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https://www.readbyqxmd.com/read/29132946/an-interview-study-of-patient-and-caregiver-perspectives-on-advance-care-planning-in-esrd
#1
Marcus Sellars, Josephine M Clayton, Rachael L Morton, Tim Luckett, William Silvester, Lucy Spencer, Carol A Pollock, Rowan G Walker, Peter G Kerr, Allison Tong
BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, it can be an emotionally charged process for patients with kidney disease and their caregivers. This study aimed to describe the perspectives and attitudes of patients with end-stage renal disease (ESRD) and their caregivers toward ACP. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Patients with ESRD (n=24) and their caregivers (n=15) aged 36 to 91 years at various stages of ACP ("not commenced," "in progress," or "completed") from 3 renal services...
November 10, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29132577/reanimating-patients-after-traumatic-cardiac-arrest-a-practical-approach-informed-by-best-evidence
#2
REVIEW
Chris Evans, David O Quinlan, Paul T Engels, Jonathan Sherbino
Resuscitation of traumatic cardiac arrest is typically considered futile. Recent evidence suggests that traumatic cardiac arrest is survivable. In this article key principles in managing traumatic cardiac arrest are discussed, including the importance of rapidly seeking prognostic information, such as signs of life and point-of-care ultrasonography evidence of cardiac contractility, to inform the decision to proceed with resuscitative efforts. In addition, a rationale for deprioritizing chest compressions, steps to quickly reverse dysfunctional ventilation, techniques for temporary control of hemorrhage, and the importance of blood resuscitation are discussed...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29119806/ethical-dilemmas-associated-with-clinicians-decisions-about-treatment-in-critically-ill-infants-born-in-c%C3%A3-rdoba-argentina
#3
Agustín Alfredo Silberberg, Juan Eduardo Gallo
The objective of this article is to examine end of life decisions made by neonatologists of Córdoba, Argentina. An anonymous questionnaire was designed to investigate neonatologists' decisions on when to initiate or withdraw treatment in critical neonates. All neonatologists who take care of critically ill neonates in Córdoba participated in the survey. More than 75% of them would initiate treatment in preterm infants with uncertain prognosis based on the viability of the newborn. Because it is common to find that critically ill neonates lack sufficient diagnostic information at birth, this attitude seems to manifest a certain therapeutic activism...
March 2017: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
https://www.readbyqxmd.com/read/29100870/rationing-potentially-inappropriate-treatment-in-newborn-intensive-care-in-developed-countries
#4
REVIEW
Dominic Wilkinson, Stavros Petrou, Julian Savulescu
In newborn intensive care, parents sometimes request treatment that professionals regard as 'futile' or 'potentially inappropriate'. One reason not to provide potentially inappropriate treatment is because it would be excessively costly relative to its benefit. Some public health systems around the world assess the cost-effectiveness of treatments and selectively fund those treatments that fall within a set threshold. This article explores the application of such thresholds to questions in newborn intensive care: (i) when a newborn infant's chance of survival is too small; (ii) how long treatment should continue; (iii) when quality of life is too low; and (iv) when newborn infants are too premature for cost-effective intensive care...
October 31, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29100643/risk-aversion-and-public-reporting-part-1-observations-from-cardiac-surgery-and-interventional-cardiology
#5
REVIEW
David M Shahian, Jeffrey P Jacobs, Vinay Badhwar, Richard S D'Agostino, Joseph E Bavaria, Richard L Prager
Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the two specialties from which almost all risk aversion observations have been derived...
November 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29067495/short-term-application-of-tocilizumab-during-myocardial-infarction-stat-mi
#6
Matthew B Carroll, Charles Haller, Christopher Smith
Acute myocardial infarction (MI) occurs when blood supply falls below critical levels and normal cellular maintenance mechanisms fail. Interleukin-6 (IL-6) is a proinflammatory cytokine released in MI and associated with poor clinical outcomes. Tocilizumab (TCZ) is a humanized monoclonal antibody against the IL-6 receptor. In a randomized, double-blinded, placebo controlled trial we assigned subjects admitted with MI a single TCZ dose of 162 mg subcutaneously vs. placebo in addition to standard of care medications and interventions...
October 24, 2017: Rheumatology International
https://www.readbyqxmd.com/read/29062749/transcatheter-aortic-valve-implantation-in-nonagenarians-selectively-feasible-or-extravagantly-futile
#7
Antonis S Manolis, Antonis A Manolis
A growing number of nonagenarians is recorded as life expectancy increases. Unfortunately, this extreme-aged group is plagued by increased prevalence of aortic stenosis amidst a higher occurrence of comorbidities that pose dilemmas to cardiologists and cardiac surgeons when having to choose a conservative or interventional treatment modality, and a surgical or transcatheter aortic valve implantation (TAVI) approach. TAVI is an expensive procedure, which also confers a higher mortality and morbidity risk in nonagenarians, compared to younger patients...
September 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29038186/incidence-duration-and-cost-of-futile-treatment-in-end-of-life-hospital-admissions-to-three-australian-public-sector-tertiary-hospitals-a-retrospective-multicentre-cohort-study
#8
Hannah E Carter, Sarah Winch, Adrian G Barnett, Malcolm Parker, Cindy Gallois, Lindy Willmott, Ben P White, Mary Anne Patton, Letitia Burridge, Gayle Salkield, Eliana Close, Leonie Callaway, Nicholas Graves
OBJECTIVES: To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions. DESIGN: Retrospective multicentre cohort study involving a clinical audit of hospital admissions. SETTING: Three Australian public-sector tertiary hospitals. PARTICIPANTS: Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012. MAIN OUTCOME MEASURES: Incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment...
October 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29016462/the-medical-futility-experience-of-nurses-in-caring-for-critically-ill-patients
#9
Ming-Yi Hsu, Shu-Fen Su, Lien-Ying Chiang, Sou-Jen Shih, Yu-Chen Chen
BACKGROUND: Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility. PURPOSE: The aim of this study was to understand the medical futility experiences of intensive care nurses...
October 10, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/28990674/the-futility-of-intraoperative-frozen-section-in-the-evaluation-of-follicular-thyroid-lesions
#10
Craig A Bollig, David Lesko, David Gilley, Laura M Dooley
OBJECTIVE: Investigate the utility of intraoperative frozen section (iFS) in patients with follicular thyroid lesions following publication of the 2015 American Thyroid Association (ATA) guidelines. STUDY DESIGN: Retrospective chart review. METHODS: Patient demographics, preoperative cytology, frozen pathology, and final pathology were reviewed on patients undergoing thyroid surgery at a tertiary care hospital in which iFS was utilized over a 5-year period...
October 9, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28973081/clinical-imaging-factors-associated-with-infarct-progression-in-patients-with-ischemic-stroke-during-transfer-for-mechanical-thrombectomy
#11
Gregoire Boulouis, Arne Lauer, Ahmer Khawdja Siddiqui, Andreas Charidimou, Robert W Regenhardt, Anand Viswanathan, Natalia Rost, Thabele M Leslie-Mazwi, Lee H Schwamm
Importance: When transferred from a referring hospital (RH) to a thrombectomy-capable stroke center (TCSC), patients with initially favorable imaging profiles (Alberta Stroke Program Early CT Score [ASPECTS] ≥6) often demonstrate infarct progression significant enough to make them ineligible for mechanical thrombectomy at arrival. In rapidly evolving stroke care networks, the question of the need for vascular imaging at the RHs remains unsolved, resulting in an important amount of futile transfers for thrombectomy...
November 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28970712/liver-transplantation-for-acute-on-chronic-liver-failure
#12
Narendra S Choudhary, Neeraj Saraf, Sanjiv Saigal, Arvinder S Soin
BACKGROUND: Acute-on chronic liver failure (ACLF) is defined as acute insult on previous liver disease that causes sudden worsening of liver functions. METHODS: ACLF is characterized by high incidence of organ failure and prognosis is remarkably worse than patients with cirrhosis. Incidence of organ failures is very high despite best medical care and timely liver transplant before development of multi organ failure is associated with good survival rates. RESULTS: At present, there are no reliable score or ways to correctly identify patients who are going to recover from patients who will need transplantation...
September 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/28940349/charlie-gard-and-the-limits-of-parental-authority
#13
Arthur Caplan, Kelly McBride Folkers
The parents of Charlie Gard, who was born August 4, 2016, with an exceedingly rare and incurable disease called mitochondrial DNA depletion syndrome, fought a prolonged and heated legal battle to allow him access to experimental treatment that they hoped would prolong his life and to prevent his doctors from withdrawing life-sustaining care. Charlie's clinicians at the Great Ormond Street Hospital in London believed that the brain damage Charlie had suffered as a result of frequent epileptic seizures, along with many other severe disabilities, would render any innovative therapy futile, and they disagreed with his parents' wishes to use an experimental therapy...
September 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28937188/surgical-futility-and-patient-centered-care-the-effects-of-human-nature-in-decision-making
#14
Justin S Hatchimonji, Dominic A Sisti, Niels D Martin
No abstract text is available yet for this article.
November 2016: Bulletin of the American College of Surgeons
https://www.readbyqxmd.com/read/28936495/the-accuracy-of-nurses-predictions-for-clinical-outcomes-in-the-chronically-critically-ill
#15
Amy R Lipson, Sarah J Miano, Barbara J Daly, Sara L Douglas
BACKGROUND: Accurately predicting survivorship of patients in the intensive care unit is known to be difficult. Previous research has shown that nurses are more likely to recognize futile medical care than other disciplines. The purpose of this study was to describe the accuracy of nurse's predictions for survival of patients who are chronically critically ill (CCI). METHODS: Using a secondary data analysis from a longitudinal, descriptive study, we evaluated nurses' predictions for survival at admission and until ICU discharge or patient death...
September 2017: Research & Reviews: Journal of Nursing and Health Sciences
https://www.readbyqxmd.com/read/28922791/targeting-hypoxia-to-improve-non-small-cell-lung-cancer-outcome
#16
REVIEW
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
#17
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
#18
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
#19
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. Recent data suggested that patients surviving to hospital discharge after OHCA presented long-term outcome similar to patients with ST-elevation myocardial infarction...
November 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
#20
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
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