keyword
https://read.qxmd.com/read/38536997/portuguese-advance-directives-a-twist-against-futility-a-cross-sectional-study
#1
JOURNAL ARTICLE
Catarina Sampaio Martins, Rui Nunes
BACKGROUND: Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. OBJECTIVES: To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions. DESIGN AND SETTING: This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool...
2024: São Paulo Medical Journal
https://read.qxmd.com/read/38528556/predictors-and-outcomes-of-withholding-and-withdrawal-of-life-sustaining-treatments-in-intensive-care-units-in-singapore-a-multicentre-observational-study
#2
JOURNAL ARTICLE
Clare Fong, Wern Lunn Kueh, Sennen Jin Wen Lew, Benjamin Choon Heng Ho, Yu-Lin Wong, Yie Hui Lau, Yew Woon Chia, Hui Ling Tan, Ying Hao Christopher Seet, Wen Ting Siow, Graeme MacLaren, Rohit Agrawal, Tian Jin Lim, Shir Lynn Lim, Toon Wei Lim, Vui Kian Ho, Chai Rick Soh, Duu Wen Sewa, Chian Min Loo, Faheem Ahmed Khan, Chee Keat Tan, Roshni Sadashiv Gokhale, Chuin Siau, Noelle Louise Siew Hua Lim, Chik-Foo Yim, Jonathen Venkatachalam, Kumaresh Venkatesan, Naville Chi Hock Chia, Mei Fong Liew, Guihong Li, Li Li, Su Mon Myat, Zena Zena, Shuling Zhuo, Ling Ling Yueh, Caroline Shu Fang Tan, Jing Ma, Siew Lian Yeo, Yiong Huak Chan, Jason Phua
BACKGROUND: Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches...
March 26, 2024: Journal of Intensive Care
https://read.qxmd.com/read/38516714/assessing-futile-trauma-transfers-in-rural-appalachia-following-a-regional-health-care-system-consolidation
#3
JOURNAL ARTICLE
Michelle A Everly, Allen Archer, Matt Heard, Keelin Roche, J Bracken Burns
This study sought to define and analyze rates of futile trauma transfers (FTTs) after the consolidation of two rural level 1 trauma centers into one. Data was extracted from the regional trauma registry for a period of 5 years (2017-2022) for all trauma patients transferred into our level 1 trauma center (n = 3369). An FTT was defined as a transfer that (1) received no major interventions and (2) died or was discharged to a hospice facility within 72 hours. Out of the 3369 transfer patients analyzed during the 33-month pre-consolidation and 33-month post-consolidation periods, 34 patients met the criteria of an FTT within the transfer-to-discharge window...
March 22, 2024: American Surgeon
https://read.qxmd.com/read/38515804/rethinking-referral-systems-in-rural-chiapas-a-mixed-methods-study
#4
JOURNAL ARTICLE
Valeria Macias, Zulema Garcia, William Pavlis, Sarah Hill, Zachary Fowler, Diana D Del Valle, Tarsicio Uribe-Leitz, Hannah Gilbert, Lina Roa, Mary-Jo DelVecchio Good
BACKGROUND: Despite the assurance of universal health coverage, large disparities exist in access to surgery in the state of Chiapas. The purpose of this study was to determine the effectiveness of the surgical referral system at hospitals operated by the Ministry of Health in Chiapas. METHODS: 13 variables were extracted from surgical referrals data from three public hospitals in Chiapas over a three-year period. Interviews were performed of health care workers involved in the referral system and surgical patients...
December 2023: Dialogues Health
https://read.qxmd.com/read/38510778/methylene-blue-in-septic-shock-a-novel-weapon-in-our-arsenal-are-utility-studies-highlighting-its-futility
#5
JOURNAL ARTICLE
Varun M Angadi, Atul Jindal
How to cite this article: Angadi VM, Jindal A. Methylene Blue in Septic Shock-A Novel Weapon in Our Arsenal: Are Utility Studies Highlighting its Futility? Indian J Crit Care Med 2024;28(1):89.
January 2024: Indian Journal of Critical Care Medicine
https://read.qxmd.com/read/38508835/safety-and-efficacy-of-givinostat-in-boys-with-duchenne-muscular-dystrophy-epidys-a-multicentre-randomised-double-blind-placebo-controlled-phase-3-trial
#6
RANDOMIZED CONTROLLED TRIAL
Eugenio Mercuri, Juan J Vilchez, Odile Boespflug-Tanguy, Craig M Zaidman, Jean K Mah, Nathalie Goemans, Wolfgang Müller-Felber, Erik H Niks, Ulrike Schara-Schmidt, Enrico Bertini, Giacomo P Comi, Katherine D Mathews, Laurent Servais, Krista Vandenborne, Jessika Johannsen, Sonia Messina, Stefan Spinty, Laura McAdam, Kathryn Selby, Barry Byrne, Chamindra G Laverty, Kevin Carroll, Giulia Zardi, Sara Cazzaniga, Nicoletta Coceani, Paolo Bettica, Craig M McDonald
BACKGROUND: Duchenne muscular dystrophy, the most common childhood muscular dystrophy, is caused by dystrophin deficiency. Preclinical and phase 2 study data have suggested that givinostat, a histone deacetylase inhibitor, might help to counteract the effects of this deficiency. We aimed to evaluate the safety and efficacy of givinostat in the treatment of Duchenne muscular dystrophy. METHODS: This multicentre, randomised, double-blind, placebo-controlled, phase 3 trial was done at 41 tertiary care sites in 11 countries...
April 2024: Lancet Neurology
https://read.qxmd.com/read/38505345/estimating-mortality-risk-in-burn-patients-admitted-at-rwanda-s-largest-referral-hospital
#7
JOURNAL ARTICLE
Ian Shyaka, Elizabeth Miranda, Lotta Velin, Francoise Mukagaju, Yves Nezerwa, Faustin Ntirenganya, Charles Furaha, Robert Riviello, Laura Pompermaier
BACKGROUND: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings...
2024: International Journal of Burns and Trauma
https://read.qxmd.com/read/38488403/the-challenges-of-nursing-care-for-patients-with-lumbar-discectomy-a-qualitative-study
#8
REVIEW
Sahar Haghighat, Khadijeh Yazdi, Gholam Reza Mahmoodi-Shan, Zahra Sabzi
AIM: Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy. DESIGN: This qualitative study was conducted in 2022 using content analysis. METHODS: Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran...
March 2024: Nursing Open
https://read.qxmd.com/read/38478852/applying-lessons-from-ars-moriendi-to-foster-dying-well-in-acute-care-settings
#9
JOURNAL ARTICLE
Kathy Forte, Danielle Larkin
Medical and technological advances have made it possible to keep people alive well beyond what was once possible, leading health care providers to focus on life-sustaining measures rather than questioning the futility of such measures and considering quality of life. In the midst of the struggle to foster dying well in a medicalized environment, acute care nurses may be challenged with shifting the focus to providing optimal end-of-life care because of lack of training, time, and resources. A remedy for the current western societal approach to medicalized dying is to look back in history to a time during the late Middle Ages, when death was an accepted part of medieval life...
March 13, 2024: Journal of Hospice and Palliative Nursing: JHPN
https://read.qxmd.com/read/38477224/the-futility-of-post-haemodialysis-blood-glucose-levels-a-retrospective-cohort-study
#10
JOURNAL ARTICLE
Jing Zhang, Richard K Le Leu, Qunyan Xu, Paul Bennett
BACKGROUND: Frequent blood glucose tests are performed for people with diabetes receiving haemodialysis. OBJECTIVES: To determine the rate of out-of-range post-haemodialysis blood glucose levels that are clinically acted upon, the intervention and outcome of each intervention, and the associations between post-haemodialysis blood glucose levels and relevant clinical predictors. DESIGN: 12-month retrospective cohort medical record review in one Australian haemodialysis centre...
March 13, 2024: Journal of Renal Care
https://read.qxmd.com/read/38475798/long-term-outcome-in-new-onset-refractory-status-epilepticus-a-retrospective-study
#11
JOURNAL ARTICLE
Federica Stretti, Stefan Yu Bögli, Francesca Casagrande, Amanda Eisele, Marian Galovic, Emanuela Keller, Giovanna Brandi
BACKGROUND: New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifiable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series of patients with NORSE. METHODS: Overall, 283 adults were admitted with status epilepticus (SE) to the Neurocritical Care Unit of the University Hospital Zurich, Switzerland, between 01...
March 12, 2024: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/38463033/experiences-in-the-use-of-multiple-doses-of-convalescent-plasma-in-critically-ill-patients-with-covid-19-an-early-phase-1-descriptive-study
#12
JOURNAL ARTICLE
Ricardo Aguilar, Sandra López-Vergès, Anarellys Quintana, Johanna Morris, Lineth Lopez, Ana Cooke, Dimas Quiel, Natalie Buitron, Yaseikiry Pérez, Lesbia Lobo, Maura Ballesteros, Yaneth Pitti, Yamilka Diaz, Lisseth Saenz, Danilo Franco, Daniel Castillo, Elimelec Valdespino, Isabel Blanco, Emilio Romero, Alcibiades Villarreal, Idalina Cubilla-Batista
BACKGROUND: At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, transfusion of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) emerged as a potential therapeutic strategy to help patients severely afflicted by COVID-19. The efficacy of CCP has been controversial as it depends on many variables pertaining to the plasma donor and the patient with COVID-19, for example, time of convalescence or symptoms onset. This feasibility and descriptive study aimed to assess the safety of multiple doses of CCP in mechanically ventilated, intubated patients with respiratory failure due to COVID-19...
March 2024: Health Science Reports
https://read.qxmd.com/read/38448221/adaptive-multi-interventional-trial-platform-to-improve-patient-care-for-fibrotic-interstitial-lung-diseases
#13
REVIEW
Leticia Kawano-Dourado, Tejaswini Kulkarni, Christopher J Ryerson, Pilar Rivera-Ortega, Bruno Guedes Baldi, Nazia Chaudhuri, Manuela Funke-Chambour, Anna-Maria Hoffmann-Vold, Kerri A Johannson, Yet Hong Khor, Sydney B Montesi, Lucilla Piccari, Helmut Prosch, María Molina-Molina, Jacobo Sellares Torres, Iazsmin Bauer-Ventura, Sujeet Rajan, Joseph Jacob, Duncan Richards, Lisa G Spencer, Barbara Wendelberger, Tom Jensen, Melanie Quintana, Michael Kreuter, Anthony C Gordon, Fernando J Martinez, Naftali Kaminski, Victoria Cornelius, Roger Lewis, Wendy Adams, Gisli Jenkins
BACKGROUND: Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is an urgent need to accelerate this process. This manuscript introduces the concept and design of an innovative research approach to drug development in fILD: a global Randomised Embedded Multifactorial Adaptive Platform in fILD (REMAP-ILD)...
March 6, 2024: Thorax
https://read.qxmd.com/read/38445109/saving-ambulance-resources-a-service-evaluation-of-the-identification-of-non-viable-out-of-hospital-cardiac-arrest-in-london-by-advanced-paramedic-practitioners-in-critical-care
#14
JOURNAL ARTICLE
Nick Brown, Chelsey Pike
BACKGROUND: Advanced paramedic practitioners in critical care (APPCCs) are advanced clinical practitioners focused on the delivery of pre-hospital critical care. While working in an ambulance control room setting, APPCCs seek to identify emergency calls appropriate for operational APPCCs to attend. These would include out-of-hospital cardiac arrest (OHCA). Through interrogation of incoming emergency calls they are also able to identify OHCA calls where resuscitation may be futile. In these cases, and within a governance framework, they stand down multiple ambulance responders, leaving only the closest responding resource to attend, thereby 'saving resources' that can be re-directed to other waiting emergency calls...
March 1, 2024: British paramedic journal
https://read.qxmd.com/read/38432332/etiologies-and-impact-of-exclusion-rates-for-transcatheter-mitral-and-tricuspid-valve-structural-heart-clinical-trials-at-a-high-volume-quaternary-care-hospital
#15
JOURNAL ARTICLE
Lu Chen, Lin Wang, George Petrossian, Newell Robinson, William Chung, Matthew Henry, Dennis Mihalatos, Ruqiyya Bano, Jonathan Weber, Jaffar Khan, David J Cohen, Andrew Berke, Ziad Ali, Omar K Khalique
There are various devices under clinical investigation for transcatheter mitral valve intervention (TMVI) and tricuspid valve intervention (TTVI), but exclusion rates remain high. We aim to investigate exclusion rates for transcatheter mitral valve repair (TMVr), transcatheter mitral valve replacement (TMVR), transcatheter tricuspid valve repair (TTVr) and transcatheter tricuspid valve replacement (TTVR). There were a total of 129 patients who were referred to St. Francis Hospital & Heart Center valve clinic and completed screening between January 2021 and July 2022...
March 1, 2024: American Journal of Cardiology
https://read.qxmd.com/read/38429709/-tie-your-camel-first-then-rely-on-god-reconceptualizing-javanese-islamic-values-to-support-palliative-care-at-home
#16
JOURNAL ARTICLE
Raditya Bagas Wicaksono, Amalia Muhaimin, Dick L Willems, Jeannette Pols
BACKGROUND: In the last decade, there has been a growing concern to make palliative care more culturally sensitive and contextually appropriate. This concern is also relevant in Indonesia, where the progress of palliative care, particularly in home-based care, has been slow. Like elsewhere in the world, there has been a growing awareness of the importance of shifting from a curative orientation towards a palliative one, especially in cases where further medical treatment is futile. In this paper we argue that the development of palliative care practices would benefit greatly from learning about the values that are important for patients, families, and health professionals...
March 2, 2024: BMC Palliative Care
https://read.qxmd.com/read/38426365/multi-disciplinary-diabetic-limb-salvage-programme-in-octogenarians-with-diabetic-foot-ulcers-is-not-futile-an-observational-study-with-historical-controls
#17
JOURNAL ARTICLE
Lixia Ge, Jiashen Zhao, Matthew Tan, Elaine Tan, Huiling Liew, Enming Yong, Jeremy Hoe, Claris Shi, Dexter Yak Seng Chan, Gary Yee Ang, Joseph Antonio Molina, Yan Sun, Wai Han Hoi, Sadhana Chandraskear, Zhiwen Joseph Lo
This study evaluated the effectiveness of a multi-disciplinary diabetic limb salvage programme in improving clinical outcomes and optimising healthcare utilisation in 406 patients aged ≥80 years with diabetic foot ulcers (DFUs), compared to 2392 younger patients enrolled from June 2020 to June 2021 and against 1716 historical controls using one-to-one propensity score matching. Results showed that elderly programme patients had lower odds of amputation-free survival (odds ratio: 0.64, 95% CI: 0...
March 2024: International Wound Journal
https://read.qxmd.com/read/38413296/risk-factors-for-mortality-in-children-with-hemorrhagic-cystitis-after-hematopoietic-transplant
#18
JOURNAL ARTICLE
Daniel Salevitz, Lucia Mirea, Gwen M Grimsby
INTRODUCTION: Hemorrhagic cystitis (HC) is a devastating complication of bone marrow (BMT) and stem cell transplant (SCT). Much of the literature has focused on exclusively adult patient populations, with limited evidence regarding risk factors for mortality and morbidity among pediatric HC patients. OBJECTIVE: To examine factors associated with all-cause mortality in children with HC after BMT/SCT. METHODS: The Pediatric Health Information System database was queried for patients with ICD-9/10 codes for hematopoietic transplant and gross hematuria, hematuria unspecified, or cystitis with hematuria...
February 15, 2024: Journal of Pediatric Urology
https://read.qxmd.com/read/38403182/lactate-and-lactate-clearance-as-predictors-of-one-year-survival-in-extracorporeal-cardiopulmonary-resuscitation-an-international-multicentre-cohort-study
#19
JOURNAL ARTICLE
Tharusan Thevathasan, Emilie Gregers, Sivagowry Rasalingam Mørk, Sêhnou Degbeon, Louise Linde, Jo Bønding Andreasen, Morten Smerup, Jacob Eifer Møller, Christian Hassager, Helle Laugesen, Henryk Dreger, Anna Brand, Felix Balzer, Ulf Landmesser, Christian Juhl Terkelsen, Jens Flensted Lassen, Carsten Skurk, Helle Søholm
AIM: Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. It was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients...
February 23, 2024: Resuscitation
https://read.qxmd.com/read/38371171/horrifying-basal-cell-carcinoma-presenting-as-progressive-pyoderma-gangrenosum-case-report
#20
Jason S Hoellwarth, Taylor J Reif, Shoko Mori, Rachel Kang, Cynthia M Magro
INTRODUCTION: Skin ulcers can be challenging to diagnose and manage, particularly with comorbid autoimmune and gastrointestinal diseases. Occam's razor encourages the simplest explanation to guide care, but reconsideration must occur when intervention proves futile. CASE PRESENTATION: We report the case of a 70-year-old male, with a 17-year history of expanding pretibial skin ulcer, presumed by prior care providers to be pyoderma gangrenosum related to Crohn's disease...
2024: Case Reports in Oncology
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