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https://www.readbyqxmd.com/read/28212133/potential-uselessness-and-futility-of-left-atrial-appendage-occlusion-and-patent-foramen-ovale-closure-in-cardioembolic-stroke
#1
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
#2
Fernando Rosell-Ortiz, José M Navalpotro-Pascual, Patricia Fernández Del Valle, Luis Sánchez-Santos, Xavier Escalada-Roig, 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 emergency medical teams (EMS) of 19 Public EMS in Spain, covering the period from 1 October 2013 to 30-October 2014 (13 months). RESULTS: Advanced life support (ALS) was initiated in 9347 cases (incidence of 18...
February 12, 2017: Resuscitation
https://www.readbyqxmd.com/read/28182822/early-termination-of-randomized-clinical-trials-in-orthopaedics
#3
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
#4
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
#5
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 liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine the survival in children who undergo OLT while receiving pre-OLT critical care. STUDY DESIGN: We analyzed 13,723 pediatric OLTs using the UNOS database from 1987-2015, including 6,746 recipients in the MELD/PELD era (2002-2015)...
January 5, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28157753/discussing-life-sustaining-therapy-with-surrogate-decision-makers
#6
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
#7
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
#8
(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
#9
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
https://www.readbyqxmd.com/read/28152833/understanding-total-cost-of-cancer-care-to-determine-strategic-interventions-to-improve-value
#10
Salimah Velji, Kavita Patel, Basit Chaudhry, Sonia Grizzle, Catherine A Lyons, Rogerio Lilenbaum
: 3 Background: Cancer centers across the country are largely unprepared to move toward value-based payment. Total cost of care data is not readily available and centers do not know how much of their patients' care is received at other hospitals, when in the trajectory of illness greatest cost is incurred, or the elements of care that present the greatest opportunity for savings. A previous examination of practice patterns Smilow Cancer Hospital (SCH) demonstrated that our patients had high rates of ED visits, hospital admissions and ICU use in their last month of life...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28150378/challenging-some-assumptions-about-empathy
#11
Peter Gallagher, Helen Moriarty, Mark Huthwaite, Bee Lim
BACKGROUND: In New Zealand little nursing or medical curricula time, if any, is specifically devoted to the enhancement of empathy. If being empathic is important in the context of patient care, it is a quality that is already present in students or is learned by students during their practicum in the company of experienced clinicians. This study aimed to compare self-reported empathy ratings between different groups of medical students and one cohort of nursing students who were either exposed or not exposed to explicit empathy training or learning in clinical settings in the presence of patients...
February 2, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28148610/retiring-the-term-futility-in-value-laden-decisions-regarding-potentially-inappropriate-medical-treatment
#12
EDITORIAL
Alexander A Kon, Judy E Davidson
No abstract text is available yet for this article.
February 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28143863/perspectives-of-older-kidney-transplant-recipients-on-kidney-transplantation
#13
Jule Pinter, Camilla S Hanson, Jeremy R Chapman, Germaine Wong, Jonathan C Craig, Jane O Schell, Allison Tong
BACKGROUND AND OBJECTIVES: Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs...
January 31, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28112617/doing-what-we-shouldn-t-medical-futility-and-moral-distress
#14
Nancy S Jecker
No abstract text is available yet for this article.
February 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28107160/groupthink-how-should-clinicians-respond-to-human-trafficking
#15
William Polk Cheshire
Human trafficking is a pervasive problem that exceeds the capacity of social and organizational resources to restrain and for which guidelines are inadequate to assist medical professionals in responding to the special needs of victims when they present as patients. One obstacle to appropriate disagreement with an inadequate status quo is the lure of group cohesion. "Groupthink" is a social psychological phenomenon in which presumed group consensus prevails despite potentially adverse consequences. In the context of the medical response to human trafficking, groupthink may foster complacency, rationalize acquiescence with inaction on the basis of perceived futility, create an illusion of unanimity, and accommodate negative stereotyping...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28091982/death-from-pulmonary-embolism-of-cyanoacrylate-glue-following-gastric-varix-endoscopic-injection
#16
Michael Philip Burke, Chris O'Donnell, Yeliena Baber
We present the case of a 25 year old woman with a complex past medical history including Crigler-Najjar syndrome (Type 1) with a liver transplant in 1993 and subsequent development of cirrhosis with portal hypertension in the transplanted liver. The deceased presented to hospital with hematemesis and investigations showed a large gastric varix. The varix was injected with cyanoacrylate glue. Within 30 min of injection the patient became acutely hypoxic. Urgent chest X-ray demonstrated radio opaque glue within the pulmonary arteries...
March 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#17
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28081583/-early-results-of-adjuvant-topical-treatment-of-recurrent-osteomyelitis-with-absorbable-antibiotic-carriers
#18
Y Gramlich, G Walter, J Gils, R Hoffmann
Background Treatment of musculoskeletal infections principally consists of radical surgical debridement and systemic administration of antibiotics. Additional local antibiotic therapy is not yet generally established, and lacks evidence-based proof of efficacy. Nonetheless, there are a variety of practical approaches, as most specialised departments are unwilling to forego this option. The established polymethylmetacrylate (PMMA) carrier system has a number of practical disadvantages. This has led to the increased use of absorbable carrier systems, and those based on calcium sulphate have given particularly encouraging results...
January 12, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28025915/field-station-as-stage-re-enacting-scientific-work-and-life-in-amani-tanzania
#19
P Wenzel Geissler, Ann H Kelly
Located high in Tanzania's Usambara Mountains, Amani Hill Station has been a site of progressive scientific endeavours for over a century, pushing the boundaries of botanical, zoological and medical knowledge, and providing expertise for imperial expansion, colonial welfare, national progress and international development efforts. The station's heyday was from the 1950s to the 1970s, a period of global disease eradication campaigns and the 'Africanization' of science. Today, Amani lies in a state of suspended motion...
December 2016: Social Studies of Science
https://www.readbyqxmd.com/read/28001142/perspective-medical-futility-a-contemporary-review
#20
Ellen Coonan
As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided-some commentators are sceptical as to whether an agreement will ever be reached-and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient's family regarding care and treatment options. Although living in a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements-including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost-interact...
2016: Journal of Clinical Ethics
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