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Futile Care

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https://www.readbyqxmd.com/read/28777877/timely-access-to-care-in-the-treatment-of-rectal-cancer-and-the-effect-on-quality-of-life
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28713042/implementation-of-the-universal-bls-termination-of-resuscitation-rule-in-a-rural-ems-system
#7
Matthew R Jordan, Michael F O'Keefe, David Weiss, C Wes Cubberley, Charles D MacLean, Daniel L Wolfson
BACKGROUND: Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile. OBJECTIVE: The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system...
September 2017: Resuscitation
https://www.readbyqxmd.com/read/28707460/the-effect-of-hospice-consultation-on-aggressive-treatment-of-lung-cancer
#8
Shin Hye Yoo, Bhumsuk Keam, Miso Kim, Tae Min Kim, Dong-Wan Kim, Dae Seog Heo
Purpose: The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent five years and examine the relationship between hospice consultation (HC) and aggressive care. Materials and Methods: The medical records of 789 patients with stage IIIB-IV NSCLC at SNUH who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed...
July 14, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28695689/patterns-of-health-services-utilization-in-the-last-two-weeks-of-life-among-cancer-patients-experience-in-an-australian-academic-cancer-center
#9
Wee Loon Ong, Richard Khor, Mathias Bressel, Phillip Tran, Jo Tedesco, Keen Hun Tai, David Ball, Gillian Duchesne, Farshad Foroudi
AIM: To report the trend in end-of-life health services (HS) utilization among cancer patients treated in a large Australian academic cancer center over a 12-year period. METHODS: This is a retrospective study of cancer patients treated at the Peter MacCallum Cancer Centre (PMCC), who had documented death between January 2002 and December 2013. Using administrative and billing database, we report on the utilization of different categories of HS within two weeks of death: diagnostic investigations (pathology and radiology), inpatient and outpatient services, and potentially futile interventions (PFI, which include radiotherapy, chemotherapy and surgery)...
July 11, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28677460/rules-are-forcing-nurses-to-attempt-futile-cpr
#10
Marc Cornock
There have been two separate cases recently of nurses in care homes being reprimanded by the Nursing and Midwifery Council (NMC) for not attempting to resuscitate patients they thought had died.
July 5, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28674716/intensive-care-unit-nurses-perceptions-of-the-obstacles-to-the-end-of-life-care-in-saudi-arabia
#11
Zakaria A Mani, Mahmoud A Ibrahim
OBJECTIVES: To explore nurses' perceptions of obstacles to the provision of end of life care (EoLC) in the intensive care unit (ICU) in Saudi Arabia. METHODS: A modified version of a questionnaire developed by Beckstrand and Kirchhoff was administered in one setting at Riyadh, Saudi Arabia between March and April 2015. RESULTS: A total of 87 questionnaires were returned from 140 potential respondents, representing a 62% response rate. Findings highlighted concerns associated with patient's family, physicians who differed in opinions, cultural differences and language barriers...
July 2017: Saudi Medical Journal
https://www.readbyqxmd.com/read/28666156/family-support-liaison-in-the-witnessed-resuscitation-a-phenomenology-study
#12
Hadi Hassankhani, Vahid Zamanzade, Azad Rahmani, Hamidreza Haririan, Joanne E Porter
BACKGROUND: Family-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority. OBJECTIVE: To explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation. DESIGN: The hermeneutic phenomenology. SETTINGS: The emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran...
June 13, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28659023/-powerlessness-or-doing-the-right-thing-moral-distress-among-nursing-home-staff-caring-for-residents-at-the-end-of-life-an-interpretive-descriptive-study
#13
Amanda Young, Katherine Froggatt, Sarah G Brearley
BACKGROUND: Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking. AIM: To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. METHODS: An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff...
February 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28648803/sorafenib-in-combination-with-transarterial-chemoembolisation-in-patients-with-unresectable-hepatocellular-carcinoma-tace-2-a-randomised-placebo-controlled-double-blind-phase-3-trial
#14
Tim Meyer, Richard Fox, Yuk Ting Ma, Paul J Ross, Martin W James, Richard Sturgess, Clive Stubbs, Deborah D Stocken, Lucy Wall, Anthony Watkinson, Nigel Hacking, T R Jeffry Evans, Peter Collins, Richard A Hubner, David Cunningham, John Neil Primrose, Philip J Johnson, Daniel H Palmer
BACKGROUND: Transarterial chemoembolisation (TACE) is the standard of care for patients with intermediate stage hepatocellular carcinoma, while the multikinase inhibitor sorafenib improves survival in patients with advanced disease. We aimed to determine whether TACE with sorafenib improves progression-free survival versus TACE with placebo. METHODS: We did a multicentre, randomised, placebo-controlled, phase 3 trial (TACE 2) in 20 hospitals in the UK for patients with unresectable, liver-confined hepatocellular carcinoma...
June 22, 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28645428/cost-effectiveness-of-laparoscopy-as-diagnostic-tool-before-primary-cytoreductive-surgery-in-ovarian-cancer
#15
Roelien van de Vrie, Hannah S van Meurs, Marianne J Rutten, Christiana A Naaktgeboren, Brent C Opmeer, Katja N Gaarenstroom, Toon van Gorp, Henk G Ter Brugge, Ward Hofhuis, Henk W R Schreuder, Henriette J G Arts, Petra L M Zusterzeel, Johanna M A Pijnenborg, Maarten van Haaften, Mirjam J A Engelen, Erik A Boss, M Caroline Vos, Kees G Gerestein, Eltjo M J Schutter, Gemma G Kenter, Patrick M M Bossuyt, Ben Willem Mol, Marrije R Buist
OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery...
June 20, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28643320/revised-protocol-of-extracorporeal-membrane-oxygenation-ecmo-therapy-in-severe-ards-recommendations-of-the-veno-venous-ecmo-expert-panel-appointed-in-february-2016-by-the-national-consultant-on-anesthesiology-and-intensive-care
#16
Romuald Lango, Zbigniew Szkulmowski, Dariusz Maciejewski, Andrzej Sosnowski, Krzysztof Kusza
Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28639161/moral-distress-and-its-contribution-to-the-development-of-burnout-syndrome-among-critical-care-providers
#17
Renata Rego Lins Fumis, Gustavo Adolpho Junqueira Amarante, Andréia de Fátima Nascimento, José Mauro Vieira Junior
BACKGROUND: Burnout appears to be common among critical care providers. It is characterized by three components: emotional exhaustion, depersonalization and personal accomplishment. Moral distress is the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. We aimed to estimate the correlation between moral distress and burnout among all intensive care unit (ICU) and the step-down unit (SDU) providers (physicians, nurses, nurse technicians and respiratory therapists)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28636702/analysis-of-survival-after-initiation-of-continuous-renal-replacement-therapy-in-a-surgical-intensive-care-unit
#18
James M Tatum, Galinos Barmparas, Ara Ko, Navpreet Dhillon, Eric Smith, Daniel R Margulies, Eric J Ley
Importance: Continuous renal replacement therapy (CRRT) benefits patients with renal failure who are too hemodynamically unstable for intermittent hemodialysis. The duration of therapy beyond which continued use is futile, particularly in a population of patients admitted to and primarily cared for by a surgical service (hereinafter referred to as surgical patients), is unclear. Objective: To analyze proportions of and independent risk factors for survival to discharge after initiation of CRRT among patients in a surgical intensive care unit (SICU)...
June 21, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28634768/futile-treatment-a-review
#19
Lenko Šarić, Ivana Prkić, Marko Jukić
The main goal of intensive care medicine is helping patients survive acute threats to their lives, while preserving and restoring life quality. Because of medical advancements, it is now possible to sustain life to an extent that would previously have been difficult to imagine. However, the goals of medicine are not to preserve organ function or physiological activity but to treat and improve the health of a person as a whole. When dealing with medical futilities, physicians and other members of the care team should be aware of some ethical principles...
June 20, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28631809/anabolic-steroids-for-treating-pressure-ulcers
#20
REVIEW
Cho Naing, Maxine A Whittaker
BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers...
June 20, 2017: Cochrane Database of Systematic Reviews
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