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Assisted dying

Shintaro Akiyama, Masakazu Nagahori, Shinya Oooka, Mariko Negi, Takashi Ito, Kento Takenaka, Kazuo Ohtsuka, Mamoru Watanabe
RATIONALE: The small intestine (SI) does not commonly harbor cancer but is occasionally involved by metastatic cancer from other organs. To manage SI cancer appropriately, surveillance for primary origin outside the SI is essential. PATIENT CONCERNS: This study presents a 54-year-old Thai man diagnosed with SI obstruction which required laparoscopy- assisted partial ileal resection. DIAGNOSES: On the basis of the expression pattern of cytokeratins (CKs) and mucins (MUCs) in the resected SI adenocarcinoma, we suspected this was metastasized from the pancreatobiliary tract...
March 2018: Medicine (Baltimore)
Claudia Bozzaro
Physician-assisted dying (assisted suicide and euthanasia) is currently an intensely discussed topic in several countries. Despite differences in legislation and application, countries with end-of-life laws have similar eligibility criteria for assistance in dying: individuals must be in a hopeless situation and experience unbearable suffering. Hopelessness, as a basic aspect of the human condition, is a central topic in Albert Camus' philosophical work The Myth of Sisyphus, which addresses the question of suicide...
March 20, 2018: Theoretical Medicine and Bioethics
Mark W H Hiew, Aubrey N Baird, Peter D Constable
OBJECTIVE To characterize signalment, clinical signs, reproductive history, surgical management, and outcomes of beef cattle undergoing cesarean section because of dystocia at a veterinary teaching hospital. DESIGN Retrospective case series with nested cohort study. ANIMALS 173 beef cattle admitted to a veterinary teaching hospital from 2001 through 2010 that underwent cesarean section because of dystocia. PROCEDURES Medical records were reviewed and information collected on cattle signalment; reproductive history; cause of dystocia; anesthetic protocol; surgical management; number, sex, and body weight of calves delivered (alive or dead); perioperative treatment; duration of hospitalization; and discharge status...
April 1, 2018: Journal of the American Veterinary Medical Association
Jongho Kim, Erika D Feller, Wengen Chen, Yuanyuan Liang, Vasken Dilsizian
OBJECTIVES: The feasibility of18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of left ventricular assist device (LVAD) infection has been demonstrated. Beyond the diagnoses of LVAD infection, the authors hypothesized that the pattern and site of the infection along its various components may significantly impact clinical management and patient outcome. BACKGROUND: In patients with end-stage heart failure, the clinical use of LVAD for destination therapy is on the rise, accompanied by a higher prevalence of infections and serious complications...
March 9, 2018: JACC. Cardiovascular Imaging
Tanja Laukkala, Alpo Vuorio, Robert Bor, Bruce Budowle, Pooshan Navathe, Eero Pukkala, Antti Sajantila
Aircraft-assisted pilot suicide is a rare but serious phenomenon. The aim of this study was to evaluate changes in pilot aircraft-assisted suicide risks, i.e., a copycat effect, in the U.S. and Germany after the Germanwings 2015 incident in the French Alps. Aircraft-assisted pilot suicides were searched in the U.S. National Transportation Safety Board (NTSB) accident investigation database and in the German Bundestelle für Flugunfalluntersuchung (BFU) Reports of Investigation database five years before and two years after the deliberate crash of the Germanwings flight into the French Alps in 2015...
March 11, 2018: International Journal of Environmental Research and Public Health
John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
Lee Verweel, Zahava R S Rosenberg-Yunger, Taranom Movahedi, Allan H Malek
Background: Canada legalized assisted dying with the passing of Bill C-14, Medical Assistance in Dying (MAiD), in June 2016. This legislation has implications for health care professionals participating in MAiD. This research aims to understand the effect that MAiD has on pharmacists and pharmacy technicians in Canada. Methods: We conducted a thematic document analysis of pharmacy guidelines, position statements and standards of practice from pharmacy regulatory authorities across Canada...
March 2018: Canadian Pharmacists Journal: CPJ, Revue des Pharmaciens du Canada: RPC
Kelly H Schlendorf, Sandip Zalawadiya, Ashish S Shah, Mark Wigger, Chan Y Chung, Sarah Smith, Matthew Danter, Chun W Choi, Mary E Keebler, D Marshall Brinkley, Suzanne Brown Sacks, Henry Ooi, Roman Perri, Joseph A Awad, Samuel Lewis, Rachel Hayes, Heather O'Dell, Callie Darragh, Alicia Carver, Cori Edmonds, Shelley Ruzevich-Scholl, JoAnn Lindenfeld
BACKGROUND: Given the shortage of suitable donor hearts for cardiac transplantation, and the favorable safety and efficacy of current agents used to treat hepatitis C virus (HCV), our institution recently piloted transplantation of select patients using HCV-positive donors. METHODS: Between September 2016 and March 2017, 12 HCV-naive patients and 1 patient with a history of treated HCV underwent heart transplantation (HT) using hearts from HCV-positive donors after informed consent...
January 31, 2018: Journal of Heart and Lung Transplantation
John A Abraham, Barry Kenneally, Kamil Amer, David S Geller
BACKGROUND: Navigation-assisted resection has been proposed as a useful adjunct to resection of malignant tumors in difficult anatomic sites such as the pelvis and sacrum where it is difficult to achieve tumor-free margins. Most of these studies are case reports or small case series, but these reports have been extremely promising. Very few reports, however, have documented benefits of navigation-assisted resection in series of pelvic and sacral primary tumors. Because this technology may add time and expense to the surgical procedure, it is important to determine whether navigation provides any such benefits or simply adds cost and time to an already complex procedure...
March 2018: Clinical Orthopaedics and related Research
Jasmin S Hanke, Günes Dogan, Amelie Zoch, Marcel Ricklefs, Leonhard Wert, Christina Feldmann, Christoph Bara, Malakh Shrestha, Jochen Tillmanns, Tibor Kempf, Johann Bauersachs, Axel Haverich, Jan D Schmitto
BACKGROUND: The HeartMate 3 (HM3; Abbott Laboratories, Lake Forest, Ill) left ventricular assist device (LVAD) received its Conformité Européenne mark for Europe in October 2015 and is currently under investigation of the Food and Drug Administration to gain approval in the United States. Within this study, we present the first real-world experiences, 1-year outcomes, and adverse events of a single-center cohort treated with the HM3. METHODS: We prospectively studied midterm results of 27 consecutive patients receiving the HM3 at a single institution...
February 13, 2018: Journal of Thoracic and Cardiovascular Surgery
Timothy L Surman, Robert G Stuklis, Justin C Chan
BACKGROUND: Multiple case studies have suggested that video-assisted thoracoscopic sympathectomy (VATS) reduces the occurrence and frequency of symptoms in long QT syndrome (LQTS) [1,2,3]. To date there has not been a literature review to report on the short-term and long-term outcomes of this procedure. Our primary aims are to review the literature findings on the clinical outcomes of VATS sympathectomy for long QT and present a local centre case report on the outcomes of T2-T5 sympathectomy...
February 13, 2018: Heart, Lung & Circulation
Eugene Wickett, André Peralta-Santos, Jason Beste, Mary Micikas, Foriest Toe, Julia Rogers, Lassana Jabateh, Bradley H Wagenaar
OBJECTIVES: In June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) program containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014-2015 Ebola-virus disease (EVD) epidemic. The purpose of this article is to analyze the performance of routine clinical TB care and the effects of this CHW program. METHODS: Retrospective cohort study utilizing data from TB patient registers at a census of all health facilities treating TB in southeastern Liberia from January 2015 - April 2017...
March 9, 2018: Tropical Medicine & International Health: TM & IH
Xiao-Fei Wu, Min Zhang, Bhesh Bhandari, Zhongqin Li
BACKGROUND: Microwave-assisted pulse-spouted bed freeze-drying (MPSFD) uses microwave heating to substitute the customary conduction heating during FD, resulting in high-quality dried samples with short drying time. The aim of this study was to determine the effect of MPSFD on volatile compounds and structural aspects of Cordyceps militaris. In order to highlight the effect of MPSFD, the freeze-drying (FD, recognized for its high-quality products) and hot air dying (HD, the most commonly used) were also evaluated using headspace solid phase micro-extraction combined with gas chromatography-mass spectrometry (HS-SPME-GC-MS) and mid-Fourier transform infrared (FTIR) spectroscopy...
March 8, 2018: Journal of the Science of Food and Agriculture
Tom E F Abbott, Nicholas Cron, Nidhi Vaid, Dorothy Ip, Hew D T Torrance, Julian Emmanuel
Background: National Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay. Methods: Planned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study...
March 2018: Annals of Medicine and Surgery
Hiroyuki Honda, Naokazu Sasagasako, Chang Shen, Masahiro Shijo, Hideomi Hamasaki, Satoshi O Suzuki, Yoshio Tsuboi, Naoki Fujii, Toru Iwaki
INTRODUCTION: Perry syndrome is a rapidly progressive, autosomal dominant parkinsonism characterized by central hypoventilation, depression and severe weight loss. To date, eight DCTN1 mutations have been identified associated with Perry syndrome. A novel F52L DCTN1 mutation case of Perry syndrome is characterized by late-onset parkinsonism and frontotemporal atrophy. METHODS: A Japanese woman suffered from slowly progressing parkinsonism since age 48. At age 59, she developed central hypoventilation, and required breathing assistance...
February 23, 2018: Parkinsonism & related Disorders
Ethan J Rowin, Barry J Maron, Patrick Abt, Michael S Kiernan, Amanda Vest, Fred Costantino, Martin S Maron, David DeNofrio
Heart transplant has become an increasingly important option for patients with end-stage nonobstructive hypertrophic cardiomyopathy (HC). However, clinical details related specifically to the overall HC transplant experience remain sparse. We assessed outcomes of HC heart transplants, from 2002 to 2016, at Tufts Medical Center. Fifty-two nonobstructive severely symptomatic patients underwent evaluation at 47 ± 13 years; 11 (21%) declined or failed to qualify, most commonly because of co-morbidities (n = 7)...
January 31, 2018: American Journal of Cardiology
Ann Bonner, Shirley Chambers, Helen Healy, Wendy Hoy, Geoff Mitchell, Adrian Kark, Sharad Ratanjee, Patsy Yates
BACKGROUND: There is increasing recognition of the clinical need for timely and coordinated supportive and palliative care for those with terminal organ failure. OBJECTIVE: To describe symptoms, quality of life and supportive care needs in the anticipated 12-month period prior to death in adults with chronic kidney disease (CKD) stages 4 or 5. METHOD: An observational, prospective, longitudinal design was used to follow 19 patients. The measures used were the Chronic Kidney Disease-Symptom Burden Index (CKD-SBI), the Australian Karnofsky Performance Scale (AKPS), the Functional Assessment of Chronic illness Therapy Palliative-14 (FACIT PAL-14), the Assessment of Quality of Life 6 Dimensions (AQoL-6D) and the Sheffield Profile for Assessment and Referral for Care (SPARC)...
February 28, 2018: Journal of Renal Care
Anderson da Silva Souza, Jacqueline de Almeida Gonçalves Sachett, João Arthur Alcântara, Monique Freire, Maria das Graças Costa Alecrim, Marcus Lacerda, Luiz Carlos de Lima Ferreira, Hui Wen Fan, Vanderson de Souza Sampaio, Wuelton Marcelo Monteiro
Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil...
February 25, 2018: Toxicon: Official Journal of the International Society on Toxinology
Ana Paula Narata, Aymeric Amelot, Richard Bibi, Denis Herbreteau, Denis Angoulvant, Yves Gruel, Kevin Janot
BACKGROUND: Dual antiplatelet therapy (DAPT) associating aspirin + clopidogrel is commonly utilized in neurovascular interventions despite unpredictable clopidogrel efficacy with 4% to 50% of patients considered nonresponders. Ticagrelor is an antiplatelet agent with low resistance rates but unknown efficacy and safety in neurovascular patients. OBJECTIVE: To evaluate frequency of ischemic and hemorrhagic events in patients treated with aspirin and ticagrelor when associated with perioperative heparin bolus for unruptured aneurysms treated with intracranial stents...
February 26, 2018: Neurosurgery
Daniel da Costa, Cristián Montenegro, Patricio Palavecino, Germán Lobos, Tomás Cermenati, Jaime Poniachik
Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO...
October 2017: Revista Médica de Chile
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