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Medically assisted death

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https://www.readbyqxmd.com/read/28098622/physician-assisted-suicide-and-euthanasia-in-the-icu-a-dialogue-on-core-ethical-issues
#1
Ewan C Goligher, E Wesley Ely, Daniel P Sulmasy, Jan Bakker, John Raphael, Angelo E Volandes, Bhavesh M Patel, Kate Payne, Annmarie Hosie, Larry Churchill, Douglas B White, James Downar
OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28068906/cherish-collaboration-for-hospitalised-elders-reducing-the-impact-of-stays-in-hospital-protocol-for-a-multi-site-improvement-program-to-reduce-geriatric-syndromes-in-older-inpatients
#2
Alison M Mudge, Merrilyn D Banks, Adrian G Barnett, Irene Blackberry, Nicholas Graves, Theresa Green, Gillian Harvey, Ruth E Hubbard, Sharon K Inouye, Sue Kurrle, Kwang Lim, Prue McRae, Nancye M Peel, Jessica Suna, Adrienne M Young
BACKGROUND: Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital...
January 9, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28067630/novel-swine-model-of-ricin-induced-acute-respiratory-distress-syndrome
#3
Shahaf Katalan, Reut Falach, Amir Rosner, Michael Goldvaser, Tal Brosh-Nissimov, Ayana Dvir, Avi Mizrachi, Orr Goren, Barak Cohen, Yoav Gal, Anita Sapoznikov, Sharon Ehrlich, Tamar Sabo, Chanoch Kronman
Pulmonary exposure to the plant toxin ricin, leads to respiratory insufficiency and death. To date, in-depth study of the functional disorders ensuing pulmonary intoxication, a prerequisite for establishing a clinically-relevant therapeutic protocol, is hampered by the lack of an appropriate animal model. To this end, we set up the pig, as a large animal model for the comprehensive study of the multifarious clinical manifestations of pulmonary ricinosis.Here we report for the first time, the monitoring of barometric whole body plethysmography for pulmonary function tests in non-anesthetized ricin-intoxicated pigs...
January 6, 2017: Disease Models & Mechanisms
https://www.readbyqxmd.com/read/28034580/canadian-cardiovascular-society-canadian-heart-rhythm-society-2016-implantable-cardioverter-defibrillator-guidelines
#4
Matthew Bennett, Ratika Parkash, Pablo Nery, Mario Sénéchal, Blandine Mondesert, David Birnie, Laurence D Sterns, Claus Rinne, Derek Exner, François Philippon, Debra Campbell, Jafna Cox, Paul Dorian, Vidal Essebag, Andrew Krahn, Jaimie Manlucu, Franck Molin, Michael Slawnych, Mario Talajic
Sudden cardiac death is a major public health issue in Canada. However, despite the overwhelming evidence to support the use of implantable cardioverter defibrillators (ICDs) in the prevention of cardiac death there remains significant variability in implantation rates across Canada. Since the most recent Canadian Cardiovascular Society position statement on ICD use in Canada in 2005, there has been a plethora of new scientific information to assist physicians in their discussions with patients considered for ICD implantation to prevent sudden cardiac death due to ventricular arrhythmias...
October 6, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28033302/the-efficacy-of-isometric-resistance-training-utilizing-handgrip-exercise-for-blood-pressure-management-a-randomized-trial
#5
Debra J Carlson, Jodie Inder, Suresh K A Palanisamy, James R McFarlane, Gudrun Dieberg, Neil A Smart
INTRODUCTION: Hypertension is a major risk factor contributing to cardiovascular disease, which is the number one cause of deaths worldwide. Although antihypertensive medications are effective at controlling blood pressure, current first-line treatment for hypertension is nonpharmacological lifestyle modifications. Recent studies indicate that isometric resistance training (IRT) may also be effective for assisting with blood pressure management. The aim of this study was to determine the efficacy of IRT for blood pressure management and the suitability of a low-intensity working control group...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28033090/community-health-workers-as-allies-in-hypertension-self-management-and-medication-adherence-in-the-united-states-2014
#6
Caitlin G Allen, J Nell Brownstein, Anamika Satsangi, Cam Escoffery
INTRODUCTION: Rates of hypertension control remain low among underserved populations in the United States; moreover, disparities in hypertension-related cardiovascular disease death are increasing. Community health workers (CHWs) can address barriers to hypertension control among underrepresented and diverse populations. We identify unique roles CHWs play in hypertension self-management and medication adherence. METHODS: In 2014, we conducted a mixed methods study with an online survey of 265 CHWs and 23 telephone interviews...
December 29, 2016: Preventing Chronic Disease
https://www.readbyqxmd.com/read/28031256/organ-donation-after-medical-assistance-in-dying-or-cessation-of-life-sustaining-treatment-requested-by-conscious-patients-the-canadian-context
#7
Julie Allard, Marie-Chantal Fortin
In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death...
December 28, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28028265/-current-state-of-medical-support-by-nurses-to-guide-cancer-patients-to-at-home-death
#8
Mitsuru Tange, Kaori Hoshina, Takashi Tsuda
The aim of this study is to clarify the palliative care support in home-based settings for patients with end-stage cancer. Fifty patients who died at home were analyzed. MSC nurses listened to the patients and informal caregivers for their preferences for place of death. Home death was selected by 30%of participants prior to the environment adjustment support and by 68% after. The period leading up to home care that started with the adjustment assistance by MSC was 5 days(median). Nurse support by the MSC is intended to promote decision making regarding the place of end-of-life care...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28002529/delayed-interval-delivery-in-twin-pregnancy-case-reports
#9
Constantin Cristian Văduva, Carmen Constantinescu, Mihaela Ţenovici, Alice Roxana Văduva, Mihaela Niculescu, Damian DiŢescu, Cristina CrenguŢa Albu, Dinu Florin Albu
The implementation of assisted reproduction has increased the incidence of multiple pregnancies. Prenatal death of one fetus in the second trimester of twin pregnancy confronts the obstetrician with a difficult problem with regard to the management of pregnancy. The scarcity of the condition and the absence of the large-scale studies make it difficult to advise the parents on the prognosis and optimal management. The unavoidable birth or death of one premature neonate has led to the aim of delayed interval delivery for the other twin...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
https://www.readbyqxmd.com/read/27997287/acute-dissociative-reaction-to-spontaneous-delivery-in-a-case-of-total-denial-of-pregnancy-diagnostic-and-forensic-aspects
#10
Vedat Şar, Nazan Aydın, Onno van der Hart, A Steven Frankel, Meriç Şar, Oğuz Omay
This article presents the history of a 21-year-old female college student with total denial of pregnancy who experienced an acute dissociative reaction during the spontaneous delivery at home without medical assistance where the newborn died immediately. Psychiatric examination, self-report questionnaires, legal documents, and witness reports have been reviewed in evaluation of the case. Evidence pointed to total denial of pregnancy, that is, until delivery. The diagnoses of an acute dissociative reaction to stress (remitted) and a subsequent PTSD were established in a follow-up examination conducted 7 months after the delivery...
December 20, 2016: Journal of Trauma & Dissociation
https://www.readbyqxmd.com/read/27996085/supportive-interventions-for-enhancing-dietary-intake-in-malnourished-or-nutritionally-at-risk-adults
#11
REVIEW
Christine Baldwin, Katherine L Kimber, Michelle Gibbs, Christine Elizabeth Weekes
BACKGROUND: Supportive interventions such as serving meals in a dining room environment or the use of assistants to feed patients are frequently recommended for the management of nutritionally vulnerable groups. Such interventions are included in many policy and guideline documents and have implications for staff time but may incur additional costs, yet there appears to be a lack of evidence for their efficacy. OBJECTIVES: To assess the effects of supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults...
December 20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27984383/hippocrates-quoted-if-an-empyema-does-not-rupture-death-will-occur-is-medical-thoracoscopy-able-to-make-it-rupture-safely
#12
Georgia Hardavella, Nikolaos A Papakonstantinou, Ioannis Karampinis, Gerasimos Papavasileiou, Shereen Ajab, Mohammed Shafaat, Stavros Malagaris, Nikolaos Anastasiou
BACKGROUND: The aim of this study was to evaluate the safety and efficacy of medical thoracoscopy through a single port [single-port medical thoracoscopy (S-MT)] for the treatment of empyema thoracis in its early stages. METHODS: We performed a retrospective analysis reviewing the medical records of 84 patients referred for empyema and treated by medical thoracoscopy at our Thoracic Departments from January 2001 until November 2014. S-MT was performed under local anesthesia with neuroleptoanalgesia and spontaneous breathing using a single 1-cm incision for debridement and lavage of the pleural cavity...
January 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/27984314/medical-management-of-pump-related-thrombosis-in-patients-with-continuous-flow-left-ventricular-assist-devices-a-systematic-review-and-meta-analysis
#13
Geetanjali Dang, Narendranath Epperla, Vijayadershan Mupiddi, Natasha Sahr, Amy Pan, Pippa Simpson, Lisa Baumann Kreuziger
Pump thrombosis is a dreaded complication of left ventricular assist device (LVADs). We completed a systematic review to evaluate the efficacy and complications associated with medical management of LVAD thrombosis. Databases were searched using the terms "vad*" or "ventricular assist device" or "heart assist device" and "thrombus" or "thrombosis" or "thromboembolism". Of 2383 manuscripts, 49 articles met the inclusion criteria. The risk of partial or no resolution of LVAD thrombosis did not significantly differ between thrombolytic and non-thrombolytic regimens (OR 0...
December 13, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27977388/general-practitioner-management-of-chronic-diseases-in-adults-with-severe-mental-illness-a-community-intervention-trial
#14
Cate M Cameron, Cate M Cameron, Jose Cumsille Nazar, Jose Cumsille Nazar, Carolyn Ehrlich, Carolyn Ehrlich, Elizabeth Kendall, Elizabeth Kendall, David Crompton, David Crompton, Ann Maree Liddy, Ann Maree Liddy, Steve Kisely, Steve Kisely
Objective The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not.Methods A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations...
December 16, 2016: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/27973966/a-computer-assisted-robotic-platform-for-vascular-procedures-exploiting-3d-us-based-tracking
#15
Marco Mura, Simone Parrini, Gastone Ciuti, Vincenzo Ferrari, Cinzia Freschi, Mauro Ferrari, Paolo Dario, Arianna Menciassi
BACKGROUND: Cardiovascular diseases are the first cause of death globally: an estimated 17.5 million people died in 2012. By combining the benefits of magnetic navigation and ultrasound (US) imaging, the authors proposed a robotic platform (i.e. the MicroVAST platform) for intravascular medical procedures. METHODS: A 3D imaging US-based tracking algorithm is implemented for the navigation of a magnetic-dragged soft-tethered device. Tests were performed to evaluate the algorithm in terms of tracking error and precision of locomotion...
December 2016: Comput Assist Surg (Abingdon)
https://www.readbyqxmd.com/read/27959709/a-fully-magnetically-levitated-circulatory-pump-for-advanced-heart-failure
#16
Mandeep R Mehra, Yoshifumi Naka, Nir Uriel, Daniel J Goldstein, Joseph C Cleveland, Paolo C Colombo, Mary N Walsh, Carmelo A Milano, Chetan B Patel, Ulrich P Jorde, Francis D Pagani, Keith D Aaronson, David A Dean, Kelly McCants, Akinobu Itoh, Gregory A Ewald, Douglas Horstmanshof, James W Long, Christopher Salerno
Background Continuous-flow left ventricular assist systems increase the rate of survival among patients with advanced heart failure but are associated with the development of pump thrombosis. We investigated the effects of a new magnetically levitated centrifugal continuous-flow pump that was engineered to avert thrombosis. Methods We randomly assigned patients with advanced heart failure to receive either the new centrifugal continuous-flow pump or a commercially available axial continuous-flow pump. Patients could be enrolled irrespective of the intended goal of pump support (bridge to transplantation or destination therapy)...
November 16, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27929242/community-acquired-pneumonia-in-adults-diagnosis-and-management
#17
Alexander Kaysin, Anthony J Viera
Community-acquired pneumonia is a leading cause of death. Risk factors include older age and medical comorbidities. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography. Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy. Using procalcitonin as a biomarker for severe infection may further assist with risk stratification...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27927843/risk-of-childhood-mortality-in-family-members-of-men-with-poor-semen-quality
#18
Heidi A Hanson, Erik N Mayer, Ross E Anderson, Kenneth I Aston, Douglas T Carrell, Justin Berger, William T Lowrance, Ken R Smith, James M Hotaling
STUDY QUESTION: What is the familial childhood mortality in first-degree (FDR) and second-degree relatives (SDR) of patients undergoing semen analysis (SA)? SUMMARY ANSWER: The relationship between infertility and congenital malformations (CM) in offspring is complex, with an increased risk of death due to CM in FDR, but not SDR, of men with lower semen parameters. WHAT IS KNOWN ALREADY: Semen quality is an established predictor of men's somatic health...
January 2017: Human Reproduction
https://www.readbyqxmd.com/read/27905492/high-fidelity-computational-simulation-of-thrombus-formation-in-thoratec-heartmate-ii-continuous-flow-ventricular-assist-device
#19
Wei-Tao Wu, Fang Yang, Jingchun Wu, Nadine Aubry, Mehrdad Massoudi, James F Antaki
Continuous flow ventricular assist devices (cfVADs) provide a life-saving therapy for severe heart failure. However, in recent years, the incidence of device-related thrombosis (resulting in stroke, device-exchange surgery or premature death) has been increasing dramatically, which has alarmed both the medical community and the FDA. The objective of this study was to gain improved understanding of the initiation and progression of thrombosis in one of the most commonly used cfVADs, the Thoratec HeartMate II...
December 1, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27898287/international-association-for-hospice-and-palliative-care-position-statement-euthanasia-and-physician-assisted-suicide
#20
Liliana De Lima, Roger Woodruff, Katherine Pettus, Julia Downing, Rosa Buitrago, Esther Munyoro, Chitra Venkateswaran, Sushma Bhatnagar, Lukas Radbruch
BACKGROUND: Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement...
January 2017: Journal of Palliative Medicine
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