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Medically assisted death

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https://www.readbyqxmd.com/read/28929846/becoming-dead-two-solitudes
#1
Eric Wasylenko
The moral divide between proponents and opponents of medical assistance in dying is wide and can be ascribed to a number of dichotomous beliefs. This article addresses a particular and less commonly described platform for the divide: human acquiescence to physical decline and death as an important stage of life, versus presumptive human mastery over the timing and manner of some peoples' death. Practical ideas are then offered for health systems that wish to bridge the divide, to provide both robust palliative end-of-life care and medical assistance in dying programs for their patients, while keeping health workers whole...
September 2017: Healthcare Management Forum
https://www.readbyqxmd.com/read/28929481/lessons-learned-from-the-total-evacuation-of-a-hospital-after-the-2016-kumamoto-earthquake
#2
Youichi Yanagawa, Hisayoshi Kondo, Takashi Okawa, Fumio Ochi
BACKGROUND: The 2016 Kumamoto Earthquakes were a series of earthquakes that included a foreshock earthquake (magnitude 6.2) on April 14 and a main shock (magnitude 7.0) on April 16, 2016. A number of hospitals in Kumamoto were severely damaged by the two major earthquakes and required total evacuation. METHODS: The authors retrospectively analyzed the activity data of the Disaster Medical Assistance Teams using the Emergency Medical Information System records to investigate the cases in which the total evacuation of a hospital was attempted following the 2016 Kumamoto Earthquake...
July 2017: Journal of Emergency Management: JEM
https://www.readbyqxmd.com/read/28929319/a-practical-approach-to-hypertension-management-in-diabetes
#3
REVIEW
Altamash Shaikh
Hypertension is one of the most important comorbidities of diabetes, contributing significantly to death and disability and leads to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. Practical approaches to hypertension in diabetes, including individualized targets are discussed, as per stage and complication of diabetes, according to current studies and guidelines. Angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARBs) are the most effective drugs for treating hypertension in diabetes, in the absence of contraindications...
September 19, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28912165/holistic-care-of-complicated-tuberculosis-in-healthcare-settings-with-limited-resources
#4
Trevor Duke, Sharon Kasa Tom, Harry Poka, Henry Welch
In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries...
September 14, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28900864/ventricular-tachycardia-with-icd-shocks-when-to-medicate-and-when-to-ablate
#5
REVIEW
Amir AbdelWahab, John Sapp
PURPOSE OF REVIEW: Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile...
September 13, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28899906/does-the-doctrine-of-double-effect-apply-to-the-prescription-of-barbiturates-syme-vs-the-medical-board-of-australia
#6
Xavier Symons
The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients...
September 12, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28893450/emergency-medicine-evaluation-and-management-of-the-end-stage-renal-disease-patient
#7
REVIEW
Brit Long, Alex Koyfman, Courtney M Lee
BACKGROUND: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28891820/transitional-objects-to-faciliate-grieving-following-perinatal-loss
#8
Lawrence D LeDuff, Wanda T Bradshaw, Stephanie M Blake
BACKGROUND: Parents who experience a perinatal loss often leave the hospital with empty arms and no tangible mementos to validate the parenting experience. Opportunities to create parenting experiences with transitional objects exist following the infant's death. PURPOSE: This article offers suggestions for staff in units where infant loss is possible to best assist parents in optimal grieving through the offering of transitional bereavement objects. METHODS/SEARCH STRATEGY: CINAHL Complete, MEDLINE, and the Cochrane Database of Systematic Reviews were searched using the following key words-perinatal bereavement, grief, perinatal loss, transitional objects, bereavement photography-and the search was limited to 5 years and the English language...
October 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28888071/the-effect-of-ventricular-assist-device-associated-biomaterials-on-human-blood-leukocytes
#9
Gemma Radley, Ina Laura Pieper, Catherine A Thornton
Ventricular assist devices (VADs) are an effective bridging or destination therapy for patients with advanced stage heart failure. These devices remain susceptible to adverse events including infection, bleeding, and thrombus; events linked to the foreign body response. Therefore, the biocompatibility of all biomaterials used is crucial to the success of medical devices. Biomaterials common in VADs-DLC: diamond-like carbon coated stainless steel; Sap: single-crystal sapphire; SiN: silicon nitride; Ti: titanium alloy; and ZTA: zirconia-toughened alumina-were tested for their biocompatibility through incubation with whole human blood for 2 h with mild agitation...
September 9, 2017: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
https://www.readbyqxmd.com/read/28887348/population-health-management-in-a-small-health-system-impact-of-controlled-substance-stewardship-in-a-patient-centered-medical-home
#10
Felicity A E Homsted, Chelsea E Magee, Noah Nesin
PURPOSE: The success of a patient-centered medical home in providing population health management (PHM) services through controlled substance stewardship is described. SUMMARY: In 2013, Penobscot Community Health Care (PCHC), in Bangor, Maine, was fully engulfed in the prescription opioid crisis. At PCHC, patients' opioid doses were startlingly high. Within the organization, measures to ensure that prescriptions were being used as prescribed, and not diverted, were underutilized...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28880904/prospective-comparison-of-two-models-of-integrating-early-infant-male-circumcision-with-maternal-child-health-services-in-kenya-the-mtoto-msafi-mbili-study
#11
Robert C Bailey, Fredrick Adera, Mary Ellen Mackesy-Amiti, Timothy Adipo, Sherry K Nordstrom, Supriya D Mehta, Walter Jaoko, F L Fredrik G Langi, Walter Obiero, Edmon Obat, Fredrick O Otieno, Marisa R Young
As countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). To address the lack of evidence regarding introduction of EIMC services in sub-Saharan African settings, we conducted a simultaneous, prospective comparison of two models of EIMC service delivery in Homa Bay County, Kenya. In one division a standard delivery package (SDP) was introduced and included health facility-based provision of EIMC services with community engagement for client referral versus in a different division a standard package plus (SDPplus) that included community-delivered EIMC services...
2017: PloS One
https://www.readbyqxmd.com/read/28874283/mortality-in-adults-with-congenital-heart-disease
#12
Pavithra Naidu, Leeanne Grigg, Dominica Zentner
AIM: Retrospective ascertainment of the causes of mortality in the adult congenital heart disease (ACHD) cohort of the Royal Melbourne Hospital (RMH). METHODS: Deceased patients (n=73) of the 2519 ACHD patients in the Royal Melbourne Hospital registry (commenced in 1991) were identified. Retrospective analysis was undertaken. Age, gender of deceased individuals, and frequency and cause of death in different congenital diagnosis groups was explored. RESULTS: Between 1991 and 2015, death occurred in 3...
October 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28861516/cannabis-as-a-substitute-for-opioid-based-pain-medication-patient-self-report
#13
Amanda Reiman, Mark Welty, Perry Solomon
Introduction: Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain. Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients...
2017: Cannabis and Cannabinoid Research
https://www.readbyqxmd.com/read/28837009/public-and-professional-insights-on-end-of-life-care-results-of-the-2016-health-care-in-canada-survey
#14
Terrence Montague, Joanna Nemis-White, John Aylen, Sara Ahmed, Sharon Baxter, Lesli Martin, Owen Adams, Amédé Gogovor
A new dimension has been added to Canadian Medicare ߝ exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100)...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28835443/a-statewide-evaluation-of-seven-strategies-to-reduce-opioid-overdose-in-north-carolina
#15
Apostolos A Alexandridis, Agnieszka McCort, Christopher L Ringwalt, Nidhi Sachdeva, Catherine Sanford, Stephen W Marshall, Karin Mack, Nabarun Dasgupta
BACKGROUND: In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose. METHODS: Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month...
August 23, 2017: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
https://www.readbyqxmd.com/read/28822745/discordant-perceptions-of-prognosis-and-treatment-options-between-physicians-and-patients-with-advanced-heart-failure
#16
Amrut V Ambardekar, Jennifer T Thibodeau, Adam D DeVore, Michelle M Kittleson, Rhondalyn C Forde-McLean, Maryse Palardy, Maria M Mountis, Linda Cadaret, Jeffrey J Teuteberg, Salpy V Pamboukian, Rongbing Xie, Lynne W Stevenson, Garrick C Stewart
OBJECTIVES: This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. BACKGROUND: The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. METHODS: Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers...
September 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28812578/throw-caution-to-the-wind-is-refeeding-syndrome-really-a-cause-of-death-in-acute-care
#17
K L Matthews, S M Capra, M A Palmer
BACKGROUND/OBJECTIVES: Refeeding syndrome (RFS), a life-threatening medical condition, is commonly associated with acute or chronic starvation. While the prevalence of patients at risk of RFS in hospital reportedly ranges from 0 to 80%, the prevalence and types of patients who die as a result of RFS is unknown. We aimed to measure the prevalence rate and examine the case histories of patients who passed away with RFS listed as a cause of death. SUBJECTS/METHODS: Patients were eligible for inclusion provided their death occurred within a Queensland hospital...
August 16, 2017: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28807990/investigating-the-genetic-causes-of-sudden-unexpected-death-in-children-through-targeted-next-generation-sequencing-analysis
#18
Laura J Dewar, Miguel Alcaide, Daniel Fornika, Luisa D'Amato, Sanam Shafaatalab, Charles M Stevens, Thambirajah Balachandra, Susan M Phillips, Shubhayan Sanatani, Ryan D Morin, Glen F Tibbits
BACKGROUND: Inherited arrhythmia syndromes are responsible for a significant portion of autopsy-negative sudden unexpected death (SUD) cases, but molecular autopsy used to identify potentially causal variants is not routinely included in SUD investigations. We collaborated with a medical examiner's office to assist in finding a diagnosis for their autopsy-negative child SUD cases. METHODS AND RESULTS: 191 child SUD cases (<5 years of age) were selected for analyses...
August 2017: Circulation. Cardiovascular Genetics
https://www.readbyqxmd.com/read/28807385/external-validation-of-a-5-year-survival-prediction-model-after-elective-abdominal-aortic-aneurysm-repair
#19
Randall R DeMartino, Ying Huang, Jay Mandrekar, Philip P Goodney, Gustavo S Oderich, Manju Kalra, Thomas C Bower, Jack L Cronenwett, Peter Gloviczki
OBJECTIVE: The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients. METHODS: All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group)...
August 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28801944/the-emergence-of-second-generation-lethal-injection-protocols-a-brief-history-and-review
#20
Daniel R Malcom, Frank Romanelli
The history of capital punishment in the United States is long and controversial. In many cases, lethal injection has brought medical personnel, ethically and professionally charged with preserving life, into the arena of assisting the state in taking life. Recent US Supreme Court decisions, including Baze v. Rees and Glossip v. Gross, have evaluated and condoned lethal injection protocols. Despite the judicial validation of some midazolam-containing protocols, controversy exists as to the level of unconsciousness provided due to the ceiling effects of the drug...
August 12, 2017: Pharmacotherapy
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