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https://www.readbyqxmd.com/read/29791762/ethical-dilemmas-in-nursing-an-integrative-review
#1
REVIEW
Jennifer Rainer, Joanne Kraenzle Schneider, Rebecca A Lorenz
AIMS: The purpose of this integrative review was to identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. BACKGROUND: The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them...
May 23, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29776804/hemicraniectomy-for-malignant-middle-cerebral-artery-syndrome-a-review-of-functional-outcomes-in-two-high-volume-stroke-centers
#2
Abhi Pandhi, Georgios Tsivgoulis, Nitin Goyal, Muhammad F Ishfaq, Shailesh Male, Efstathios Boviatsis, Jason J Chang, Ramin Zand, Konstantinos Voumvourakis, Lucas Elijovich, Anne W Alexandrov, Marc D Malkoff, Daniel Hoit, Adam S Arthur, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Despite recent landmark randomized controlled trials showing significant benefits for hemicraniectomy (HCT) compared with medical therapy (MT) in patients with malignant middle cerebral artery infarction (MMCAI), HCT rates have not substantially increased in the United States. We sought to evaluate early outcomes in patients with MMCAI who were treated with HCT (cases) in comparison to patients treated with MT due to the perception of procedural futility by families (controls)...
May 15, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29748717/ethical-challenges-in-resuscitation
#3
REVIEW
Spyros D Mentzelopoulos, Anne-Marie Slowther, Zoe Fritz, Claudio Sandroni, Theodoros Xanthos, Clifton Callaway, Gavin D Perkins, Craig Newgard, Eleni Ischaki, Robert Greif, Erwin Kompanje, Leo Bossaert
PURPOSE: A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. METHODS: Following agreement on the article's outline, subgroups of 2-3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research...
May 10, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29746987/age-and-benefit-of-early-coronary-angiography-after-out-of-hospital-cardiac-arrest-in-patients-presenting-with-shockable-rhythm-insights-from-the-sudden-death-expertise-center-registry
#4
Nadia Aissaoui, Wulfran Bougouin, Florence Dumas, Franckie Beganton, Richard Chocron, Olivier Varenne, Christian Spaulding, Nicole Karam, Gilles Montalescot, Pierre Aubry, Georges Sideris, Eloi Marijon, Xavier Jouven, Alain Cariou
BACKGROUND: Little is known about the association between provision of post-resuscitation care and prognosis of out-of-hospital cardiac arrest(OHCA) in elderly patients. Previous studies have suggested futility after 65 years of age. OBJECTIVES: We aimed to evaluate the association of early coronary angiogram(CAG) followed if necessary by percutaneous coronary intervention(PCI), with favorable outcome after OHCA among elderly patients, compared to younger patients...
May 7, 2018: Resuscitation
https://www.readbyqxmd.com/read/29731386/characteristics-and-outcomes-of-do-not-resuscitate-patients-admitted-to-the-emergency-department-intensive-care-unit
#5
An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang
BACKGROUND: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. OBJECTIVE: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. METHOD: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital...
May 3, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29720083/general-practitioners-attitudes-towards-patients-with-poorly-controlled-type-2-diabetes-a-qualitative-study
#6
Anja Wollny, Michael Pentzek, Oliver Rudolf Herber, Heinz-Harald Abholz, Jürgen In der Schmitten, Andrea Icks, Stefan Wilm, Elisabeth Gummersbach
BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs' attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control. METHODS: Qualitative research in German general practice; 20 GPs, randomly chosen from participants of a larger study; in-depth narrative interviews, audio-recorded and transcribed; inductive coding and categorisation in a multi-professional team; abstraction of major themes in terms of attitudinal responses...
May 2, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29713689/improving-rates-of-implantable-cardioverter-defibrillator-deactivation-in-end-of-life-care
#7
M R Javaid, Suzanne Squirrell, Fahad Farooqi
Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. National guidelines advise that patients approaching the end of their natural life should be offered a compassionate choice of having their defibrillator deactivated. Following an actual clinical incident involving a patient receiving avoidable ICD shocks in his final hours, we identified shortcomings in communication and gaps in knowledge about ICD management in end-of-life care...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29707293/a-population-based-analysis-of-outcomes-after-radiotherapy-in-intensive-care-unit-patients-with-lung-cancer
#8
Alexander V Louie, Lihua Li, Krista Bray Jenkyn, Britney Allen, George B Rodrigues, Andrew Warner, David A Palma, Salimah Z Shariff
Background: As the value of radiotherapy (RT) in intensive care unit (ICU) patients with lung cancer is of uncertain efficacy, we evaluated characteristics, outcomes and RT utilization for such patients in Ontario, Canada. Methods: Multiple administrative databases were linked deterministically using unique encoded identifiers to identify eligible patients between April 1, 2007, and March 31, 2014. Differences in patient, treatment, institution and tumor characteristics between RT and non-RT groups at the level of episode of care were compared...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29682574/baseline-predictors-of-visual-acuity-outcome-in-patients-with-wet-age-related-macular-degeneration
#9
REVIEW
Xinyuan Zhang, Timothy Y Y Lai
Age-related macular degeneration (AMD) is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD) causes more severe visual acuity (VA) loss compared with the dry form due to formation of choroidal neovascularization (CNV). Antivascular endothelial growth factor (anti-VEGF) agents such as ranibizumab and aflibercept are now the standard of care treatment for wAMD. Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29678145/evaluation-of-pet-and-laparoscopy-in-staging-advanced-gastric-cancer-a-multicenter-prospective-study-plastic-study
#10
H J F Brenkman, E C Gertsen, E Vegt, R van Hillegersberg, M I van Berge Henegouwen, S S Gisbertz, M D P Luyer, G A P Nieuwenhuijzen, J J B van Lanschot, S M Lagarde, W O de Steur, H H Hartgrink, J H M B Stoot, K W E Hulsewe, E J Spillenaar Bilgen, M J van Det, E A Kouwenhoven, D L van der Peet, F Daams, J W van Sandick, N C T van Grieken, J Heisterkamp, B van Etten, J W Haveman, J P Pierie, F Jonker, A Y Thijssen, E J T Belt, P van Duijvendijk, E Wassenaar, H W M van Laarhoven, F J Wessels, N Haj Mohammad, H F van Stel, G W J Frederix, P D Siersema, J P Ruurda
BACKGROUND: Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. METHODS: This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3-4b, N0-3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT...
April 20, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29620949/associations-between-race-and-dementia-status-and-the-quality-of-end-of-life-care
#11
Elizabeth A Luth, Holly G Prigerson
BACKGROUND: Non-Hispanic black and dementia patients receive more invasive and futile treatment at end of life (EOL) relative to others. Little is known about the relationship between race/ethnicity, dementia, and EOL care quality. OBJECTIVE: Identify the relationship between race/ethnicity, dementia, and proxy reporters' evaluation of EOL care quality in older adults. DESIGN: Latent class analysis (LCA) of national survey data. SETTING: 1588 deceased Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study (2011-2016)...
April 5, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29575587/outcomes-of-patients-with-syncope-and-suspected-dementia
#12
Timothy R Holden, Manish N Shah, Tommy A Gibson, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Judd E Hollander, Bret A Nicks, Daniel K Nishijima, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Benjamin C Sun
OBJECTIVES: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016...
March 25, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29571968/ocular-treatment-of-choroidal-melanoma-in-relation-to-the-prevention-of-metastatic-death-a-personal-view
#13
REVIEW
Bertil Damato
About 50% of patients with choroidal melanoma develop metastatic disease, despite successful eradication of the primary tumor. Patient care is complicated by the fact that we do not know whether ocular treatment ever influences survival and if so in whom. Some authorities believe that metastatic spread is never preventable, because it has always occurred by the time the ocular tumor is detected. Others hold the view that metastatic spread can occur late, at least in some patients, in whom timely and successful treatment is life-saving...
March 20, 2018: Progress in Retinal and Eye Research
https://www.readbyqxmd.com/read/29565935/cost-implications-of-avoidable-rapid-response-call-activations-in-older-patients
#14
Ashwin Subramaniam, Cameron Green, Mohammad Omair, Lionel Soh, Aun Chian Yeoh, Ravindranath Tiruvoipati
BACKGROUND: Rapid response calls (RRCs) are designed to appropriately manage clinical deterioration. However, not all RRCs are appropriate due to medical futility or the patient's wishes. Incidence and costs associated with avoidable-RRC (ARRC) remain underexplored. AIMS: The aim of this study was to describe the incidence and costs of ARRC activations in older patients. METHODS: We retrospectively reviewed RRCs in patients aged ≥80 years over six months...
March 23, 2018: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29549119/the-case-for-early-use-of-rapid-whole-genome-sequencing-in-management-of-critically-ill-infants-late-diagnosis-of-coffin-siris-syndrome-in-an-infant-with-left-congenital-diaphragmatic-hernia-congenital-heart-disease-and-recurrent-infections
#15
Nathaly M Sweeney, Shareef A Nahas, Shimul Chowdhury, Miguel Del Campo, Marilyn C Jones, David P Dimmock, Stephen F Kingsmore, Rcigm Investigators
Congenital diaphragmatic hernia (CDH) results from incomplete formation of the diaphragm leading to herniation of abdominal organs into the thoracic cavity. CDH is associated with pulmonary hypoplasia, congenital heart disease and pulmonary hypertension. Genetically, it is associated with aneuploidies, chromosomal copy number variants, and single gene mutations. CDH is the most expensive non-cardiac congenital defect: Management frequently requires implementation of Extracorporeal Membrane Oxygenation (ECMO), which increases management expenditures 2...
March 16, 2018: Cold Spring Harbor Molecular Case Studies
https://www.readbyqxmd.com/read/29533131/the-hospice-patient-s-right-to-oral-care-making-time-for-the-mouth
#16
Kristi Soileau, Nanette Elster
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care...
April 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29510817/pulmonary-artery-perfusion-versus-no-pulmonary-per-fusion-during-cardiopulmonary-bypass
#17
Katrine Bredahl Buggeskov

During conventional cardiopulmonary bypass (CPB) there is no active perfusion of the pulmonary circulation and the mechanical ventilation is ceased leaving the lungs exposed to warm ischemia.
 
Pulmonary dysfunction is seen in varying degrees after major surgery, but more severe in cardiac surgery patients probably due to the effects of CPB. The evidence for effect and safety are limited, but active pulmonary artery perfusion during CPB could be beneficial for the patients' postoperative oxygenation...
March 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29508654/primary-to-comprehensive-stroke-center-transfers-appropriateness-not-futility
#18
Mayank Goyal, Bijoy K Menon, Alexis T Wilson, Mohammed A Almekhlafi, Ryan McTaggart, Mahesh Jayaraman, Andrew M Demchuk, Michael D Hill
Background and purpose Ischemic stroke patients must be transferred to comprehensive stroke centers for endovascular treatment, but this transfer can be interpreted post hoc as "futile" if patients do not ultimately undergo the procedure or have a poor outcome. We posit that transfer decisions must instead be evaluated in terms of appropriateness at the time of decision-making. Methods We propose a classification schema for Appropriateness of Transfer for Endovascular Thrombectomy based on patient, logistic, and center characteristics...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29502872/natural-history-of-portal-vein-embolization-before-liver-resection-a-23-year-analysis-of-intention-to-treat-results
#19
Fernando A Alvarez, Denis Castaing, Rodrigo Figueroa, Marc Antoine Allard, Nicolas Golse, Gabriella Pittau, Oriana Ciacio, Antonio Sa Cunha, Daniel Cherqui, Daniel Azoulay, René Adam, Eric Vibert
BACKGROUND: Portal vein embolization (PVE) use is nowadays debated due to the risk of technical or biological unresectability after the period of time needed to achieve future liver remnant (FLR) hypertrophy. We evaluated the safety and efficacy of PVE in a single high-volume hepatobiliary center, with emphasis in the feasibility to achieve tumor resection. METHODS: Patients undergoing PVE before major hepatectomy at our institution between 1993 and 2015 were retrospectively analyzed...
March 2, 2018: Surgery
https://www.readbyqxmd.com/read/29493583/anticipating-uncertainty-and-irrevocable-decisions-provider-perspectives-on-implementing-whole-genome-sequencing-in-critically-ill-children-with-heart-disease
#20
Danton S Char, Sandra Soo-Jin Lee, David Magnus, Mildred Cho
PurposeTo investigate the potential impacts of whole-genome sequencing (WGS) in the pediatric critical-care context, we examined how clinicians caring for critically ill children with congenital heart disease (CHD) anticipate and perceive the impact of WGS on their decision-making process and treatment recommendations.MethodsWe conducted semistructured in-person and telephone interviews of clinicians involved in the care of critically ill children with CHD at a high-volume pediatric heart center. We qualitatively analyzed the transcribed interviews...
March 1, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
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