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Medical futility

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https://www.readbyqxmd.com/read/28927764/how-to-value-patient-values-cesarean-sections-for-the-periviable-fetus-and-home-births
#1
REVIEW
Howard Minkoff, Fouad Atallah
Respect for patient autonomy involves providing sufficient information to patients to allow them to make informed decisions, and then honoring their requests unless they are unethical or futile. At times, the factors that patients consider may not be purely biologic ones but rather will include "spiritual" factors (a sense of control in a home birth). When patients balance biologic risks against spiritual gain, physicians may not be comfortable giving deference to patients' choice. In order to explicate this issue we explore two clinical scenarios: home birth, and cesarean section for a periviable fetus; and we consider futility and limits on affirmative autonomy...
September 15, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28918118/case-report-aquatic-therapy-and-end-stage-dementia
#2
Bruce E Becker, Stacy Lynch
A 54-year old female, retired due to progressive cognitive decline, was diagnosed with early-onset Alzheimer's dementia. Conventional medication therapy for dementia had proven futile. Initial evaluation revealed a non-verbal female seated in a wheelchair, dependent on 2-person assist for all transfers and activities of daily living (ADLs.) She had been either non-responsive or actively resistive for both ADLs and transfers in the 6 months prior to assessment. Following a total of 17 one hour therapy sessions over 19 weeks in a warm water therapy pool, she achieved ability to tread water for 15 minutes, transfers improved to moderate to-maximum assist from seated, ambulation improved to 1000' with minimum-to-moderate assist of 2 persons...
September 13, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28905989/assessment-of-futility-in-out-of-hospital-cardiac-arrest
#3
P Setälä, S Hoppu, I Virkkunen, A Yli-Hankala, A Kämäräinen
BACKGROUND: Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out-of-hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility. METHODS: We conducted this study using the Utstein template during a 12-month study period...
September 14, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28898482/impact-of-renal-replacement-therapy-on-survival-in-patients-with-kdigo-stage-3-acute-kidney-injury-a-propensity-score-matched-analysis
#4
Hoi-Ping Shum, King-Chung Chan, Catherine Wing-Yan Tam, Wing-Wa Yan, Tak Mao Chan
PURPOSE: To investigate the impact of renal replacement therapy (RRT) on 90-day mortality in critically ill patients suffering from KDIGO stage 3 acute kidney injury (AKI) with or without life-threatening complications using propensity score matching analysis. MATERIAL AND METHODS: We conducted a retrospective analysis of critically ill adult patients with KDIGO Stage 3 AKI with or without RRT during ICU stay between 1/1/2011-31/12/2013. Cox regression analysis and propensity score matching methods were used to determine predictors for 90-day mortality...
September 12, 2017: Nephrology
https://www.readbyqxmd.com/read/28881383/processes-of-code-status-transitions-in-hospitalized-patients-with-advanced-cancer
#5
Areej El-Jawahri, Kelsey Lau-Min, Ryan D Nipp, Joseph A Greer, Lara N Traeger, Samantha M Moran, Sara M D'Arpino, Ephraim P Hochberg, Vicki A Jackson, Barbara J Cashavelly, Holly S Martinson, David P Ryan, Jennifer S Temel
BACKGROUND: Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. METHODS: We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR...
September 7, 2017: Cancer
https://www.readbyqxmd.com/read/28876621/the-absolute-number-of-repeat-operations-for-complex-intra-abdominal-sepsis-is-not-a-useful-predictor-of-non-survival
#6
M F Scriba, G L Laing, J L Bruce, D L Clarke
BACKGROUND: When multiple repeat laparotomies are required to manage intra-abdominal sepsis, questions about futility of treatment frequently arise. This study focuses specifically on patients who required two or more repeat laparotomies and describes the spectrum of disease necessitating multiple repeat laparotomies and the associated outcomes in the hope of clarifying the issue. METHOD: This study was conducted over a 20-month period (December 2012 - July 2014) at Greys Hospital in Pietermaritzburg, South Africa...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28872748/30-day-mortality-after-systemic-anticancer-treatment-as-a-real-world-quality-of-care-indicator-the-northland-experience
#7
Edmond Ang, Los Vincent Newton
BACKGROUND: Systemic Anticancer Treatment (SACT) at the end of life is considered poor practice due to futility and associated toxicities. Consequently, 30-Day Mortality after SACT is increasingly recognised as a potential real world quality of care indicator in medical oncology. AIMS: Whangarei Base Hospital (WBH) provides outpatient SACT treatment to all patients living in the Northland region of New Zealand. The goal of this study is to report our 30 Day mortality after SACT and to contribute to the experience of its use in Australasia...
September 5, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28768712/factors-influencing-the-reporting-of-adverse-medical-device-events-qualitative-interviews-with-physicians-about-higher-risk-implantable-devices
#8
Anna R Gagliardi, Ariel Ducey, Pascale Lehoux, Thomas Turgeon, Sue Ross, Patricia Trvovich, Anthony Easty, Chaim Bell, David Urbach
BACKGROUND: Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical device events (AMDEs). Little is known about factors that influence whether and how physicians report AMDEs, an essential step in developing behaviour change interventions. This study explored factors that influence AMDE reporting. METHODS: Qualitative interviews were conducted with physicians who differed by specialties that implant cardiovascular and orthopaedic devices prone to AMDEs, geography and years in practice...
August 2, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28768400/strategies-for-appropriate-patient-centered-care-to-decrease-the-nationwide-cost-of-cancers-in-korea
#9
Jong-Myon Bae
In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care...
July 2017: Journal of Preventive Medicine and Public Health, Yebang Ŭihakhoe Chi
https://www.readbyqxmd.com/read/28754353/-futile-care-an-emergency-medicine-approach-ethical-and-legal-considerations
#10
Jeremy R Simon, Chadd Kraus, Mark Rosenberg, David H Wang, Elizabeth P Clayborne, Arthur R Derse
Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background...
July 26, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28735650/prognostic-utility-of-neuroinjury-biomarkers-in-post-out-of-hospital-cardiac-arrest-ohca-patient-management
#11
S S Gul, K W Huesgen, K K Wang, K Mark, J A Tyndall
Despite aggressive intervention, patients who survive an out-of-hospital cardiac arrest (OHCA) generally have very poor prognoses, with nationwide survival rates of approximately 10-20%. Approximately 90% of survivors will have moderate to severe neurological injury ranging from moderate cognitive impairment to brain death. Currently, few early prognostic indicators are considered reliable enough to support patients' families and clinicians' in their decisions regarding medical futility. Blood biomarkers of neurological injury after OHCA may be of prognostic value in these cases...
August 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28733295/the-impact-of-healthcare-professionals-personality-and-religious-beliefs-on-the-decisions-to-forego-life-sustaining-treatments-an-observational-multicentre-cross-sectional-study-in-greek-intensive-care-units
#12
Asimenia Ntantana, Dimitrios Matamis, Savvoula Savvidou, Kyriaki Marmanidou, Maria Giannakou, Μary Gouva, George Nakos, Vasilios Koulouras
OBJECTIVES: To assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs). SETTING: Cross-sectional, observational, national study in 18 multidisciplinary Greek ICUs, with >6 beds, between June and December 2015. PARTICIPANTS: 149 doctors and 320 nurses who voluntarily and anonymously answered the End-of-Life (EoL) attitudes, Personality (EPQ) and Religion (SpREUK) questionnaires...
July 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28718858/donationsutredningen-%C3%A3-ppnar-f%C3%A3-r-nya-organdonatorer-kr%C3%A3-ver-reflexion-om-m%C3%A3-nniskov%C3%A3-rdesprincipen-och-samtycke
#13
Stellan Welin
Swedish white paper on donation can give more donors without compromising ethics The White Paper on organ donation (SOU 2015:84) proposes new regulations for organ donation. In particular it spells out that it is permissible to take medical steps to preserve organs while the patient is still alive. It is proposed that this should be allowed after the medical team has declared that the continuation of life sustaining treatment is futile. The white paper opens up for donation after cardiac death. There has been some critique of the white paper for lack of deeper ethical discussions...
July 14, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28713042/implementation-of-the-universal-bls-termination-of-resuscitation-rule-in-a-rural-ems-system
#14
Matthew R Jordan, Michael F O'Keefe, David Weiss, C Wes Cubberley, Charles D MacLean, Daniel L Wolfson
BACKGROUND: Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile. OBJECTIVE: The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system...
September 2017: Resuscitation
https://www.readbyqxmd.com/read/28707460/the-effect-of-hospice-consultation-on-aggressive-treatment-of-lung-cancer
#15
Shin Hye Yoo, Bhumsuk Keam, Miso Kim, Tae Min Kim, Dong-Wan Kim, Dae Seog Heo
Purpose: The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent five years and examine the relationship between hospice consultation (HC) and aggressive care. Materials and Methods: The medical records of 789 patients with stage IIIB-IV NSCLC at SNUH who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed...
July 14, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28704248/low-end-tidal-carbon-dioxide-at-the-onset-of-emergent-trauma-surgery-is-associated-with-nonsurvival-a-case-series
#16
Roman Dudaryk, Danielle K Bodzin, Juliet J Ray, Craig S Jabaley, Richard R McNeer, Richard H Epstein
BACKGROUND: End-tidal carbon dioxide (EtCO2) is a valuable marker of the return of adequate circulation after cardiac arrest due to medical causes. Previously, the prognostic value of capnography in trauma has been studied among limited populations in prehospital and emergency department settings. We aimed to investigate the relationship between early intraoperative EtCO2 and nonsurvival of patients undergoing emergency surgery at a level 1 academic trauma center as a case series. If there is a threshold below which survival was extremely unlikely, it might be useful in guiding decision-making in the early termination of futile resuscitative efforts...
October 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28695689/patterns-of-health-services-utilization-in-the-last-two-weeks-of-life-among-cancer-patients-experience-in-an-australian-academic-cancer-center
#17
Wee Loon Ong, Richard Khor, Mathias Bressel, Phillip Tran, Jo Tedesco, Keen Hun Tai, David Ball, Gillian Duchesne, Farshad Foroudi
AIM: To report the trend in end-of-life health services (HS) utilization among cancer patients treated in a large Australian academic cancer center over a 12-year period. METHODS: This is a retrospective study of cancer patients treated at the Peter MacCallum Cancer Centre (PMCC), who had documented death between January 2002 and December 2013. Using administrative and billing database, we report on the utilization of different categories of HS within two weeks of death: diagnostic investigations (pathology and radiology), inpatient and outpatient services, and potentially futile interventions (PFI, which include radiotherapy, chemotherapy and surgery)...
July 11, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28657462/the-reception-of-gall-s-organology-in-early-nineteenth-century-vilnius
#18
Eglė Sakalauskaitė-Juodeikienė, Paul Eling, Stanley Finger
Much has been written about the development and reception of Franz Joseph Gall's (1758-1828) ideas in Western Europe. There has been little coverage, however, of how his Schädellehre or organology was received in Eastern Europe. With this in mind, we examined the transmission and acceptance/rejection of Gall's doctrine in Vilnius (now Lithuania). We shall focus on what two prominent professors at Vilnius University felt about organology. The first of these men was Andrew Sniadecki (1768-1838), who published an article on Gall's system in the journal Dziennik Wileński in 1805...
October 2017: Journal of the History of the Neurosciences
https://www.readbyqxmd.com/read/28645428/cost-effectiveness-of-laparoscopy-as-diagnostic-tool-before-primary-cytoreductive-surgery-in-ovarian-cancer
#19
RANDOMIZED CONTROLLED TRIAL
Roelien van de Vrie, Hannah S van Meurs, Marianne J Rutten, Christiana A Naaktgeboren, Brent C Opmeer, Katja N Gaarenstroom, Toon van Gorp, Henk G Ter Brugge, Ward Hofhuis, Henk W R Schreuder, Henriette J G Arts, Petra L M Zusterzeel, Johanna M A Pijnenborg, Maarten van Haaften, Mirjam J A Engelen, Erik A Boss, M Caroline Vos, Kees G Gerestein, Eltjo M J Schutter, Gemma G Kenter, Patrick M M Bossuyt, Ben Willem Mol, Marrije R Buist
OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery...
September 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28645403/nonbeneficial-futile-emergency-medical%C3%A2-interventions
#20
EDITORIAL
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No abstract text is available yet for this article.
July 2017: Annals of Emergency Medicine
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