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https://www.readbyqxmd.com/read/29777602/-suspension-of-respiratory-support-in-patients-with-amyotrophic-lateral-sclerosis
#1
Agustín A Silberberg, Josefina Robetto, Mora Achával
Decision making in advanced Amyotrophic Lateral Sclerosis (ALS) patients keeps on being a controversial issue. The aim of this work is to discuss ethical implications of withdrawing respiratory support treatment in patients with ALS. Through a bibliographic search on Pubmed database (2010-2016) we investigated whether or not the use of Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV) would increase survival and quality of life. We included 38 review articles. From these papers, results and ethical implications of initiating and mainly withdrawing respiratory support were analyzed...
May 2018: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
https://www.readbyqxmd.com/read/29776349/randomised-controlled-trial-rct-of-cannabinoid-replacement-therapy-nabiximols-for-the-management-of-treatment-resistant-cannabis-dependent-patients-a-study-protocol
#2
Anjali K Bhardwaj, David J Allsop, Jan Copeland, Iain S McGregor, Adrian Dunlop, Marian Shanahan, Raimondo Bruno, Nghi Phung, Mark Montebello, Craig Sadler, Jessica Gugusheff, Melissa Jackson, Jennifer Luksza, Nicholas Lintzeris
BACKGROUND: The cannabis extract nabiximols (Sativex®) effectively supresses withdrawal symptoms and cravings in treatment resistant cannabis dependent individuals, who have high relapse rates following conventional withdrawal treatments. This study examines the efficacy, safety and cost-effectiveness of longer-term nabiximols treatment for outpatient cannabis dependent patients who have not responded to previous conventional treatment approaches. METHODS/DESIGN: A phase III multi-site outpatient, randomised, double-blinded, placebo controlled parallel design, comparing a 12-week course of nabiximols to placebo, with follow up at 24 weeks after enrolment...
May 18, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29773276/-psychiatric-comorbidities-of-alcohol-dependence
#3
Alain Dervaux, Xavier Laqueille
Psychiatric disorders are common among patients with alcohol dependence. Symptoms of alcohol intoxication or withdrawal need to be disentangled from symptoms of psychiatric disorders. Alcohol dependence could induce psychiatric disorders, in particular depressive disorders and anxiety disorders. Patients with psychiatric disorders may self-medicate with alcohol use. There may be common factors promoting both alcohol dependence and psychiatric disorders: about 40% of patients with alcohol dependence present personality disorders...
May 14, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29773072/formal-procedure-to-facilitate-the-decision-to-withhold-or-withdraw-life-sustaining-interventions-in-a-neonatal-intensive-care-unit-a-seven-year-retrospective-study
#4
G Sorin, R Vialet, B Tosello
BACKGROUND: Neonatal deaths are often associated with the complex decision to limit or withdraw life-sustaining interventions (LSIs) rather than therapeutic impasses. Despite the existence of a law, significant disparities in clinical procedures remain. This study aimed to assess deaths occurring in a Neonatal Intensive Care Unit (NICU) and measure the impact of a traceable Limitation or Withdrawal of Active Treatment (LWAT) file on the treatment of these newborns. METHODS: In this monocentric retrospective study, we reviewed all consecutive neonatal deaths occurring during two three-year periods among patients in the NICU at the North Hospital of Marseille: cohort 1 (from 2009 to 2011 without the LWAT file) and cohort 2 (from 2013 to 2015 after introduction of the LWAT file)...
May 17, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29771804/preemptive-analgesia-decreases-pain-following-anorectal-surgery-a-prospective-randomized-double-blinded-placebo-controlled-trial
#5
Justin T Van Backer, Matthew R Jordan, Danielle T Leahy, Jesse S Moore, Peter Callas, Timothy Dominick, Peter A Cataldo
BACKGROUND: Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied...
May 15, 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29771249/-new-italian-law-about-end-of-life-self-determination-and-shared-care-pathway
#6
Rosagemma Ciliberti, Matteo Gulino, Ilaria Gorini
The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo)...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29771096/-patient-physician-relation-a-grounded-theory-of-the-experience-of-hiv-treatment-side-effects
#7
Caroline Dufour, Marilou Gagnon
Antivirals induce many significant side effects and reduce the quality of life for People Living with HIV (PLWHIV). The management of side effects is crucial to maintain the patient's quality of life and adherence to treatments. The patient-physician relation is essential when managing side effects as it influences the experience for the PLWHIV. This grounded theory analyzes the patient-physician relationship in context with side effects. In the greater Ottawa/Gatineau area, 50 PLWHIV have participated in a semi-structured interview to share their experience with side effects...
March 2018: Recherche en Soins Infirmiers
https://www.readbyqxmd.com/read/29769117/a-protocol-for-a-network-meta-analysis-of-interventions-to-treat-patients-with-sudden-sensorineural-hearing-loss
#8
Nadera Ahmadzai, Shaun Kilty, Dianna Wolfe, Jamie Bonaparte, David Schramm, Elizabeth Fitzpatrick, Vincent Lin, Wei Cheng, Becky Skidmore, David Moher, Brian Hutton
BACKGROUND: Hearing loss is one of the leading causes of disability worldwide, with greater than 20% of Canadian adults having measurable hearing loss in at least one ear. Patients with hearing loss experience impaired quality of life, and emotional and financial consequences that affect themselves and their families. Sudden sensorineural hearing loss (SSNHL) is a common but difficult to treat form of hearing loss that has a sudden onset of ≤ 72 h associated with various etiologies, with the majority of cases being idiopathic...
May 16, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29767789/effects-of-tannic-acid-extract-on-performance-and-intestinal-health-of-broiler-chickens-following-coccidiosis-vaccination-and-or-a-mixed-species-eimeria-challenge
#9
R M Tonda, J K Rubach, B S Lumpkins, G F Mathis, M J Poss
Two experiments were conducted to investigate the effects of tannic acid extract (TAE) formulations on the performance and intestinal health of male Cobb × Cobb 500 broilers exposed to coccidiosis. In the first experiment, 320 broiler chicks were randomly assigned to 5 treatments with 8 replicates. Treatments included non-medicated, uninfected (NC); non-medicated, infected (PC); salinomycin (SAL, 66 mg/kg); tannic acid (TA, 0.5 g/kg) and TAE (TAE, 0.5 g/kg). On d 14, all groups (except NC) were orally inoculated with Eimeria acervulina, E...
May 15, 2018: Poultry Science
https://www.readbyqxmd.com/read/29767392/a-novel-rabbit-model-for-benign-biliary-stricture-formation-and-the-effects-of-medication-infusions-on-stricture-formation
#10
Qin Yang, Junke Wang, Fei Liu, Wenjie Ma, Haijie Hu, Congdun Ran, Fuyu Li, Qiuwei Pan
BACKGROUND: Benign biliary stricture (BBS) is highly refractory. Currently, there is no effective strategy for prevention of BBS recurrence. The aim of this study is to establish a novel BBS rabbit model and to investigate the efficacy of biliary infusion with anti-proliferative medications for treating BBS. METHOD: A BBS model was established via surgical injury and biliary infection. The biliary infusion tube was inserted into the common bile duct via the stump of cystic duct after cholecystectomy...
May 16, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29766728/-euthanasia-legal-comparison-in-selected-european-countries
#11
Adam Doležal
This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victims Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area...
2018: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29765246/efficacy-of-opioids-versus-placebo-in-chronic-pain-a-systematic-review-and-meta-analysis-of-enriched-enrollment-randomized-withdrawal-trials
#12
Diana S Meske, Oluwadolapo D Lawal, Harrison Elder, Valerie Langberg, Florence Paillard, Nathaniel Katz
Introduction: Opioids have been used for millennia for the treatment of pain. However, the long-term efficacy of opioids to treat chronic non-cancer pain continues to be debated. To evaluate opioids' efficacy in chronic non-cancer pain, we performed a meta-analysis of published clinical trials for μ-opioid receptor agonists performed for US Food and Drug Administration approval. Methods: MEDLINE and Cochrane trial register were searched for enriched enrollment randomized withdrawal studies (before June 2016)...
2018: Journal of Pain Research
https://www.readbyqxmd.com/read/29764875/efficacy-and-safety-of-ghx02-in-the-treatment-of-acute-bronchitis-protocol-of-a-phase-ii-double-blind-randomised-placebo-controlled-trial
#13
Yee Ran Lyu, Won-Kyung Yang, So Jung Park, Seung-Hyeong Kim, Wee-Chang Kang, In Chul Jung, Yang Chun Park
INTRODUCTION: Acute bronchitis is a self-limiting infection of the large airways; cough is the primary symptom, usually lasting for about 3 weeks. Annually, approximately 5% of adults develop acute bronchitis, and its economic burden is substantial. There are also problems of antibiotic abuse in public health systems and symptomatic therapies are commonly prescribed, for which there is insufficient supporting evidence. GHX02 contains four herbs originating from gwaruhaengryeon-hwan, which has been used in the treatment of patients with acute bronchitis in Korea...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29764395/longitudinal-changes-in-bone-and-mineral-metabolism-after-cessation-of-cinacalcet-in-dialysis-patients-with-secondary-hyperparathyroidism
#14
Irene Ruderman, Edward R Smith, Nigel D Toussaint, Tim D Hewitson, Stephen G Holt
BACKGROUND: The calcimimetic agent cinacalcet is effective for the management of secondary hyperparathyroidism (SHPT) in dialysis patients. Changes to reimbursement of cinacalcet in Australia provided an opportunity to assess effects of medication cessation on biochemical and clinical outcomes in dialysis patients, including changes to novel biomarkers such as calciprotein particles (CPP). CPP are nanoparticles of mineral and protein in the circulation associated with increased vascular calcification in patients with chronic kidney disease...
May 15, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29762777/the-intracerebral-hemorrhage-score-a-self-fulfilling-prophecy
#15
D Jay McCracken, Brendan P Lovasik, Courtney E McCracken, Jason M Frerich, Margaret E McDougal, Jonathan J Ratcliff, Daniel L Barrow, Gustavo Pradilla
BACKGROUND: The ICH Score has become the standard for risk-stratification of 30-d mortality in patients with intracerebral hemorrhage (ICH), but treatment has evolved over the last 17 yr since its inception. We sought to determine if the ICH Score remains an accurate predictor of 30-d mortality in these high acuity patients. OBJECTIVE: To determine the role the ICH Score has on mortality in current treatment of patients. METHODS: A retrospective review of 554 patients treated for acute, spontaneous ICH at 2 large academic institutions between 2010 and 2014 was carried out...
May 14, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29759276/hypnotic-discontinuation-in-chronic-insomnia
#16
REVIEW
Jonathan P Hintze, Jack D Edinger
Patients with chronic insomnia are commonly prescribed hypnotic medications. The long-term effects of chronic hypnotics are not known and discontinuation is encouraged but often difficult to achieve. A gradual taper is preferred to abrupt cessation to avoid rebound insomnia and withdrawal symptoms. Written information provided to the patient about medication discontinuation may be helpful. Cognitive behavioral therapy or behavioral therapies alone can improve hypnotic discontinuation outcomes. There is limited evidence for adjunct medications to assist in hypnotic cessation for insomnia...
June 2018: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/29757346/effectiveness-of-a-multifaceted-intervention-to-reduce-night-time-sedative-use-in-a-rehabilitation-unit-a-pre-post-intervention-study
#17
Juliana Delos Reyes, Anthony T Sharkey, Laura Morrison, Maria Costello, Cate Crowe, Robert Murphy, Shaun T O'Keeffe, Eamon C Mulkerrin
Background: night-time sedation prescribed during a hospital stay can result in long-term use of such medications in older people. We examined the effectiveness of a multifaceted intervention to reduce night time sedation in an inpatient rehabilitation unit. Methods: an initial retrospective survey of night-time sedative use was followed by prospective re-evaluation after a number of changes were made including education of staff and of patients regarding the potential hazards of sedative medications, measures to promote sleep hygiene and facilitate a 'quiet time' after 10 pm and development of a withdrawal protocol for patients on long-term night sedation...
May 11, 2018: Age and Ageing
https://www.readbyqxmd.com/read/29756066/postanaesthetic-shivering-from-pathophysiology-to-prevention
#18
REVIEW
Maria Bermudez Lopez
Postoperative shivering is a common complication of anaesthesia. Shivering is believed to increase oxygen consumption, increase the risk of hypoxemia, induce lactic acidosis, and catecholamine release. Therefore, it might increase the postoperative complications especially in high-risk patients. Moreover, shivering is one of the leading causes of discomfort for postsurgical patients. Shivering is usually triggered by hypothermia. However, it occurs even in normothermic patients during the perioperative period...
April 2018: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29754875/spike-persistence-and-normalization-in-benign-epilepsy-with-centrotemporal-spikes-implications-for-management
#19
Hunmin Kim, Soo Yeon Kim, Byung Chan Lim, Hee Hwang, Jong-Hee Chae, Jieun Choi, Ki Joong Kim, Dennis J Dlugos
PURPOSE: This study was performed 1) to determine the timing of spike normalization in patients with benign epilepsy with centrotemporal spikes (BECTS); 2) to identify relationships between age of seizure onset, age of spike normalization, years of spike persistence and treatment; and 3) to assess final outcomes between groups of patients with or without spikes at the time of medication tapering. METHODS: Retrospective analysis of BECTS patients confirmed by clinical data, including age of onset, seizure semiology and serial electroencephalography (EEG) from diagnosis to remission...
May 10, 2018: Brain & Development
https://www.readbyqxmd.com/read/29754428/tapering-off-long-term-opioid-therapy-in-chronic-non-cancer-pain-patients-a-randomized-clinical-trial
#20
Geana Paula Kurita, Jette Højsted, Per Sjøgren
BACKGROUND: The indications for initiating long-term opioid treatment (L-TOT) for chronic non-cancer pain (CNCP) are often unclear and associated with problematic use. This study aimed at evaluating the efficacy of stabilizing opioid therapy followed by a sequential opioid tapering off program in CNCP patients. METHODS: A randomized clinical trial with a medications stabilization period (Phase 1) followed by a opioid tapering off program (Phase 2). In Phase 2, patients were randomized to Control Group (stable treatment) or Taper off Group (sequential opioid dose reduction) and assessed at baseline, after stabilization and up to six months...
May 13, 2018: European Journal of Pain: EJP
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