM: The aim of this study was to investigate if a delay in a patient's first contact with a health care professional, and any subsequent delay in diagnosis, affected self-assessed quality of life prior to start of treatment for rectal cancer. METHOD: Questionnaires were administered when the patients had been informed of the diagnosis and planned treatment. The primary endpoint was self-assessed quality of life according to a seven-point Likert scale. The response variables were dichotomized and analysed by unadjusted and adjusted binary logistic regression...
August 4, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28768400/strategies-for-appropriate-patient-centered-care-to-decrease-the-nationwide-cost-of-cancers-in-korea
#16
Jong-Myon Bae
In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care...
July 2017: Journal of Preventive Medicine and Public Health, Yebang Ŭihakhoe Chi
https://www.readbyqxmd.com/read/28758765/ptsd-mental-illness-and-care-among-survivors-of-sexual-violence-in-northern-uganda-findings-from-the-ways-study
#17
Kennedy Amone-P'Olak, Ask Elklit, Sarah Bøgelund Dokkedahl
BACKGROUND: Previous studies have mainly considered war-affected youth as a homogenous group yet several subpopulations of war-affected youth, such as survivors of sexual violence, exist with unique mental health problems and treatment needs. This study aimed to assess posttraumatic stress disorder (PTSD), perceptions and meaning of mental illness, and access and barriers to mental health care among survivors of sexual violence. METHOD: Data were collected from survivors of sexual violence during war (N = 181) who are participants in the longitudinal War-Affected Youth Survey (WAYS) study in Northern Uganda...
July 31, 2017: Psychological Trauma: Theory, Research, Practice and Policy
https://www.readbyqxmd.com/read/28754353/-futile-care-an-emergency-medicine-approach-ethical-and-legal-considerations
#18
Jeremy R Simon, Chadd Kraus, Mark Rosenberg, David H Wang, Elizabeth P Clayborne, Arthur R Derse
Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background...
July 26, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28735650/prognostic-utility-of-neuroinjury-biomarkers-in-post-out-of-hospital-cardiac-arrest-ohca-patient-management
#19
S S Gul, K W Huesgen, K K Wang, K Mark, J A Tyndall
Despite aggressive intervention, patients who survive an out-of-hospital cardiac arrest (OHCA) generally have very poor prognoses, with nationwide survival rates of approximately 10-20%. Approximately 90% of survivors will have moderate to severe neurological injury ranging from moderate cognitive impairment to brain death. Currently, few early prognostic indicators are considered reliable enough to support patients' families and clinicians' in their decisions regarding medical futility. Blood biomarkers of neurological injury after OHCA may be of prognostic value in these cases...
August 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28733295/the-impact-of-healthcare-professionals-personality-and-religious-beliefs-on-the-decisions-to-forego-life-sustaining-treatments-an-observational-multicentre-cross-sectional-study-in-greek-intensive-care-units
#20
Asimenia Ntantana, Dimitrios Matamis, Savvoula Savvidou, Kyriaki Marmanidou, Maria Giannakou, Μary Gouva, George Nakos, Vasilios Koulouras
OBJECTIVES: To assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs). SETTING: Cross-sectional, observational, national study in 18 multidisciplinary Greek ICUs, with >6 beds, between June and December 2015. PARTICIPANTS: 149 doctors and 320 nurses who voluntarily and anonymously answered the End-of-Life (EoL) attitudes, Personality (EPQ) and Religion (SpREUK) questionnaires...
July 21, 2017: BMJ Open
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