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https://www.readbyqxmd.com/read/28501253/resection-of-the-primary-tumor-in-stage-iv-colorectal-cancer-when-is-it-necessary
#1
REVIEW
Leandro Feo, Michael Polcino, Garrett M Nash
Management of metastatic colorectal cancer requires accurate staging and multidisciplinary evaluation, leading to a consensus treatment plan with the ultimate goal of increasing survival and improving the quality of life, while taking into consideration the patient's performance status, disease burden, and goals of care. Since the introduction of multidrug chemotherapeutic regimens, survival of patients with metastatic colorectal cancer has improved. Many patients with unresectable disease are undergoing surgery for asymptomatic primary tumors despite evidence that it is usually a futile intervention...
June 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28500122/navigating-the-benefits-and-burdens-of-life-saving-treatment-in-severely-decompensated-cirrhosis-an-illustrative-multisourced-narrative
#2
Philip Berry, Kuldeep Cheent, Heather Lewis, Marcus Peck
Severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life-extending treatment. Using accounts and interviews with a patient, her mother, consultant hepatologists and a consultant intensivist, this article explores the decision making around a 43-year-old woman with alcoholic liver disease who died after 100 days in a hospital. Particular focus is given to decisions on escalation, recognition of futility, distress associated with therapy and how messages given during end-of-life discussions are processed...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28481130/perception-of-futile-care-and-caring-behaviors-of-nurses-in-intensive-care-units
#3
Somaye Rostami, Ravanbakhsh Esmaeali, Hedayat Jafari, Jamshid Yazdani Cherati
OBJECTIVES: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. METHOD: This correlation, analytical study was conducted with 181 nursing staff of the intensive care units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28467148/outcomes-of-cardiac-arrest-in-residential-care-homes-for-the-elderly-in-hong-kong
#4
Kit Ling Fan, Ling Pong Leung
OBJECTIVE: Studies done in the 1990's suggested nursing home residents with cardiac arrest had minimal chance of survival and resuscitation was not recommended. More recent studies showed opposing results. In Hong Kong, the proportion of elderly living in the residential care homes for the elderly is increasing. There is no study of out-of-hospital cardiac arrest outcomes in this population. This study aimed at evaluating the prognosis of out-of-hospital cardiac arrest occurring in the residential care homes for the elderly...
May 3, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28457980/reversal-of-trauma-induced-coagulopathy-using-first-line-coagulation-factor-concentrates-or-fresh-frozen-plasma-retic-a-single-centre-parallel-group-open-label-randomised-trial
#5
Petra Innerhofer, Dietmar Fries, Markus Mittermayr, Nicole Innerhofer, Daniel von Langen, Tobias Hell, Gottfried Gruber, Stefan Schmid, Barbara Friesenecker, Ingo H Lorenz, Mathias Ströhle, Verena Rastner, Susanne Trübsbach, Helmut Raab, Benedikt Treml, Dieter Wally, Benjamin Treichl, Agnes Mayer, Christof Kranewitter, Elgar Oswald
BACKGROUND: Effective treatment of trauma-induced coagulopathy is important; however, the optimal therapy is still not known. We aimed to compare the efficacy of first-line therapy using fresh frozen plasma (FFP) or coagulation factor concentrates (CFC) for the reversal of trauma-induced coagulopathy, the arising transfusion requirements, and consequently the development of multiple organ failure. METHODS: This single-centre, parallel-group, open-label, randomised trial was done at the Level 1 Trauma Center in Innsbruck Medical University Hospital (Innsbruck, Austria)...
April 27, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28454534/palliative-care-for-people-with-dementia-in-the-terminal-phase-a-mixed-methods-qualitative-study-to-inform-service-development
#6
Jenny T van der Steen, Natashe Lemos Dekker, Marie-José H E Gijsberts, Laura H Vermeulen, Margje M Mahler, B Anne-Mei The
BACKGROUND: When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of a small evidence base. METHODS: In 2015-2016, we performed a mixed-methods qualitative study in which we (1) analysed the domains and recommendations from the European Association for Palliative Care (EAPC) dementia white paper and identified those with particular relevance for the terminal phase; (2) performed a series of focus group discussions with Dutch family caregivers of people with dementia in variable stages; (3) conducted interviews with experts involved in 15 special forms of terminal care for people with dementia in five countries...
April 28, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28441973/treatment-limiting-decisions-in-patients-with-severe-traumatic-brain-injury-in-a-norwegian-regional-trauma-center
#7
Annette Robertsen, Reidun Førde, Nils Oddvar Skaga, Eirik Helseth
BACKGROUND: Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting. METHODS: A retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs...
April 26, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28430791/the-medically-managed-patient-with-severe-symptomatic-aortic-stenosis-in-the-tavr-era-patient-characteristics-reasons-for-medical-management-and-quality-of-shared-decision-making-at-heart-valve-treatment-centers
#8
Kumar Dharmarajan, Jill Foster, Megan Coylewright, Philip Green, John P Vavalle, Osman Faheem, Pei-Hsiu Huang, Amar Krishnaswamy, Vinod H Thourani, Lisa A McCoy, Tracy Y Wang
BACKGROUND: Little is known about patients with severe symptomatic aortic stenosis (AS) who receive medical management despite evaluation at a heart valve treatment center. OBJECTIVE: We identified patient characteristics associated with medical management, physician-reported reasons for selecting medical management, and patients' perceptions of their involvement and satisfaction with treatment selection. METHODS AND RESULTS: Of 454 patients evaluated for AS at 9 established heart valve treatment centers from December 12, 2013 to August 19, 2014, we included 407 with severe symptomatic AS...
2017: PloS One
https://www.readbyqxmd.com/read/28424017/computed-tomography-perfusion-based-selection-of-endovascularly-treated-acute-ischaemic-stroke-patients-are-there-lessons-to-be-learned-from-the-pre-evidence-era
#9
Marios-Nikos Psychogios, Michael Knauth, Raya Bshara, Katharina Schregel, Ioannis Tsogkas, Ismini Papageorgiou, Ilko Maier, Jan Liman, Daniel Behme
Introduction Some of the latest groundbreaking trials suggest that noncontrast cranial computed tomography and computed tomography-angiography are sufficient tools for patient selection within six hours of symptom onset. Before endovascular stroke therapy became the standard of care, patient selection was one of the most useful tools to avoid futile reperfusions. We report the outcomes of endovascularly treated stroke patients selected with a perfusion-based paradigm and discuss the implications in the current era of endovascular treatment...
April 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#10
Rajat N Moman, Caitlin Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: he Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at one year to select those who would benefit from advanced care planning. Such goals of care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end-of-life, potentially reduce the number of futile interventions...
April 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28399755/nmc-ruling-could-encourage-futile-cpr
#11
Alison Moore
What would you do if you found a patient had died in the night while under your care? Most nurses would inform their superiors and probably play a part in contacting relatives with the bad news. Their actions would be aimed at protecting the dignity of the person who had died and showing respect for them and their bereaved family.
April 12, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28389221/welfare-law-and-ethics-in-the-veterinary-intensive-care-unit-a-discussion-of-the-different-types-of-suffering-that-patients-may-endure-in-the-veterinary-intensive-care-unit-the-legal-limits-to-that-suffering-and-the-ethics-underpinning-at-what-point-that-suffering
#12
REVIEW
Peter S Fordyce
OBJECTIVES: In UK law, allowing an animal protected under the Animal Welfare Act 2006 (AWA 2006) (as devolved) to suffer 'unnecessarily' may render the person responsible for it to prosecution. The act does not define suffering, although 'case law' suggests that suffering encompasses more than pain. Clinicians responsible for animals under their care in the intensive care unit (ICU) are likely to also be responsible in law for the welfare of those animals, and may be called upon to justify why any suffering was necessary, or more likely, why they did not act to end any suffering when it became 'unnecessary'...
January 11, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28376877/rationale-and-design-of-the-placid-study-a-randomised-trial-comparing-the-efficacy-and-safety-of-inhaled-loxapine-versus-im-aripiprazole-in-acutely-agitated-patients-with-schizophrenia-or-bipolar-disorder
#13
L San, G Estrada, N Oudovenko, E Vieta
BACKGROUND: The management of acute agitation manifesting in patients with schizophrenia or bipolar disorder requires swift pharmacological intervention to provide rapid symptomatic relief and prevent escalation to aggression and violence. Antipsychotic medications are widely used in this setting and the availability of an inhaled formulation with deep lung absorption of the antipsychotic loxapine has the potential to deliver a faster onset of therapeutic effect than the available intramuscular formulations of antipsychotics...
April 4, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28359616/recognising-the-boundary-between-heroism-and-futility-in-veterinary-intensive-care
#14
EDITORIAL
Richard Eddie Clutton
No abstract text is available yet for this article.
January 12, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28326805/a-retrospective-analysis-of-care-in-patients-with-dementia-hospitalized-at-a-tertiary-medical-center
#15
Riddhi Patira, Huaqing Zhao, Ausim Azizi
BACKGROUND: Hospitalization is an opportunity to address various aspects related to management of dementia, including the goals of care to avoid futile care. We studied the prevalence of these factors when patients with dementia are hospitalized. DESIGN: One hundred and thirty-one charts of patients with dementia admitted to a single university-based hospital were retrospectively reviewed. Data were collected and analyzed for age, gender, the severity of dementia, co-morbidities, co-existing vascular dementia, reversible causes of dementia, mental status scores, medications, consultations, procedures, complications, availability of advance directives, decision-maker, code status, and goals of care discussion...
March 22, 2017: Aging & Mental Health
https://www.readbyqxmd.com/read/28320259/levosimendan-for-hemodynamic-support-after-cardiac-surgery
#16
Giovanni Landoni, Vladimir V Lomivorotov, Gabriele Alvaro, Rosetta Lobreglio, Antonio Pisano, Fabio Guarracino, Maria G Calabrò, Evgeny V Grigoryev, Valery V Likhvantsev, Marcello F Salgado-Filho, Alessandro Bianchi, Vadim V Pasyuga, Massimo Baiocchi, Federico Pappalardo, Fabrizio Monaco, Vladimir A Boboshko, Marat N Abubakirov, Bruno Amantea, Rosalba Lembo, Luca Brazzi, Luigi Verniero, Pietro Bertini, Anna M Scandroglio, Tiziana Bove, Alessandro Belletti, Maria G Michienzi, Dmitriy L Shukevich, Tatiana S Zabelina, Rinaldo Bellomo, Alberto Zangrillo
Background Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving patients in whom perioperative hemodynamic support was indicated after cardiac surgery, according to prespecified criteria. Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0...
May 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28302424/external-validation-of-the-universal-termination-of-resuscitation-rule-for-out-of-hospital-cardiac-arrest-in-british-columbia
#17
Brian Grunau, John Taylor, Frank X Scheuermeyer, Robert Stenstrom, William Dick, Takahisa Kawano, David Barbic, Ian Drennan, Jim Christenson
STUDY OBJECTIVE: The Universal Termination of Resuscitation Rule (TOR Rule) was developed to identify out-of-hospital cardiac arrests eligible for field termination of resuscitation, avoiding futile transportation to the hospital. The validity of the rule in emergency medical services (EMS) systems that do not routinely transport out-of-hospital cardiac arrest patients to the hospital is unknown. We seek to validate the TOR Rule in British Columbia. METHODS: This study included consecutive, nontraumatic, adult, out-of-hospital cardiac arrests treated by EMS in British Columbia from April 2011 to September 2015...
March 14, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28291728/variation-in-emergency-percutaneous-coronary-intervention-in-ventilated-patients-in-the-uk-insights-from-a-national-database
#18
John Rawlins, Peter F Ludman, Darragh O'Neil, Mamas A Mamas, Mark de Belder, Simon Redwood, Adrian Banning, Andrew Whittaker, Nick Curzen
AIMS: Pre-procedural ventilation is a marker of high risk in PCI patients. Causes include out-of-hospital cardiac arrest (OHCA) and cardiogenic shock. OHCA occurs in approximately 60,000 patients in the UK per annum. No consensus exists regarding the need/timing of coronary angiography ± revascularization without ST elevation. The aim was to describe the national variation in the rate of emergency PCI in ventilated patients. METHODS AND RESULTS: Using the UK national database for PCI in 2013, we identified all procedures performed as 'emergency' or 'salvage' for whom ventilation had been initiated before the PCI...
February 13, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28267007/twenty-years-of-a-veterans-spinal-cord-injury-colorectal-clinic-flexible-sigmoidoscopy-and-multiple-hemorrhoid-ligation
#19
Bard C Cosman, Luis C Cajas-Monson, Sonia L Ramamoorthy
BACKGROUND: Colorectal and anal problems arise in chronic spinal cord injury care. We review 20 years of experience in a colorectal clinic at a veterans medical center treating mostly male veterans who have spinal cord injury. OBJECTIVE: We aim to show the results of colorectal interventions in a population with chronic spinal cord injury. DESIGN: This study is a retrospective records review. SETTINGS: This study was conducted at a Department of Veterans Affairs regional spinal cord injury center...
April 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28250852/pet-imaging-based-phenotyping-as-a-predictive-biomarker-of-response-to-tyrosine-kinase-inhibitor-therapy-in-non-small-cell-lung-cancer-are-we-there-yet
#20
Victor H Gerbaudo, Chun K Kim
The increased understanding of the molecular pathology of different malignancies, especially lung cancer, has directed investigational efforts to center on the identification of different molecular targets and on the development of targeted therapies against these targets. A good representative is the epidermal growth factor receptor (EGFR); a major driver of non-small cell lung cancer tumorigenesis. Today, tumor growth inhibition is possible after treating lung tumors expressing somatic mutations of the EGFR gene with tyrosine kinase inhibitors (TKI)...
March 2017: Nuclear Medicine and Molecular Imaging
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