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Medical futility

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https://www.readbyqxmd.com/read/29776804/hemicraniectomy-for-malignant-middle-cerebral-artery-syndrome-a-review-of-functional-outcomes-in-two-high-volume-stroke-centers
#1
Abhi Pandhi, Georgios Tsivgoulis, Nitin Goyal, Muhammad F Ishfaq, Shailesh Male, Efstathios Boviatsis, Jason J Chang, Ramin Zand, Konstantinos Voumvourakis, Lucas Elijovich, Anne W Alexandrov, Marc D Malkoff, Daniel Hoit, Adam S Arthur, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Despite recent landmark randomized controlled trials showing significant benefits for hemicraniectomy (HCT) compared with medical therapy (MT) in patients with malignant middle cerebral artery infarction (MMCAI), HCT rates have not substantially increased in the United States. We sought to evaluate early outcomes in patients with MMCAI who were treated with HCT (cases) in comparison to patients treated with MT due to the perception of procedural futility by families (controls)...
May 15, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29766728/-euthanasia-legal-comparison-in-selected-european-countries
#2
Adam Doležal
This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victims Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area...
2018: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29724811/charlie-gard-in-defence-of-the-law
#3
Eliana Close, Lindy Willmott, Benjamin P White
Much of the commentary in the wake of the Charlie Gard litigation was aimed at apparent shortcomings of the law. These include concerns about the perceived inability of the law to consider resourcing issues, the vagueness of the best interests test and the delays and costs of having disputes about potentially life-sustaining medical treatment resolved by the courts. These concerns are perennial ones that arise in response to difficult cases. Despite their persistence, we argue that many of these criticisms are unfounded...
May 3, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29720083/general-practitioners-attitudes-towards-patients-with-poorly-controlled-type-2-diabetes-a-qualitative-study
#4
Anja Wollny, Michael Pentzek, Oliver Rudolf Herber, Heinz-Harald Abholz, Jürgen In der Schmitten, Andrea Icks, Stefan Wilm, Elisabeth Gummersbach
BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs' attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control. METHODS: Qualitative research in German general practice; 20 GPs, randomly chosen from participants of a larger study; in-depth narrative interviews, audio-recorded and transcribed; inductive coding and categorisation in a multi-professional team; abstraction of major themes in terms of attitudinal responses...
May 2, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29709558/bursectomy-versus-omentectomy-alone-for-resectable-gastric-cancer-jcog1001-a-phase-3-open-label-randomised-controlled-trial
#5
Yukinori Kurokawa, Yuichiro Doki, Junki Mizusawa, Masanori Terashima, Hitoshi Katai, Takaki Yoshikawa, Yutaka Kimura, Shuji Takiguchi, Yasunori Nishida, Norimasa Fukushima, Yoshiaki Iwasaki, Masahide Kaji, Motohiro Hirao, Hiroshi Katayama, Mitsuru Sasako
BACKGROUND: The role of bursectomy, in which the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon are dissected, has long been controversial for preventing peritoneal metastasis. We investigated the survival benefit of bursectomy in patients with resectable gastric cancer. METHODS: This phase 3, open-label, randomised controlled trial was done at 57 hospitals in Japan. Patients aged 20-80 years who had cT3(SS)-cT4a(SE) histologically proven gastric adenocarcinoma with an Eastern Cooperative Oncology Group performance status of 0 or 1 and body-mass index less than 30 kg/m2 and who did not have distant metastasis or bulky lymph nodes were randomly assigned (1:1) during surgery to receive omentectomy alone (non-bursectomy) or bursectomy...
April 27, 2018: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29688246/drug-consumption-and-futile-medication-prescribing-in-the-last-year-of-life-an-observational-study
#6
D Curtin, D O'Mahony, P Gallagher
Background: the last year of life for many older people is associated with high symptom burden and frequent hospitalizations. Hospital physicians have an opportunity to prioritize essential medications and deprescribe potentially futile medications. Objective: to measure medication consumption during hospitalization in the last year of life and the prevalence of potentially inappropriate medications (PIMs) at hospital discharge. Design: retrospective chart review...
April 23, 2018: Age and Ageing
https://www.readbyqxmd.com/read/29685180/traumatic-cardiac-arrest-in-sweden-1990-2016-a-population-based-national-cohort-study
#7
T Djarv, C Axelsson, J Herlitz, A Stromsoe, J Israelsson, A Claesson
BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA). METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016...
April 23, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29642690/impella-protected-pci-the-clinical-results-achieved-so-far
#8
Gabriele Pesarini, Andrea Gratta, Giulia Dolci, Mattia Lunardi, Flavio L Ribichini
The ability of interventional cardiologists to identify high-risk percutaneous coronary interventions (PCI) patients, requires the integration of different features belonging to medical history, organ damage, coronary anatomy and the nature of the acute event. The selection of a subgroup of patients that could benefit from mechanical support during interventions is a key feature to success. The introduction of the Impella percutaneous axial pump have added an easy to set-up, less-invasive and time consuming active-support device to the interventional toolbox...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29606404/the-utility-of-abnormal-initial-arterial-blood-gas-values-in-determining-clinical-futility-of-trauma-cases-with-severe-hemorrhage
#9
Andrew Katirai, Mark J Landau, Jack M Berger
BACKGROUND: Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients...
March 23, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29604283/challenging-management-of-double-vision-after-functional-endoscopic-sinus-surgery-a-series-of-6-cases
#10
Elad Ben Artsi, Tamara Wygnanski-Jaffe, Benjamin Shalev, Abraham Spierer, Iftach Yassur, Ofira Zloto, Daphna Prat, Ayelet Priel, Guy Ben Simon
PURPOSE: To present 6 cases of orbital trauma diplopia and strabismus after functional endoscopic sinus surgeries (FESS). DESIGN: Retrospective observational case series. METHODS: The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes. STUDY POPULATION: All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included...
March 28, 2018: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/29572693/human-chorionic-gonadotropin-serum-levels-following-ovulation-triggering-and-ivf-cycle-outcome
#11
Yossi Mizrachi, Eran Horowitz, Jacob Farhi, David Levran, Arieh Raziel, Ariel Weissman
PURPOSE: The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome. METHODS: A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10-12 h following ovulation triggering with 250 mcg r-hCG...
March 23, 2018: Journal of Assisted Reproduction and Genetics
https://www.readbyqxmd.com/read/29565935/cost-implications-of-avoidable-rapid-response-call-activations-in-older-patients
#12
Ashwin Subramaniam, Cameron Green, Mohammad Omair, Lionel Soh, Aun Chian Yeoh, Ravindranath Tiruvoipati
BACKGROUND: Rapid response calls (RRCs) are designed to appropriately manage clinical deterioration. However, not all RRCs are appropriate due to medical futility or the patient's wishes. Incidence and costs associated with avoidable-RRC (ARRC) remain underexplored. AIMS: The aim of this study was to describe the incidence and costs of ARRC activations in older patients. METHODS: We retrospectively reviewed RRCs in patients aged ≥80 years over six months...
March 23, 2018: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29477988/futility-and-appropriateness-challenging-words-important-concepts
#13
D Robin Taylor, Calvin J Lightbody
The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives...
April 2018: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29460473/when-a-physician-and-a-clinical-ethicist-collaborate-for-better-patient-care
#14
Thalia Arawi, Lama Charafeddine
Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care...
February 20, 2018: Developing World Bioethics
https://www.readbyqxmd.com/read/29458928/adjunctive-vitamin-d-in-the-treatment-of-non-remitted-depression-lessons-from-a-failed-clinical-trial
#15
Monique Aucoin, Kieran Cooley, Leena Anand, Melissa Furtado, Alex Canzonieri, Alexa Fine, Kathryn Fotinos, Ranjith Chandrasena, Larry J Klassen, Irvin Epstein, Wende Wood, Martin A Katzman
BACKGROUND: Many patients with depression fail to achieve remission after several consecutive treatments. Vitamin D deficiency is prevalent and new research suggests that it may have an impact on mood, primarily through an effect on neurotransmitters. Numerous observational studies suggest a relationship between low levels of vitamin D and increased incidence and severity of mood disorders. A small number of pilot studies have been undertaken but lack rigorous methodology required to draw conclusions about a clinical role for this nutrient in treatment resistant depression...
February 2018: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/29440801/a-retrospective-study-of-end-of-life-care-decisions-in-the-critically-ill-in-a-surgical-intensive-care-unit
#16
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29440148/interventions-in-hospitalised-patients-with-cancer-the-importance-of-impending-death-awareness
#17
Eric Cornelis Theodorus Geijteman, Marcella van der Graaf, Frederika E Witkamp, Sanne van Norden, Bruno H Stricker, Carin C D van der Rijt, Agnes van der Heide, Lia van Zuylen
OBJECTIVES: Burdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated.We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions. METHODS: Questionnaire study and medical record study...
February 9, 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29429570/outcomes-for-haematological-cancer-patients-admitted-to-an-intensive-care-unit-in-a-university-hospital
#18
Emine Alp, Tuğba Tok, Leylagül Kaynar, Fatma Cevahir, İsmail Hakkı Akbudak, Kürşat Gündoğan, Mustafa Çetin, Jordi Rello
BACKGROUND: Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients' re-assessment for support. METHODS: Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients' data were collected from medical records and Infection Control Committee surveillance reports...
February 8, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29408228/initial-electrical-frequency-predicts-survival-and-neurological-outcome-in-out-of-hospital-cardiac-arrest-patients-with-pulseless-electrical-activity
#19
Christoph Weiser, Michael Poppe, Fritz Sterz, Harald Herkner, Christian Clodi, Christoph Schriefl, Alexandra Warenits, Mathias Vossen, Michael Schwameis, Alexander Nürnberger, Alexander Spiel
BACKGROUND: Outcome is generally poor in out of hospital cardiac arrests (OHCA) with initial non-shockable rhythms. Termination of resuscitation rules facilitate early prognostication at the scene to cease resuscitation attempts in futile situations and to proceed advanced life support in promising conditions. As pulseless electrical activity (PEA) is present as first rhythm in every 4th OHCA we were interested if the initial electrical frequency in PEA predicts survival. METHODS: All patients >18 years of age with non-traumatic OHCA and PEA as first rhythm between August 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study...
April 2018: Resuscitation
https://www.readbyqxmd.com/read/29403623/explaining-the-role-of-organizational-culture-on-succession-planning-at-the-ministry-of-health-and-medical-education-a-qualitative-study
#20
Mohammad Mehrtak, Esmaeil Farzaneh, Shahram Habibzadeh, Aziz Kamran, Hamed Zandian, Abdollah Mahdavi
Background: Developing and guiding new knowledge are futile unless the organizational culture can also be transformed. Future leaders cannot emerge out of an organizational environment that is not conducive to the accumulation of experiences. Objective: The aim of this study was to explore the role of organizational culture in creating a succession-planning system at the Ministry of Health and Medical Education in 2014. Methods: The present qualitative framework analysis held interviews with 23 director generals, administrative directors and deputies from the headquarters of the Iranian Ministry of Health and Medical Education in 2014 who were selected through snowball sampling...
November 2017: Electronic Physician
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