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Quality Of Death

Courtney P Williams, Kelly M Kenzik, Andres Azuero, Grant R Williams, Maria Pisu, Karina I Halilova, Stacey A Ingram, Supriya K Yagnik, Andres Forero, Smita Bhatia, Gabrielle B Rocque
BACKGROUND: National Comprehensive Cancer Network (NCCN) guideline-based treatment is a marker of high-quality care. The impact of guideline discordance on cost and health care utilization is unclear. MATERIALS AND METHODS: This retrospective cohort study of Medicare claims data from 2012 to 2015 included women age ≥65 with stage I-III breast cancer receiving care within the University of Alabama at Birmingham Cancer Community Network. Concordance with NCCN guidelines was assessed for treatment regimens...
August 17, 2018: Oncologist
Christopher A Pickett, Todd C Villines, Jon R Resar, Edward A Hulten
BACKGROUND: Up to half the patients with cryptogenic stroke under the age of 55 years have been found to have a PFO. Observational studies have demonstrated a benefit from closure of PFO and several RCTs have shown a trend toward benefit. The cost and clinical effectiveness of PFO closure is unclear. METHODS AND RESULTS: We searched for RCTs of PFO closure in patients with cryptogenic stroke and performed a detailed cost analysis and meta-analysis of treatment outcomes based on the results of the meta-analysis...
July 21, 2018: International Journal of Cardiology
Abi Merriel, Julia Hussein, Address Malata, Arri Coomarasamy, Michael Larkin
BACKGROUND: In Malawi there are too few maternity healthcare workers to enable delivery of high quality care to women. These staff are often overworked and have low job satisfaction. Skilled maternity healthcare workers are essential to improve outcomes for mothers and babies. This study focuses on understanding the working life experience of maternity staff at district hospitals in Malawi with the aim of developing relevant low-cost solutions to improve working life. METHODS: A qualitative study using semi-structured interviews was undertaken in three district hospitals around Malawi's Capital city...
August 17, 2018: BMC Pregnancy and Childbirth
Devika Nadkarni, Sara Gravelyn, Monica Brova, Sarem Rashid, Randy Yee, Donovan Guttieres, Katie Clifford, Darash Desai, Muhammad Zaman
BACKGROUND: Our objective is to estimate the effects of therapeutic oxytocin supply chain factors and social determinants of health on patient access to oxytocin in low-income settings using system dynamics modeling. Postpartum hemorrhage (PPH), a major cause of maternal mortality disproportionately affects women in low and middle income countries (LMICs). The World Health Organization recommends therapeutic oxytocin as the frontline uterotonic for PPH management and prevention. However, lack of access to quality therapeutic oxytocin in Tanzania, and throughout Sub-Saharan Africa, continues to result in a high number of preventable maternal deaths...
August 17, 2018: BMC Health Services Research
Eisuke Nakazawa, Shoichi Maeda, Keiichiro Yamamoto, Aru Akabayashi, Yuzaburo Uetake, Margie H Shaw, Richard A Demme, Akira Akabayashi
BACKGROUND: This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as "reuse cardiac organ transplantation." METHODS: Medical, legal, and ethical analysis, with a main focus on ethical analysis...
August 17, 2018: BMC Medical Ethics
Dalal Alali, Kirrie Ballard, Hans Bogaardt
BACKGROUND: Multiple Sclerosis (MS) refers to a chronic inflammation of the central nervous system including the brain and spinal cord. Dysphagia is one of the symptoms that represent challenges in clinical practice for the management of MS patients. Dysphagia can result in serious complications leading to morbidity and death in late stages of MS. However, little attention is given to dysphagia, its symptoms and how it affects the quality of life of adults with MS. OBJECTIVES: The purpose of this study is to identify the frequency of dysphagia in adults with MS and determine the main symptoms suggestive of dysphagia and its impact on the patients' quality of life...
August 8, 2018: Multiple Sclerosis and related Disorders
Jinglan Jin, Hongqin Xu, Ruihong Wu, Junqi Niu, Shibo Li
PURPOSE: We aimed to study the aberrant DNA methylation profile associated with hepatitis B virus (HBV) infection and to identify key genes and pathways associated with the HBV infection stage. METHODS: A total of 54 antiviral treatment-naive HBV-infected patients and 6 healthy controls were included. Genome-wide methylated DNA immunoprecipitation analysis was performed, as previously described, after which the chip data were preprocessed. Subsequently, Cytoscape software was used for the construction of a protein-protein interaction network, and Database for Annotation, Visualization, and Integrated Discovery software was used to conduct functional enrichment analysis...
August 17, 2018: Journal of Medical Virology
Robert Moshiro, Jeffrey M Perlman, Hussein Kidanto, Jan Terje Kvaløy, Paschal Mdoe, Hege L Ersdal
BACKGROUND: Effective positive pressure ventilation (PPV) of non-breathing newborns is crucial in facilitating cardio-respiratory adaptation at birth. Identifying predictors of death in newborns receiving PPV is important in order to facilitate preventative strategies. OBJECTIVE: The objective of this study was to determine the perinatal predictors of death including the quality of PPV administered among admitted newborns. METHODS: An observational study of admitted newborns who received PPV after birth was conducted...
2018: PloS One
Bert-Ram Sah, Kasia Owczarczyk, Musib Siddique, Gary J R Cook, Vicky Goh
Esophageal, esophago-gastric, and gastric cancers are major causes of cancer morbidity and cancer death. For patients with potentially resectable disease, multi-modality treatment is recommended as it provides the best chance of survival. However, quality of life may be adversely affected by therapy, and with a wide variation in outcome despite multi-modality therapy, there is a clear need to improve patient stratification. Radiomic approaches provide an opportunity to improve tumor phenotyping. In this review we assess the evidence to date and discuss how these approaches could improve outcome in esophageal, esophago-gastric, and gastric cancer...
August 16, 2018: Abdominal Radiology
Michael Mankbadi, Samira Hassan, Michelle McGee, Bonnie Jan, Sibani Mangal, Jake Altier, Manjunath Harlapur
Brugada syndrome (BS) is an inherited cardiac ion channelopathy that is a rare, but treatable, cause of sudden cardiac death (SCD). There are many studies that explore the management of symptomatic BS, but few trials have been conducted regarding management of asymptomatic Brugada patients. Asymptomatic BS patients are shown to be at increased risk (0.5%-1.5%) for SCD compared to the general population and account for nearly 20% of deaths from SCD in patients with structurally normal hearts. Treatment for asymptomatic BS patients is often debated with the current guidelines allowing for management decisions to be made on a case-by-case basis...
June 13, 2018: Curēus
Mónica M C González
The influence of light on mammalian physiology and behavior is due to the entrainment of circadian rhythms complemented with a direct modulation of light that would be unlikely an outcome of circadian system. In mammals, physiological and behavioral circadian rhythms are regulated by the suprachiasmatic nucleus (SCN) of the hypothalamus. This central control allows organisms to predict and anticipate environmental change, as well as to coordinate different rhythmic modalities within an individual. In adult mammals, direct retinal projections to the SCN are responsible for resetting and synchronizing physiological and behavioral rhythms to the light-dark (LD) cycle...
2018: Frontiers in Neurology
Muhammad Farhan Khaliq, Maria Shoaib, Syed Maaz Tariq, Muhammad Taimoor Khan
Cerebral air embolism (CAE) is a rare, avoidable and potentially fatal iatrogenic complication. Here, we report a case of CAE associated with a central venous catheter in the internal jugular vein that resulted in neurological deficits and generalised epileptic seizures. A 64-year-old man admitted for fasciotomy for compartment syndrome developed CAE with left-sided neurological deficits. The suspected origin was retrograde air flow from the right internal jugular venous catheter. The air spontaneously resorbed without the need for specific therapy, and he made a good recovery...
August 16, 2018: BMJ Case Reports
Wiebren A A Tjalma
Surgery is the golden standard for early stage cervical cancer. Surgery can be done by an open or a closed procedure. A closed procedure or minimal invasive surgery (MIS) reduces the morbidity and retrospective analysis suggested that there was no difference in survival. In daily practice this meant that open surgery was replaced by MIS. The results of the first randomized phase 3 trial comparing open versus closed surgery threw another light on the topic. This well designed RCT revealed that MIS was associated with significant higher recurrence rates and a significant worse overall survival...
August 6, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Selina Kikkenborg Berg, Trine Bernholdt Rasmussen, Rikke Elmose Mols, Charlotte Brun Thorup, Britt Borregaard, Anne Vinggaard Christensen, Pernille Fevejle Cromhout, Ola Ekholm, Knud Juel, Lars Thrysoee
BACKGROUND: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. AIM: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission...
August 17, 2018: European Journal of Cardiovascular Nursing
Mary Dillon, Louisa Flander, Daniel D Buchanan, Finlay A Macrae, Jon D Emery, Ingrid M Winship, Alex Boussioutas, Graham G Giles, John L Hopper, Mark A Jenkins, Driss Ait Ouakrim
BACKGROUND: The Australian National Bowel Cancer Screening Programme (NBCSP) was introduced in 2006. When fully implemented, the programme will invite people aged 50 to 74 to complete an immunochemical faecal occult blood test (iFOBT) every 2 years. METHODS AND FINDINGS: To investigate colorectal cancer (CRC) screening occurring outside of the NBCSP, we classified participants (n = 2,480) in the Australasian Colorectal Cancer Family Registry (ACCFR) into 3 risk categories (average, moderately increased, and potentially high) based on CRC family history and assessed their screening practices according to national guidelines...
August 2018: PLoS Medicine
Ya-Lan Shih, Yu-Ching Hsu, Wei-Hsin Chiu, Co-Shi Chantal Chao
Preparing for a good death is an important and meaningful concept in Chinese culture because people hope to know residual life to make effort for their unfinished business. However, the family of terminally ill patients with cancer may be annoyed and frustrated about unexpected bereavement if they have unresolved conflicts with the loved one, missing a chance for declaring love, untimely apologizing and saying goodbye. The study aimed to explore this difficult issue. The medical records of 121 deceased terminally ill patients with cancer at National Cheng Kung University Hospital between December 2010 and February 2012 were reviewed...
September 2018: Holistic Nursing Practice
Alex H S Harris, Alfred C Kuo, Kevin J Bozic, Edmund Lau, Thomas Bowe, Shalini Gupta, Nicholas J Giori
BACKGROUND: The American Joint Replacement Registry (AJRR) Total Joint Risk Calculator uses demographic and clinical parameters to provide risk estimates for 90-day mortality and 2-year periprosthetic joint infection (PJI). The tool is intended to help surgeons counsel their Medicare-eligible patients about their risk of death and PJI after total joint arthroplasty (TJA). However, for a predictive risk model to be useful, it must be accurate when applied to new patients; this has yet to be established for this calculator...
September 2018: Clinical Orthopaedics and related Research
Praveen Adusumilli, Lingaraj Nayak, Vidya Viswanath, Leela Digumarti, Raghunadha Rao Digumarti
Introduction: Desisting from disease directed treatment in the past weeks of life is a quality criterion in oncology service. Patients with advanced cancer have unrealistic expectations from chemotherapy and hold on to it as a great source of hope. Many oncologists continue futile and unnecessary treatments, instead of conveying to the patients the lack of benefit, resulting in delayed referral for palliative care (PC). Materials and Methods: This is a retrospective analysis of case records from June 2014 to December 2015...
July 2018: South Asian Journal of Cancer
Irisa Zile, Inguna Ebela, Valdis Folkmanis, Ingrida Rumba Rozenfelde
Introduction: Stillbirth is one of the most common adverse pregnancy outcomes worldwide. Late foetal death (LFD) rates are mostly used for international comparisons because of the large variations in stillbirth rates between countries. Objective: To examine trends in LFD (including antepartum and intrapartum) by multiple births, birth weight, and maternal age in two time periods. Methods: A retrospective cohort study was used to analyse data from the Medical Birth Register (2001-2014), divided into 2 periods of 7 years each...
2018: Journal of Pregnancy
Jessica Y Ho, Arun S Hendi
OBJECTIVES: To assess whether declines in life expectancy occurred across high income countries during 2014-16, to identify the causes of death contributing to these declines, and to examine the extent to which these declines were driven by shared or differing factors across countries. DESIGN: Demographic analysis using aggregated data. SETTING: Vital statistics systems of 18 member countries of the Organisation for Economic Co-operation and Development...
August 15, 2018: BMJ: British Medical Journal
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