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Do not resuscitate

Joong Wan Park, Jae Yun Jung, Joonghee Kim, Young Ho Kwak, Do Kyun Kim, Jung Chan Lee, Eun Mi Ham, Soyun Hwang, Hyuksool Kwon
OBJECTIVE: We developed a novel compression assist device (palm presser) to perform chest compressions using a palm in infant cardiopulmonary resuscitation (CPR). We hypothesized that the palm presser will increase compression depth without increasing hands-off time and will reduce rescuer fatigue compared with the two-finger technique (TFT). METHODS: In this randomized crossover manikin trial, participants performed two minutes of CPR with a 30:2 compression:ventilation ratio using the palm presser and the TFT in randomized sequence on an infant manikin...
August 17, 2018: Prehospital Emergency Care
Munir H Buhaya
This image represents a physician unilaterally completing a do-not-resuscitate order for an unrepresented patient.
August 1, 2018: AMA Journal of Ethics
Fatimata Seydou Sall, Alban De Luca, Lionel Pazart, Aurore Pugin, Gilles Capellier, Abdo Khoury
Introduction: There is a continuous debate concerning the superiority of endotracheal intubation on bag-valve-mask (BVM) ventilation in patients with cardiac arrest. In this manikin-based observational study, we evaluate and compare the performance of manual ventilation through a facemask (BVM) and an endotracheal tube (ETT). Methods: One hundred and forty healthcare providers were instructed to manually ventilate a manikin as they would do for a 75 kg adult patient in respiratory arrest...
2018: BMJ Open Respiratory Research
Fatemeh Bahramnezhad, Mohammad Ali Cheraghi, Neda Mehrdad
Families of patients who are dying have a key role in decisions regarding do-not-resuscitate orders. The objective of this study was to explore the aspects and characteristics of this decision by the families of Muslim patients with cancer. This study is a conventional content analysis. Eighteen families who met the inclusion criteria participated in this study and were selected by purposive sampling. Data collection was done by a semistructured interview (each interview was 60-110 minutes). The data analysis was performed using content analysis...
September 2018: Holistic Nursing Practice
Theresa S Yang, David W Hsia, Dong W Chang
PURPOSE: Readmission after hospitalization for malignant pleural effusion (MPE) may represent gaps in the quality of health care delivery. The goal of this study was to determine the frequency of 30-day readmission for MPE and identify clinical factors associated with rehospitalization. PATIENTS AND METHODS: A retrospective cohort of adults hospitalized for MPE from 2009 to 2011 was analyzed using an administrative database. The primary outcome was all-cause 30-day readmission rate...
August 15, 2018: Journal of Oncology Practice
Charlie C Hall, Jean Lugton, Juliet Anne Spiller, Emma Carduff
OBJECTIVES: Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) discussions with patients and their caregivers have been subjected to intense ethical and legal debate in recent years. Legal cases and national guidelines have tried to clarify the best approach to DNACPR discussions; however, there is little evidence of how best to approach them from the patient, family or caregiver perspective. This paper describes published accounts of patient, family and caregiver experiences of discussions about advance cardiopulmonary resuscitation (CPR) decision making...
August 14, 2018: BMJ Supportive & Palliative Care
Amelia Barwise, Carolina Jaramillo, Paul Novotny, Mark L Wieland, Charat Thongprayoon, Ognjen Gajic, Michael E Wilson
OBJECTIVE: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. PATIENTS AND METHODS: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. RESULTS: Of the 27,523 patients admitted to the ICU, 779 (2...
August 9, 2018: Mayo Clinic Proceedings
J Díez-Manglano, S Isasi de Isasmendi Pérez, M Rubio Gómez, F Formiga, L Á Sánchez Muñoz, J Castiella Herrero, E Casariego Vales, O H Torres Bonafonte
OBJECTIVES: To describe the care provided at the end of life for patients who die in internal medicine departments. METHODS: An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death. RESULTS: The study included 1,447 patients with a median age of 84 years...
August 1, 2018: Revista Clínica Española
Gerald Dieter Griffin, Dominique Charron, Reem Al-Daccak
All traumas suppress the immune system, resulting in higher morbidity and mortality. Infections, poor nutritional status, chronic illness, fatigue, therapies or procedures performed during and after transport also negatively affect the immune system. Large populations are impacted by trauma worldwide and suffer enormous costs in both direct and indirect expenditures from physical, psychological and functional losses. Most therapies and studies of trauma, brain trauma, stroke, immune suppression and their co-morbidities do not address nor discuss methods that promote immune system resuscitation or efficacy to support its role in post-trauma healing and rehabilitation...
August 2018: Medical Hypotheses
Young Sun Ro, Sang Do Shin, Seung Chul Lee, Kyoung Jun Song, Joo Jeong, Dae Han Wi, Sungwoo Moon
OBJECTIVES: We aimed to evaluate the associations between the centralization of dispatch centers and dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) for out-of-hospital cardiac arrest (OHCA) patients. METHODS: All emergency medical services (EMS)-treated adults in Gyeonggi province (34 fire departments covering 43 counties, with a population of 12.6 million) with OHCAs of cardiac etiology were enrolled between 2013 and 2016, excluding cases witnessed by EMS providers...
July 29, 2018: Resuscitation
Helen Yue-Lai Chan, Jeffrey Sheung-Ching Ng, Kin-Sang Chan, Po-Shan Ko, Doris Yin-Ping Leung, Carmen Wing-Han Chan, Lai-Ngor Chan, Iris Fung-Kam Lee, Diana Tze-Fan Lee
BACKGROUND: Although evidence increasingly demonstrates the effects of advance care planning, the relevant studies are of questionable quality, and lack consensus regarding when and with whom to initiate the conversation. OBJECTIVE: To examine the effects of a structured, nurse-led post-discharge advance care planning programme on congruence between the end-of-life care preferences of the patient and family members, decisional conflicts and the documentation of care preferences...
July 23, 2018: International Journal of Nursing Studies
Michael Macfarlane, Stephanie Shayler, Louisa Nelms, Derek Willis
OBJECTIVES: The 2014 Court of Appeals decision with respect to Tracey vs Cambridge University Hospital ('the Tracey judgement') changed the requirements for discussing Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with patients. This study is a retrospective case note review aiming to identify any changes in practice around discussing DNACPR decisions in hospices following the judgement. METHODS: 150 case notes from 2013 (before the Tracey judgement) were compared with 150 case notes from 2015 (following the Tracey judgement)...
July 25, 2018: BMJ Supportive & Palliative Care
Nay Myo Oo, Ian A Scott, Raquel Maggacis, Nalaka Rajakaruna
Objective The aims of this study were to assess: (1) concordance between patient preferences stated in advance care plans (ACPs) and hospital care over the subsequent 12 months; (2) change in preferences over time; (3) justifications for discordant care; and (4) effects of ACP completion on hospital utilisation. Methods A retrospective study was conducted of 198 patients with an ACP form registered with an ACP registry and tagged with a hospital unique record number. Data collected from ACP forms and hospital records comprised ACP completion and revisions, care preferences, patient characteristics and hospital care...
July 23, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Robyn McDannold, Bentley J Bobrow, Vatsal Chikani, Annemarie Silver, Daniel W Spaite, Tyler Vadeboncoeur
BACKGROUND: Clinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation. OBJECTIVES: To quantify whether chest compressions with guideline-compliant depth (>2 in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest...
June 30, 2018: American Journal of Emergency Medicine
Masoud Fallahi, Somaye Mahdavikian, Alireza Abdi, Fariba Borhani, Parvin Taghizadeh, Behzad Hematpoor
Background: Despite advances with regard to "do not attempt resuscitation order", physicians are still reluctant to implement it. In fact, while the nurses could be of great help in making decision about "do not attempt resuscitation order," they are mostly neglected in this process. The current study was conducted to determine the nurses and physicians' viewpoints about decision making process of "do not attempt resuscitation order". Methods: A descriptive analytical study was carried out with participation of 152 physicians and 152 nurses...
2018: Multidisciplinary Respiratory Medicine
Freda DeKeyser Ganz, Rotem Sharfi, Nehama Kaufman, Sharon Einav
BACKGROUND: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. RESEARCH OBJECTIVES: To describe the perceptions of nurses working on internal medicine wards of slow codes, including the factors associated with its implementation...
January 1, 2018: Nursing Ethics
Paolo Biban
No abstract text is available yet for this article.
July 2018: Pediatric Critical Care Medicine
Simon S Buttrick, Iahn Cajigas, Justin K Achua, Kristine O'Phelan, Kenneth W Goodman, Ronald J Benveniste
OBJECTIVE: To determine whether a set of simple criteria can identify patients in the NICU at high risk of poor outcome and delivery of nonbeneficial care early in the course of their illness. Secondarily, factors affecting limitation of care protocols were assessed. METHODS: We prospectively identified patients who were admitted to the NICU with partial loss of brainstem reflexes persisting for >24 hours due to an intrinsic lesion of the brain (trauma, stroke, hemorrhage, etc...
July 5, 2018: World Neurosurgery
Neil T Srinivasan, Richard J Schilling
Sudden cardiac death (SCD) and arrhythmia represent a major worldwide public health problem, accounting for 15-20 % of all deaths. Early resuscitation and defibrillation remains the key to survival, yet its implementation and the access to public defibrillators remains poor, resulting in overall poor survival to patients discharged from hospital. Novel approaches employing smart technology may provide the solution to this dilemma. Though the majority of cases are attributable to coronary artery disease, a thorough search for an underlying cause in cases where the diagnosis is unclear is necessary...
June 2018: Arrhythmia & Electrophysiology Review
E Batard, F Javaudin, E Kervagoret, E Caruana, Q Le Bastard, G Chapelet, N Goffinet, E Montassier
OBJECTIVES: We aimed to assess whether treatment with ceftriaxone/cefotaxime is associated with lower in-hospital mortality than amoxicillin-clavulanate in pati0ents hospitalized in medical wards for community-onset pneumonia. METHODS: We conducted a retrospective and multicentre study of patients hospitalized in French medical wards for community-onset pneumonia between 2002 and 2015. Treatments with ceftriaxone/cefotaxime or amoxicillin-clavulanate were defined by their start in the emergency department for a duration of 5 days or more with no other β-lactam...
June 28, 2018: Clinical Microbiology and Infection
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