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Do not resuscitate

Sheng-Yu Fan, Ying-Wei Wang, I-Mei Lin
BACKGROUND: As the "do not resuscitate" (DNR) discussion involves communication, this study explored (1) the effects of a title that included "allow natural death", and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion. METHODS: Healthy adults (n = 524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision...
October 10, 2018: BMC Palliative Care
Lindsay F J Mildenhall, Tetsuya Isayama
The majority of newborn resuscitations require very little beyond simple airway management and assisted ventilation. If cardiovascular collapse is serious enough to warrant additional support, resuscitation algorithms recommend moving to chest compressions and then on to medications and possibly volume replacement if vital signs remain marginal or absent. The evidence base upon which this part of the neonatal resuscitation algorithm is structured is sparse. Chest compressions and medications are rare interventions that do not lend themselves easily to clinical trials...
September 27, 2018: Seminars in Fetal & Neonatal Medicine
Jacek Siewiera, Dariusz Tomaszewski, Jacek Piechocki, Andrzej Kübler
BACKGROUND: In intensive care units (ICUs), a patient's vital functions may be maintained, regardless of the patient's chances of survival. A key issue is how to precisely determine the moment in which life-support treatment should be withheld. In many countries, the decision-making process is regulated by the guidelines of scientific societies. However, heuristic errors may influence this process. OBJECTIVES: The objective of this study was to assess factors involved in decisions to implement or withhold treatment in general ICUs in Poland...
October 2, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Robert Bishop, Brian Joy, Melissa Moore-Clingenpeel, Tensing Maa
BACKGROUND: High-quality cardiopulmonary resuscitation is associated with improved survival and neurological outcomes after cardiac arrest. Unfortunately, health care professionals frequently do not perform resuscitation within guidelines after life-support training. OBJECTIVES: To determine if brief intermittent training in cardiopulmonary resuscitation could improve nurses' skills to perform high-quality resuscitation 70% or more of the time during 2 minutes of cardiopulmonary resuscitation after 3 training sessions...
October 2018: Critical Care Nurse
F Fernández-Méndez, R Barcala-Furelos, M Otero-Agra, M Fernández-Méndez, M Santos-Folgar, A Rodríguez-Núñez
OBJECTIVE: To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). DESIGN: A cross-sectional quasi-experimental study was carried out. PARTICIPANTS: A sample of 113 nursing students participated in the study. INTERVENTIONS: Three hands-only CPR tests with continuous compressions were performed: (i)without external help; (ii)with the mobile phone turned off; and (iii)guided by APP...
September 27, 2018: Medicina Intensiva
Kensuke Nakamura, Yoshiharu Kinugasa, Shinobu Sugihara, Masayuki Hirai, Kiyotaka Yanagihara, Nobuhiko Haruki, Koichi Matsubara, Masahiko Kato, Kazuhiro Yamamoto
AIMS: Patients with end-stage heart failure (HF) often require surrogate decision making for end-of-life care owing to a lack of decision-making capacity. However, the clinical characteristics of surrogate decision making for life-sustaining treatments in Japan remain to be investigated. METHODS AND RESULTS: Among 934 patients admitted to our hospital for HF from January 2004 to December 2015, we retrospectively reviewed the medical records of consecutive 106 patients who died in hospital (mean age 73 ± 13 years; male, 52...
September 27, 2018: ESC Heart Failure
Shilpi Chabra, Taylor Sawyer
The transformation of a general pediatrician into a neonatologist requires rigorous training in a diverse range of core skills during neonatal-perinatal medicine fellowship. This training includes the care of high-risk newborn infants, as well as interdisciplinary communication with care team members and families in the neonatal intensive care unit. In addition, neonatal-perinatal medicine fellows need to acquire competency in key procedurals skills, including neonatal resuscitation techniques, to be able to safely practice neonatology without direct supervision on graduation...
January 2018: Journal of Medical Education and Curricular Development
Christopher Stutchfield, Anna Davies, Amber Young
BACKGROUND: Optimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation. OBJECTIVES: To identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome. DESIGN: Systematic review. METHODS: Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date...
September 27, 2018: Archives of Disease in Childhood
Chih-Hung Wang, Jin-Lin Chang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Wen-Jone Chen, Wei-Kung Tseng
AIM: Resuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. METHODS: This study was a retrospective study in a single medical centre. Patients with an IHCA between 2006 and 2015 were screened. The estimated average glucose (eAG) level was converted from the HbA1c level measured within three months prior to the IHCA...
September 24, 2018: Resuscitation
Sheng-Der Hsu, Cheng-Jueng Chen, I-Duo Wang, Kuen-Tze Lin, Chia-Chi Wang, Wu-Chien Chien, Chi-Hsiang Chung, Wei-Kuo Chang
BACKGROUND: Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture...
September 21, 2018: World Journal of Surgery
Ikwan Chang, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park, So Yeon Kong
OBJECTIVE: We aimed to demonstrate the association of bystander cardiopulmonary resuscitation (BCPR) with survival outcomes after pediatric out-of-hospital cardiac arrest (OHCA) by community property value groups. METHODS: This observational study enrolled all emergency medical services (EMS)-treated pediatric OHCAs in Korea between 2012 and 2015. Enrolled patients were divided into three groups: BCPR with dispatcher-assistance (DA), BCRP-without-DA, and no-BCPR...
September 17, 2018: Resuscitation
Lucy A Kernick, Karen J Hogg, Yvonne Millerick, Fliss E M Murtagh, Ayse Djahit, Miriam Johnson
BACKGROUND: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. AIM: To evaluate the literature regarding advance care planning in heart failure. DESIGN: Systematic review and narrative analysis (PROSPERO CRD42017059190). DATA SOURCES: Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus...
September 20, 2018: Palliative Medicine
Anna Weil, Sharon Marie Weldon, Miranda Kronfli, Ben Watkins, Roger Kneebone, Fernando Bello, Sarah Cox
BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life...
September 9, 2018: Nurse Education Today
Jan Albert Nicolaas Groot, Leonore Ten Bokum, Hubertus Laurentius Antonius van den Oever
Background: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI's have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation: A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose...
2018: Journal of Intensive Care
Carrie A Sims, Yuxia Guan, Sarmistha Mukherjee, Khushboo Singh, Paul Botolin, Antonio Davila, Joseph A Baur
Hemorrhagic shock depletes nicotinamide adenine dinucleotide (NAD) and causes metabolic derangements that, in severe cases, cannot be overcome, even after restoration of blood volume and pressure. However, current strategies to treat acute blood loss do not target cellular metabolism. We hypothesized that supplemental nicotinamide mononucleotide (NMN), the immediate biosynthetic precursor to NAD, would support cellular energetics and enhance physiologic resilience to hemorrhagic shock. In a rodent model of decompensated hemorrhagic shock, rats receiving NMN displayed significantly reduced lactic acidosis and serum IL-6 levels, two strong predictors of mortality in human patients...
September 6, 2018: JCI Insight
João Gabriel Rosa Ramos, Fernanda Correia Tourinho, Patrícia Borrione, Paula Azi, Tuanny Andrade, Vanessa Costa, Zan Reis, Paulo Benigno Pena Batista, Ana Verena Mendes
OBJECTIVE: To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations. METHODS: Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program...
September 3, 2018: Revista Brasileira de Terapia Intensiva
Kah Poh Loh, Maya Abdallah, Meng-Shiou Shieh, Mihaela S Stefan, Penelope S Pekow, Peter K Lindenauer, Supriya G Mohile, Dilip Babu, Tara Lagu
Background: Invasive mechanical ventilation (IMV), dialysis for acute kidney failure, and other critical care therapies (CCTs) are associated with a high risk for complications in patients with metastatic cancer. Inpatient palliative care (IPC) can assist in assessing patients' preferences for life-prolonging treatment at the end of life. This study investigated the use pattern of IPC, outcomes (in-hospital mortality, length of stay [LOS], discharge destination, and cost of care), and predictors of IPC use in patients with metastatic cancer who received CCTs...
September 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Alze Pereira Dos Santos Tavares, Carmen Tzanno-Matins, Marcio J C Arruda, Bárbara Antunes
BACKGROUND: Renal Supportive/Palliative Care is gaining gradual recognition as a patient-centered care approach that should be integrated to the traditional disease-centered model of care, mainly in elder patients with advanced chronic kidney disease (CKD). The objective of this study was to assess knowledge, perceptions, attitude, experience and interest in palliative care among renal care providers. METHODS: Online survey, administered between May 23 to June 13, 2017 to members of the Brazilian Society of Nephrology (BSN)...
August 3, 2018: Annals of Palliative Medicine
Jimmy K Wong, T Edward Kim, Seshadri C Mudumbai, Stavros G Memtsoudis, Nicholas J Giori, Steven K Howard, Roberta K Oka, Robert King, Edward R Mariano
BACKGROUND: Hospital-related factors associated with mortality and morbidity after hip fracture surgery are not completely understood. The Veterans Health Administration (VHA) is the largest single-payer, networked healthcare system in the country serving a relatively homogenous patient population with facilities that vary in size and resource availability. These characteristics provide some degree of financial and patient-level controls to explore the association, if any, between surgical volume and facility resource availability and hospital performance regarding postoperative complications after hip fracture surgery...
August 30, 2018: Clinical Orthopaedics and related Research
Anica C Law, Jennifer P Stevens, Samuel Hohmann, Allan J Walkey
OBJECTIVES: To assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. DESIGN: Retrospective cohort study; difference-in-difference design to compare outcomes in Massachusetts with outcomes of other states (before and after the March 31, 2016, compliance deadline). SETTING: Administrative claims data collected from medical centers across the United States (Vizient). PATIENTS: Adults between 18 and 99 years old who were admitted to ICUs for greater than or equal to 1 day...
October 2018: Critical Care Medicine
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