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Do not resuscitate

Michael G Fadel, Krishan Parekh, Paul Hayden, Priya Krishnan
Introduction: Treatment escalation plans (TEPs) are important to ensure that every patient has their ceiling of care discussed and documented formally. At Medway Foundation Trust, we introduced TEP forms in September 2016 which are to be completed by the relevant consultant within 24 hours of admission. Aims and methods: To evaluate whether TEP forms had been effective at improving escalation planning and whether they had a subsequent impact in do not attempt cardiopulmonary resuscitation (DNACPR) decision-making...
2018: BMJ Open Quality
Bilal Moaed, Oz Mordechai, Myriam Weyl Ben-Arush, Sharon Tamir, Ruth Ofir, Sergey Postovsky
BACKGROUND: It is currently expected that about 20% of children with cancer will ultimately die. Writing advanced life directives sufficiently long before the actual death of a child ensues allows both parents and medical staff to develop optimal treatment plans in the best interests of the child. AIM OF THE STUDY: The aim of the study was to evaluate factors that may influence the process of decision-making regarding Do-Not-Resuscitate (DNR) status. METHODS: Retrospective single institution study...
November 28, 2018: Journal of Pediatric Hematology/oncology
Borna E Tabibian, Arsalaan A Salehani, Elizabeth N Kuhn, Matthew C Davis, Christopher D Shank, Winfield S Fisher Iii
BACKGROUND: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. OBJECTIVE: This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU...
November 29, 2018: Journal of Palliative Medicine
Dana M Zive, Valerie M Jimenez, Erik K Fromme, Susan W Tolle
BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally. OBJECTIVES: Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2). DESIGN: Descriptive retrospective study. SETTING/SUBJECTS: Oregon decedents with an active form in the Oregon POLST Registry...
November 21, 2018: Journal of Palliative Medicine
Demis Lipe, Al Giwa, Nicholas D Caputo, Nachiketa Gupta, Joseph Addison, Alexis Cournoyer
Background Patients suffering from an out-of-hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta-analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out-of-hospital cardiac arrest was performed...
December 4, 2018: Journal of the American Heart Association
Jung-Yeon Choi, Sun-Wook Kim, Sol-Ji Yoon, Min-Gu Kang, Kwang-Il Kim, Cheol-Ho Kim
Purpose: Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients. Patients and methods: This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups...
2018: Clinical Interventions in Aging
Mona Pettersson, Anna T Höglund, Mariann Hedström
INTRODUCTION: In cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent...
2018: PloS One
Elizabeth Dzeng
The focus on patient autonomy in American and increasingly British medicine highlights the importance of choice. However, to truly honour patient autonomy, there must be both understanding and non-control. Fifty-eight semi-structured in-depth interviews were conducted with internal medicine physicians at three hospitals in the US and one in the UK. At hospitals where autonomy was prioritised, trainees equated autonomy with giving a menu of choices and felt uncomfortable giving a recommendation based on clinical knowledge as they worried that that would infringe upon patient autonomy...
November 20, 2018: Sociology of Health & Illness
Jiacai Cho, Jamie Zhou, Dominic Lo, Anselm Mak, Sen Hee Tay
OBJECTIVES: To determine the extent of end-of-life suffering and predictors of high symptom prevalence in the last one year of life in patients with systemic rheumatic diseases (SRDs) and the extent of supportive care received. METHODS: We identified adult patients with SRDs who died between 1 April 2006 and 1 April 2016. We collected data within 1 year before their death, on the following: (i) cumulative symptom prevalence, (ii) rates of Advance Care Planning (ACP), Do-Not-Resuscitate (DNR) orders and referral to a palliative physician...
November 2, 2018: Seminars in Arthritis and Rheumatism
Robert Gałązkowski, Oryna Detsyk, Natalia Izhytska, Mieczysław Grzegocki, Marcin Podgórski, Klaudiusz Nadolny
OBJECTIVE: Introduction: Sudden cardiac arrest is a condition that requires the implementation of advanced emergency medical procedures. It constitutes a significant medical, economic and social issue. The aim: To assess the medical rescue actions performed by the students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk in an out-of-hospital cardiac arrest (OHCA) patient. PATIENTS AND METHODS: Material and methods: The research involved students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Judith Hold, Camille Payne, Jason Lesandrini, Avery Caz Glover
BACKGROUND: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility. OBJECTIVE: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility...
November 14, 2018: American Journal of Hospice & Palliative Care
John Freese, Charles B Hall, Elizabeth A Lancet, Rachel Zeig-Owens, Mark Menegus, Norma Keller, Jeffrey Rabrich, Todd L Slesinger, Robert A Silverman, David J Prezant
Therapeutic hypothermia, the standard for post-resuscitation care of out-of-hospital sudden cardiac arrest (SCA), is an area that the most recent resuscitation guidelines note "has not been studied adequately." We conducted a two-phase study examining the role of intra-arrest hypothermia for out-of-hospital SCA, first standardizing the resuscitation and transport of patients to resuscitation centers where post-resuscitation hypothermia was required and then initiating hypothermia during out-of-hospital resuscitation efforts...
November 14, 2018: Therapeutic Hypothermia and Temperature Management
Markus Besemann, Jacqueline Hebert, James M. Thompson, Rory A. Cooper, Gaurav Gupta, Suzette Brémault-Phillips, Sarah J. Dentry
Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
OBJECTIVE: To determine the factors that influence the decision to transfer children in septic shock from level II to level I pediatric intensive care unit (PICU) care. DESIGN: Interviews with level II PICU physicians in Michigan and Northwest Ohio. A hypothetical scenario of a 14-year-old boy in septic shock was presented. BASELINE: 40 mL/kg fluid resuscitation, central venous and peripheral arterial access, and high-dose vasopressor infusions were provided...
December 2018: Journal of Intensive Care Medicine
Shunsuke Kojima, Eiji Hiraoka, Junya Arai, Yosuke Homma, Yasuhiro Norisue, Osamu Takahashi, Taihei Soma, Toshihiko Suzuki, Masahiko Noguchi, Kentaro Shibayama, Kotaro Obunai, Hiroyuki Watanabe
Background: A do-not-resuscitate (DNR) order is reportedly associated with a decrease in performance measures, but it should not be applied to noncardiopulmonary resuscitation procedures. Good performance measures are associated with improvement in heart failure outcomes. Aim: To analyze the influence of DNR order on performance measures of heart failure at our hospital, where lectures on DNR order are held every 3 months. Design: Retrospective cohort study...
2018: International Journal of General Medicine
Bruno De Oliveira, Malligere Prasanna, Malcolm Lemyze, Laurent Tronchon, Didier Thevenin, Jihad Mallat
BACKGROUND: Central venous oxygen saturation (ScvO2) is often used to help to guide resuscitation of critically ill patients. The standard gold technique for ScvO2 measurement is the co-oximetry (Co-oximetry_ScvO2), which is usually incorporated in most recent blood gas analyzers. However, in some hospitals, those machines are not available and only calculated ScvO2 (Calc_ScvO2) is provided. Therefore, we aimed to investigate the agreement between Co-oximetry_ScvO2 and Calc_ScvO2 in a general population of critically ill patients and septic shock patients...
2018: PloS One
Kristopher S Pfirman, Corey A White, Abiy Kelil, Hemant C Modi
BACKGROUND Brugada syndrome is a cardiac disorder associated with sudden death due to sodium channelopathy, most commonly the SCN5a mutation. There are 3 different patterns of electrocardiogram (ECG) changes characterized as type I, II, and III. ECG patterns consist of variations of incomplete RBBB and ST elevation in anterior precordial leads only. Treatment, if warranted, consists of implantable cardioverter-defibrillator. CASE REPORT A 63-year-old male presented with abdominal pain for 4 days that was persistent, and after further imaging, he was found to have hepatic metastases from a stage IV small cell carcinoma of the lung...
November 3, 2018: American Journal of Case Reports
Calvin J Lightbody, Jonathan N Campbell, G Peter Herbison, Heather K Osborne, Alice Radley, D Robin Taylor
OBJECTIVES: To assess the effect of using a treatment escalation/limitation plan (TELP) on the frequency of harms in 300 patients who died following admission to hospital. DESIGN: A retrospective case note review of 300 unselected, consecutive deaths comprising: (1) patients with a TELP in addition to a do-not-attempt cardiopulmonary resuscitation order (DNACPR); (2) those with DNACPR only; and (3) those with neither. Patient deaths were classified retrospectively as 'expected' or 'unexpected' using the Gold Standard Framework Prognostic Indicator Guidance...
October 31, 2018: BMJ Open
Muni Rubens, Venkataraghavan Ramamoorthy, Anshul Saxena, Sankalp Das, Sandeep Appunni, Sagar Rana, Brittany Puebla, Deborah T Suarez, Mariana Khawand-Azoulai, Suleyki Medina, Ana Viamonte-Ros
BACKGROUND: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). METHODS: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ2 and independent t tests were used for categorical and continuous variables...
November 1, 2018: American Journal of Hospice & Palliative Care
Wenche Torunn Mathiesen, Tonje S Birkenes, Helene Lund, Anastasia Ushakova, Eldar Søreide, Conrad Arnfinn Bjørshol
AIM: To assess the factors associated with the knowledge and expectations among the general public regarding dispatcher assistance in out-of-hospital cardiac arrest incidents. BACKGROUND: In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. DESIGN: A cross-sectional observational survey containing six questions and seven demographic items...
October 30, 2018: Journal of Advanced Nursing
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