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Medical futility

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https://www.readbyqxmd.com/read/28326805/a-retrospective-analysis-of-care-in-patients-with-dementia-hospitalized-at-a-tertiary-medical-center
#1
Riddhi Patira, Huaqing Zhao, Ausim Azizi
BACKGROUND: Hospitalization is an opportunity to address various aspects related to management of dementia, including the goals of care to avoid futile care. We studied the prevalence of these factors when patients with dementia are hospitalized. DESIGN: One hundred and thirty-one charts of patients with dementia admitted to a single university-based hospital were retrospectively reviewed. Data were collected and analyzed for age, gender, the severity of dementia, co-morbidities, co-existing vascular dementia, reversible causes of dementia, mental status scores, medications, consultations, procedures, complications, availability of advance directives, decision-maker, code status, and goals of care discussion...
March 22, 2017: Aging & Mental Health
https://www.readbyqxmd.com/read/28319243/association-of-antioxidant-supplement-use-and-dementia-in-the-prevention-of-alzheimer-s-disease-by-vitamin-e-and-selenium-trial-preadvise
#2
Richard J Kryscio, Erin L Abner, Allison Caban-Holt, Mark Lovell, Phyllis Goodman, Amy K Darke, Monica Yee, John Crowley, Frederick A Schmitt
Importance: Oxidative stress is an established dementia pathway, but it is unknown if the use of antioxidant supplements can prevent dementia. Objective: To determine if antioxidant supplements (vitamin E or selenium) used alone or in combination can prevent dementia in asymptomatic older men. Design, Setting, and Participants: The Prevention of Alzheimer's Disease by Vitamin E and Selenium (PREADViSE) trial began as a double-blind randomized clinical trial in May 2002, which transformed into a cohort study from September 2009 to May 2015...
March 20, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28315947/impact-of-18-f-fdg-pet-ct-on-surgical-management-in-patients-with-advanced-melanoma-an-outcome-based-analysis
#3
Andrea Forschner, Susann-Cathrin Olthof, Brigitte Gückel, Peter Martus, Werner Vach, Christian la Fougère, Konstantin Nikolaou, Ulrike Keim, Thomas Kurt Eigentler, Claus Garbe, Christina Pfannenberg
PURPOSE: To evaluate the influence of (18)F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy. METHODS AND MATERIALS: A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT...
March 18, 2017: European Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/28302424/external-validation-of-the-universal-termination-of-resuscitation-rule-for-out-of-hospital-cardiac-arrest-in-british-columbia
#4
Brian Grunau, John Taylor, Frank X Scheuermeyer, Robert Stenstrom, William Dick, Takahisa Kawano, David Barbic, Ian Drennan, Jim Christenson
STUDY OBJECTIVE: The Universal Termination of Resuscitation Rule (TOR Rule) was developed to identify out-of-hospital cardiac arrests eligible for field termination of resuscitation, avoiding futile transportation to the hospital. The validity of the rule in emergency medical services (EMS) systems that do not routinely transport out-of-hospital cardiac arrest patients to the hospital is unknown. We seek to validate the TOR Rule in British Columbia. METHODS: This study included consecutive, nontraumatic, adult, out-of-hospital cardiac arrests treated by EMS in British Columbia from April 2011 to September 2015...
March 14, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28267007/twenty-years-of-a-veterans-spinal-cord-injury-colorectal-clinic-flexible-sigmoidoscopy-and-multiple-hemorrhoid-ligation
#5
Bard C Cosman, Luis C Cajas-Monson, Sonia L Ramamoorthy
BACKGROUND: Colorectal and anal problems arise in chronic spinal cord injury care. We review 20 years of experience in a colorectal clinic at a veterans medical center treating mostly male veterans who have spinal cord injury. OBJECTIVE: We aim to show the results of colorectal interventions in a population with chronic spinal cord injury. DESIGN: This study is a retrospective records review. SETTINGS: This study was conducted at a Department of Veterans Affairs regional spinal cord injury center...
April 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28258238/resistance-to-antifungal-therapies
#6
REVIEW
Rajendra Prasad, Atanu Banerjee, Abdul Haseeb Shah
The evolution of antifungal resistance among fungal pathogens has rendered the limited arsenal of antifungal drugs futile. Considering the recent rise in the number of nosocomial fungal infections in immunocompromised patients, the emerging clinical multidrug resistance (MDR) has become a matter of grave concern for medical professionals. Despite advances in therapeutic interventions, it has not yet been possible to devise convincing strategies to combat antifungal resistance. Comprehensive understanding of the molecular mechanisms of antifungal resistance is essential for identification of novel targets that do not promote or delay emergence of drug resistance...
February 28, 2017: Essays in Biochemistry
https://www.readbyqxmd.com/read/28249382/when-surgery-is-not-an-option-is-there-a-clinical-need-for-transcatheter-tricuspid-valve-therapies
#7
Alec Vahanian, Jean M Juliard, Eric Brochet
Severe functional tricuspid regurgitation (FTR) is frequent and carries a poor prognosis when left untreated. The strategy in symptomatic patients should be decided by a Heart Team which will choose between valve surgery, transcatheter intervention, heart transplantation or palliative medical therapy. The field of application of transcatheter tricuspid valve therapy will certainly focus on inoperable or high-risk patients first, especially those with FTR occurring late after left-sided valve surgery. If surgery is contraindicated because of multiple comorbidities interventions which are likely to be "futile" should be avoided...
March 1, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28230644/expanding-the-donor-pool-through-intensive-care-to-facilitate-organ-donation-results-of-a-spanish-multicenter-study
#8
Beatriz Domínguez-Gil, Elisabeth Coll, José Elizalde, Jaime E Herrero, Teresa Pont, Brígida Quindós, Bella Marcelo, María A Bodí, Adolfo Martínez, Agustín Nebra, Francisco Guerrero, José M Manciño, Juan Galán, Miguel Lebrón, Eduardo Miñambres, Rafael Matesanz
BACKGROUND: Intensive Care to facilitate Organ Donation (ICOD) may help to increase the donor pool. We describe the Spanish experience with ICOD. METHODS: ACCORD-Spain consisted of an audit of the donation pathway from patients dead as a result of a devastating brain injury (possible donors) in 68 hospitals during 11/1/2014-4/30/2015. We focused on possible donors whose family was interviewed to discuss organ donation once intensive care with a therapeutic purpose was deemed futile and brain death (BD) was a likely outcome...
February 23, 2017: Transplantation
https://www.readbyqxmd.com/read/28225696/what-to-do-when-there-aren-t-enough-beds-in-the-picu
#9
Michael A Rubin, Robert D Truog
The concepts of medical futility and rationing are often misunderstood and lead to significant consternation when resources are stretched and pediatric intensive care unit (PICU) beds are unavailable. While the two concepts overlap, each has its own distinct application and moral justification. Most importantly, we should avoid using one to justify the other. Bioethics professionals should assist critical care clinicians in clarifying when each rubric should be applied as well as how to develop policies to standardize the approach...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28220732/should-doctors-provide-futile-medical-treatment-if-patients-or-their-proxies-are-prepared-to-pay-for-it
#10
D J McQuoid-Mason
Ethically and legally doctors are not obliged to provide futile treatment to patients, even if the patient or their proxies are prepared to pay for it. However, it may be justified where such treatment is harmless and has a placebo effect. In deciding about a request for futile treatment, doctors should be guided by the ethical principles of patient autonomy, beneficence, non-maleficence and justice. Guidelines are provided to assist doctors in making such decisions. Where futile treatment is withdrawn or refused, palliative care must always be offered...
January 30, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28216281/clinicians-perspectives-on-advance-care-planning-for-patients-with-ckd-in-australia-an-interview-study
#11
Marcus Sellars, Allison Tong, Tim Luckett, Rachael L Morton, Carol A Pollock, Lucy Spencer, William Silvester, Josephine M Clayton
BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, ACP is not widely implemented in chronic kidney disease (CKD) care settings. This study aims to describe clinicians' beliefs, challenges, and perspectives of ACP in patients with CKD. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Nephrologists (n=20), nurses (n=7), and social workers (n=4) with a range of experience in facilitating ACP for patients with CKD across Australia...
February 16, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28212133/potential-uselessness-and-futility-of-left-atrial-appendage-occlusion-and-patent-foramen-ovale-closure-in-cardioembolic-stroke
#12
Gian L Nicolosi
International guidelines indicate that interventional closure of left atrial appendage and patent foramen ovale may be considered in selected patients for stroke prevention. These procedures appear, however, from the published literature, at high risk of uselessness and futility in the single case, if not even capable to induce harm and adverse events. In fact, all reported systematic reviews and meta-analyses have not shown in a convincing manner the superiority of these procedures in stroke prevention, taking into account the occurrence of possible complications also, as compared with alternative medical treatment...
February 16, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28202420/out-of-hospital-cardiac-arrest-ohca-attended-by-mobile-emergency-teams-with-a-physician-on-board-results-of-the-spanish-ohca-registry-oshcar
#13
Fernando Rosell-Ortiz, Xavier Escalada-Roig, Patricia Fernández Del Valle, Luis Sánchez-Santos, José M Navalpotro-Pascual, Alfredo Echarri-Sucunza, José M Adsuar-Quesada, Isabel Ceniceros-Rozalén, José I Ruiz-Azpiazu, Karlos Ibarguren-Olalde, Nuria López-Cabeza, María V Mier-Ruiz, Enrique Martín-Sánchez, Marta Martínez Del Valle, Guadalupe Inza-Muñoz, Juan A Cordero Torres, María J García-Ochoa, José A Cortés-Ramas, Raúl Canabal-Berlanga, Rafael Zoyo López-Navarro, Juan B López-Messa, Javier García Del Águila, Daniel Alonso-Moreno, Carmen Pozo-Pérez, José Bravo-Castello, Natividad Ramos-García, Ignacio Gómez-Larrosa, Francisco J Mellado-Vergel
Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS. METHODS: We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014. RESULTS: Advanced life support (ALS) was initiated in 9347 cases (incidence 18...
February 13, 2017: Resuscitation
https://www.readbyqxmd.com/read/28182822/early-termination-of-randomized-clinical-trials-in-orthopaedics
#14
Nicolas Piuzzi, Morad Chughtai, Anton Khlopas, Chukwuweike U Gwam, George Muschler, Kurt P Spindler, Michael A Mont
Randomized controlled clinical trials (RCTs) in orthopaedics, similar to all medical fields, provide the highest level of clinical data and constitute the cornerstone for evidence-based therapeutic advances. Orthopaedic clinical trials face the same challenges as in other medical fields, such as insufficient recruitment, unforeseen adverse events, and futility. In this article, we highlight the reasons for early termination of clinical trials and provide examples of each type.
February 7, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28181897/-discontinuation-of-potentially-inappropriate-medications-at-the-end-of-life-perspectives-from-patients-their-relatives-and-physicians
#15
E C T Geijteman, M M A Tempelman, M K Dees, B A A Huisman, R S G M Perez, L van Zuylen, A van der Heide
OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life expectancy of less than three months, 12 patient relatives, and 20 medical specialists and 12 general practitioners who cared for them. For analysis we applied the constant comparative method, which forms part of the grounded theory approach...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28167225/no-child-left-behind-liver-transplantation-in-critically-ill-children
#16
Abbas Rana, Michael Kueht, Moreshwar Desai, Fong Lam, Tamir Miloh, Jennifer Moffett, N Thao N Galvan, Ronald Cotton, Christine O'Mahony, John Goss
BACKGROUND: Advances in critical care prolong survival in children with liver failure, allowing more critically ill children to undergo orthotopic liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine survival in children who undergo OLT while receiving pre-OLT critical care. STUDY DESIGN: We analyzed 13,723 pediatric OLTs using the United Network for Organ Sharing (UNOS) database from 1987 to 2015, including 6,746 recipients in the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) era (2002 to 2015)...
February 3, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28157753/discussing-life-sustaining-therapy-with-surrogate-decision-makers
#17
David Y Hwang
Clinicians caring for patients with severe stroke in intensive care units often grapple with requests from surrogate decision makers for life-prolonging treatment that members of the care team may believe to be futile. An example is a surrogate decision maker's request to place a tracheostomy and feeding tube in a patient who, in the clinical judgment of the neurocritical care team, is very unlikely to recover interactive capacity. This article presents a case, discusses definitions of medical futility, and summarizes recommended steps for mediating conflict regarding potentially inappropriate treatment...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28156627/making-treatment-decisions-at-end-of-life-in-a-comprehensive-cancer-center
#18
Lee Ellington, Kathi Mooney
51 Background: End of life treatment decisions are challenging for cancer patients and oncology providers. Patients must understand their prognosis and options, deciding if and when to increase palliative care and decrease tumor-focused therapy. Cancer centers committed to offering clinical trials and evaluate new therapies add complexity to these decisions. To better define crucial points for decision making, we reviewed the care patients received during the last 6 months of life at one comprehensive cancer center...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156567/are-hospital-clinicians-aware-of-legislation-surrounding-provision-of-palliative-care
#19
(no author information available yet)
118 Background: Many deaths require medical treatment to be withheld or withdrawn. Patients or their substitute decision makers may disagree with these decisions, and sometimes refuse the right to appropriate palliative care. An awareness of legal frameworks surrounding end of life decisions is vital to navigate through these conflicts. Without this, patients suffer unnecessarily. METHODS: 542 hospital doctors and nurses were recruited from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156478/using-touch-based-technology-to-screen-patients-in-the-icu
#20
Matthew J Loscalzo, Rupinder Sidhu, David Horak, Sorin Buga
76 Background: The intensive care unit (ICU) is associated with high mortality rates, significant costs, along with occasionally futile and non-indicated care. Surveys of patients indicate the majority wish to focus on comfort and being at home at the end of life as opposed to the aggressive interventions received in the hospital. Although a small percentage of patients may be awake, medical teams look to the families to provide the direction of care for a patient in the ICU. City of Hope National Medical Center has utilized tablet-based screening of caregivers for years, and now in conjunction with delirium screening has started to roll out tablet-based screening for patients who are awake and do not have delirium...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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