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Medical futility

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https://www.readbyqxmd.com/read/29143944/one-thousand-seventy-eight-autologous-ivf-cycles-in-women-45%C3%A2-years-and-older-the-largest-single-center-cohort-to-date
#1
Vinay Gunnala, Mohamad Irani, Alexis Melnick, Zev Rosenwaks, Steven Spandorfer
PURPOSE: The purpose of this study was to determine IVF outcomes in women 45 years and older using autologous oocytes. METHODS: This is a retrospective cohort study reviewing all IVF cycles in women ≥ 45 years old from January 1995 to June 2015 that were conducted at one academic medical center. One thousand seventy-eight fresh, autologous IVF cycles met inclusion criteria. PGD/S, natural IVF, and donor egg cycles were excluded. Outcomes were analyzed for the different age groups (age 45, n = 773; age 46, n = 221; age 47, n = 57; age 48, n = 22; age 49, n = 5)...
November 16, 2017: Journal of Assisted Reproduction and Genetics
https://www.readbyqxmd.com/read/29132946/an-interview-study-of-patient-and-caregiver-perspectives-on-advance-care-planning-in-esrd
#2
Marcus Sellars, Josephine M Clayton, Rachael L Morton, Tim Luckett, William Silvester, Lucy Spencer, Carol A Pollock, Rowan G Walker, Peter G Kerr, Allison Tong
BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, it can be an emotionally charged process for patients with kidney disease and their caregivers. This study aimed to describe the perspectives and attitudes of patients with end-stage renal disease (ESRD) and their caregivers toward ACP. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Patients with ESRD (n=24) and their caregivers (n=15) aged 36 to 91 years at various stages of ACP ("not commenced," "in progress," or "completed") from 3 renal services...
November 10, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29119806/ethical-dilemmas-associated-with-clinicians-decisions-about-treatment-in-critically-ill-infants-born-in-c%C3%A3-rdoba-argentina
#3
Agustín Alfredo Silberberg, Juan Eduardo Gallo
The objective of this article is to examine end of life decisions made by neonatologists of Córdoba, Argentina. An anonymous questionnaire was designed to investigate neonatologists' decisions on when to initiate or withdraw treatment in critical neonates. All neonatologists who take care of critically ill neonates in Córdoba participated in the survey. More than 75% of them would initiate treatment in preterm infants with uncertain prognosis based on the viability of the newborn. Because it is common to find that critically ill neonates lack sufficient diagnostic information at birth, this attitude seems to manifest a certain therapeutic activism...
March 2017: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
https://www.readbyqxmd.com/read/29112564/a-surgical-clostridium-associated-risk-of-death-score-predicts-mortality-after-colectomy-for-clostridium-difficile
#4
Audrey S Kulaylat, Zain Kassam, Christopher S Hollenbeak, David B Stewart
BACKGROUND: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. OBJECTIVE: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy...
December 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29105267/caution-needed-in-introduction-of-provisional-approvals-for-medicines
#5
Jessica Pace, Narcyz Ghinea, Ian Kerridge, Wendy Lipworth
The Australian government recently released its response to the Review of Medicines and Medical Devices Regulation, accepting most recommendations. One recommendation involves the introduction of provisional approvals for perceived life-saving and innovative new treatments, allowing these to be approved on the basis of more limited data on the condition that further safety and efficacy data (including real-world evidence) are collected to determine whether full approval should be granted. However, experience with similar schemes overseas raises significant questions about the safety and efficacy of products made available through these pathways...
November 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29067495/short-term-application-of-tocilizumab-during-myocardial-infarction-stat-mi
#6
Matthew B Carroll, Charles Haller, Christopher Smith
Acute myocardial infarction (MI) occurs when blood supply falls below critical levels and normal cellular maintenance mechanisms fail. Interleukin-6 (IL-6) is a proinflammatory cytokine released in MI and associated with poor clinical outcomes. Tocilizumab (TCZ) is a humanized monoclonal antibody against the IL-6 receptor. In a randomized, double-blinded, placebo controlled trial we assigned subjects admitted with MI a single TCZ dose of 162 mg subcutaneously vs. placebo in addition to standard of care medications and interventions...
October 24, 2017: Rheumatology International
https://www.readbyqxmd.com/read/29063996/dr-google-and-premature-consent-patients-who-trust-the-internet-more-than-they-trust-their-provider
#7
John K Davis
A growing number of patients make up their minds about some medical issue before they see their provider, either by googling their symptoms or asking a friend. They've made up their minds before coming in, and they resist their provider's recommendations even after receiving information and advice from their provider. This is a new kind of medical autonomy problem; it differs from cases of standard consent, futility, or conscientious refusal. Providers sometimes call this problem "Dr. Google." I call it premature consent...
October 24, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/29027469/bucking-the-current-trend-in-bioelectrochemical-systems-a-case-for-bioelectroanalytics
#8
Thomas William Seviour, Jamie Hinks
Turning wastewater directly into electricity is alluring, widespread use of microbial fuel cells (MFCs) to achieve this at industrial scale appears increasingly unlikely despite intense research efforts lasting over a decade. Such endeavors have not been futile, however, and game-changing discoveries have resulted from these well-intentioned, scientifically rigorous but ultimately frustrated attempts to resolve the Waste-Energy dichotomy. The appeal of MFCs is largely of conceptual elegance rather than financial competitiveness, based on the green ideal that bacteria can be turned into cost effective bio-batteries...
October 13, 2017: Critical Reviews in Biotechnology
https://www.readbyqxmd.com/read/29016462/the-medical-futility-experience-of-nurses-in-caring-for-critically-ill-patients
#9
Ming-Yi Hsu, Shu-Fen Su, Lien-Ying Chiang, Sou-Jen Shih, Yu-Chen Chen
BACKGROUND: Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility. PURPOSE: The aim of this study was to understand the medical futility experiences of intensive care nurses...
October 10, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/28988904/subcallosal-cingulate-deep-brain-stimulation-for-treatment-resistant-depression-a-multisite-randomised-sham-controlled-trial
#10
Paul E Holtzheimer, Mustafa M Husain, Sarah H Lisanby, Stephan F Taylor, Louis A Whitworth, Shawn McClintock, Konstantin V Slavin, Joshua Berman, Guy M McKhann, Parag G Patil, Barry R Rittberg, Aviva Abosch, Ananda K Pandurangi, Kathryn L Holloway, Raymond W Lam, Christopher R Honey, Joseph S Neimat, Jaimie M Henderson, Charles DeBattista, Anthony J Rothschild, Julie G Pilitsis, Randall T Espinoza, Georgios Petrides, Alon Y Mogilner, Keith Matthews, DeLea Peichel, Robert E Gross, Clement Hamani, Andres M Lozano, Helen S Mayberg
BACKGROUND: Deep brain stimulation (DBS) of the subcallosal cingulate white matter has shown promise as an intervention for patients with chronic, unremitting depression. To test the safety and efficacy of DBS for treatment-resistant depression, a prospective, randomised, sham-controlled trial was conducted. METHODS: Participants with treatment-resistant depression were implanted with a DBS system targeting bilateral subcallosal cingulate white matter and randomised to 6 months of active or sham DBS, followed by 6 months of open-label subcallosal cingulate DBS...
October 4, 2017: Lancet Psychiatry
https://www.readbyqxmd.com/read/28980297/remote-ischemic-preconditioning-of-human-myocardium-ripe-study-protocol-for-a-double-blinded-randomized-controlled-trial
#11
Marek A Deja, Ryszard Wiaderkiewicz, Piotr Czekaj, Ewa Czech, Marcin Malinowski, Leszek Machej, Andrzej Węglarzy, Adam Kowalówka, Magda Piekarska, Bartosz Szurlej, Tomasz Latusek
BACKGROUND: Remote preconditioning was showed to be a potent protective phenomenon in many animals. Several studies aimed to demonstrate it was feasible in humans by trying to show its protective effect during cardiac surgery. Of these studies some small studies and one bigger trial were positive while two other bigger studies showed no effectiveness of remote preconditioning as assessed by levels of postoperatively released cardiac markers. Recently two large clinical trials also failed to prove the benefit of remote preconditioning in cardiac surgery...
October 5, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28970712/liver-transplantation-for-acute-on-chronic-liver-failure
#12
Narendra S Choudhary, Neeraj Saraf, Sanjiv Saigal, Arvinder S Soin
BACKGROUND: Acute-on chronic liver failure (ACLF) is defined as acute insult on previous liver disease that causes sudden worsening of liver functions. METHODS: ACLF is characterized by high incidence of organ failure and prognosis is remarkably worse than patients with cirrhosis. Incidence of organ failures is very high despite best medical care and timely liver transplant before development of multi organ failure is associated with good survival rates. RESULTS: At present, there are no reliable score or ways to correctly identify patients who are going to recover from patients who will need transplantation...
September 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/28936495/the-accuracy-of-nurses-predictions-for-clinical-outcomes-in-the-chronically-critically-ill
#13
Amy R Lipson, Sarah J Miano, Barbara J Daly, Sara L Douglas
BACKGROUND: Accurately predicting survivorship of patients in the intensive care unit is known to be difficult. Previous research has shown that nurses are more likely to recognize futile medical care than other disciplines. The purpose of this study was to describe the accuracy of nurse's predictions for survival of patients who are chronically critically ill (CCI). METHODS: Using a secondary data analysis from a longitudinal, descriptive study, we evaluated nurses' predictions for survival at admission and until ICU discharge or patient death...
September 2017: Research & Reviews: Journal of Nursing and Health Sciences
https://www.readbyqxmd.com/read/28927764/how-to-value-patient-values-cesarean-sections-for-the-periviable-fetus-and-home-births
#14
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
#15
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
#16
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...
November 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
#17
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
#18
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
#19
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
#20
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
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