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https://www.readbyqxmd.com/read/28699936/clinician-attitudes-regarding-icd-deactivation-in-dnr-dni-patients
#1
Andrew Bradley, Adam Marks
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) offer lifesaving therapies but can become burdensome at the end of life. Many ICD patients choose to implement a do-not-resuscitate/do-not-intubate (DNR/DNI) order. When hospitalized, patients are seen by a range of clinicians whose beliefs about ICD management in DNR/DNI patients may vary. OBJECTIVE: To assess clinician opinions on managing ICDs in DNR/DNI patients and stratify it by specialty and training level...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28682190/advance-care-planning-program-and-the-knowledge-and-attitude-concerning-palliative-care
#2
Huei-Chuan Sung, Shu-Chen Wang, Sheng-Yu Fan, Chia-Ying Lin
OBJECTIVES: The study aimed to evaluate the effects of an advance care planning (ACP) program on knowledge and attitudes concerning palliative care, and decisions regarding DNR orders in the older residents in a long-term care institution. METHODS: A quasi-experimental design was used. Participants were cognitively unimpaired older residents in a long-term care institution in Taiwan. The experimental group (n = 29) received the intervention including an individual interview using an ACP handbook and a group patient education; whereas the control group (n = 28) received the group patient education only...
June 1, 2017: Clinical Gerontologist
https://www.readbyqxmd.com/read/28679640/palliative-sedation-with-propofol-for-an-adolescent-with-a-dnr-order
#3
Liza-Marie Johnson, Joel Frader, Joanne Wolfe, Justin N Baker, Doralina L Anghelescu, John D Lantos
Death from cancer is often painful. Usually, the pain can be relieved in ways that allow patients to remain awake and alert until the end. Sometimes, however, the only way to relieve pain is to sedate patients until they are unconscious. This method has been called palliative sedation therapy. Palliative sedation therapy is controversial because it can be misunderstood as euthanasia. We present a case in which an adolescent who is dying of leukemia has intractable pain. Experts in oncology, ethics, pain management, and palliative care discuss the trade-offs associated with different treatment strategies...
July 5, 2017: Pediatrics
https://www.readbyqxmd.com/read/28662781/do-not-resuscitate-orders-in-the-perioperative-environment-a%C3%A2-multidisciplinary-quality-improvement-project
#4
Malgorzata Baumann, Shelley Killebrew, Katherine Zimnicki, Katherine Balint
Do-not-resuscitate (DNR) orders in the perioperative environment must be managed according to national and institutional guidelines. Health care professionals, including perioperative nurses, may be unfamiliar with the guidelines and unsure of their role in reevaluating a DNR order. We conducted a multidisciplinary quality improvement project at a metropolitan community hospital that aimed to improve health care providers' compliance with the institutional policy, nursing involvement in DNR reevaluation, and communication between providers...
July 2017: AORN Journal
https://www.readbyqxmd.com/read/28660622/palliative-care-access-for-hospitalized-patients-with-end-stage-liver-disease-across-the-united-states
#5
Barret Rush, Keith R Walley, Leo Anthony Celi, Neil Rajoriya, Mayur Brahmania
OBJECTIVE: Patients with end-stage liver disease (ESLD) often have a high symptom burden. Historically, palliative care (PC) services have been underutilized in this population. We investigated the use of PC services in patients with ESLD hospitalized across the United States. METHODS: We utilized the Nationwide Inpatient Sample (NIS) to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD, defined as those with at least two liver decompensation events, were included in the analysis...
June 29, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28659419/aggressiveness-of-care-following-intracerebral-hemorrhage-in-women-and-men
#6
Rahul Guha, Amelia Boehme, Stacie L Demel, Janet J Li, Xuemei Cai, Michael L James, Sebastian Koch, Carl D Langefeld, Charles J Moomaw, Jennifer Osborne, Padmini Sekar, Kevin N Sheth, E Woodrich, Bradford B Worrall, Daniel Woo, Seemant Chaturvedi
OBJECTIVE: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). METHODS: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0...
June 28, 2017: Neurology
https://www.readbyqxmd.com/read/28655622/increased-cardiac-arrest-survival-and-bystander-intervention-in-enclosed-pedestrian-walkway-systems
#7
Minha Lee, Derya Demirtas, Jason E Buick, Michael J Feldman, Sheldon Cheskes, Laurie J Morrison, Timothy C Y Chan
BACKGROUND: Cities worldwide have underground or above-ground enclosed walkway systems for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrests (OHCAs). The characteristics and outcomes of OHCAs that occur in such systems are unknown. OBJECTIVE: To determine whether OHCAs occurring in enclosed pedestrian walkway systems have differing demographics, prehospital intervention, and survival outcomes compared to the encompassing city, by examining the PATH walkway system in Toronto...
June 24, 2017: Resuscitation
https://www.readbyqxmd.com/read/28641620/-role-of-microparticles-derived-from-acute-promyelocytic-leukemia-cells-in-coagulopathy
#8
Ying-Mei Zhang, Bo Chen, Long-Yue Wu, Jin-Xiao Hou, Jin-Yue Fu
OBJECTIVE: To evaluate the role of microparticle (MP) derived from acute promyelocytic leukemia (APL) cells and tissue factor (TF) carried by the MP in hypercoagulable state, and the effect of treatment with cytotoxic chemotherapy/differentiating agents on procoagulant activity (PCA) of these MP. METHODS: Bone marrow mononuclear cells (BMMNC) were extracted from 5 APL patients and 5 sex- and age- matched patients with iron deficiency anemia as controls. The cells were cultured in vitro for 48 h, then MP-rich culture medium and MP-free culture medium were harvested and MP was further obtained from certain volume of MP-rich culture medium...
June 2017: Zhongguo Shi Yan Xue Ye Xue za Zhi
https://www.readbyqxmd.com/read/28625532/emergency-department-do-not-resuscitate-order-in-patients-with-spontaneous-intracerebral-hemorrhage
#9
Ju-Sing Fan, Hsien-Hao Huang, Yen-Chia Chen, Chorng-Kuang How, David Hung-Tsang Yen
OBJECTIVES: To explore the determinant factors and prognostic significance of emergency department do-not-resuscitate (ED-DNR) orders for patients with spontaneous intracerebral hemorrhage (SICH). METHODS: Consecutive adult SICH patients treated in our ED from January 1, 2012 to December 31, 2016 were selected as the eligible cases from our hospital's stroke database. Patients' information was comprehensively reviewed from the database and medical and nursing charts...
June 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28620153/premature-labor-and-neonatal-septicemia-caused-by-capnocytophaga-ochracea
#10
Abdullah A Alhifany, Thamer A Almangour, Deanne E Tabb, David H Levine
BACKGROUND Capnocytophaga ochracea is a gram-negative anaerobic organism commonly found in human oral flora. It is characteristically sensitive to beta-lactams and resistant to aminoglycosides. CASE REPORT A 23-year-old woman presented with lower abdominal pain and was admitted for premature labor at 24-weeks of gestation. At presentation, the cervix was closed and the membrane was intact; however, contractions continued, the membrane subsequently ruptured before receiving any steroids or magnesium, and the mother gave birth to a 540-gram female baby...
June 16, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28614079/do-not-resuscitate-with-no-surrogate-and-no-advance-directive-an-ethics-case-study
#11
Jamie Diamond, Umesh Gidwani, Rosamond Rhodes
Do-not-resuscitate (DNR) orders are typically signed by physicians in conjunction with patients or their surrogate decision makers in order to instruct healthcare providers not to perform cardiopulmonary resuscitation (CPR). Both the medical literature and CPR guidelines fail to address when it is appropriate for physicians to sign DNR orders without any knowledge of a patient's wishes. We explore the ethical issues surrounding instituting a two-physician DNR for a dying patient with multiple comorbidities and no medical record on file, no advance directives, and no surrogate decision maker...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28595818/do-not-resuscitate-orders-and-high-risk-pediatric%C3%A2-surgery-professional-nuisance-or%C3%A2-medical%C3%A2-necessity
#12
Lauren M Baumann, Kibileri Williams, Fizan Abdullah, Richard J Hendrickson, Tolulope A Oyetunji
BACKGROUND: There is a paucity of data in the literature regarding end-of-life care and do-not-resuscitate (DNR) status of the pediatric surgical patient, although invasive procedures are frequently performed in very high risk and critically ill children. Despite significant efforts in adult medicine to enhance discussions around end-of-life care, little is known about similar endeavors in the pediatric population. METHODS: A retrospective review of the National Surgical Quality Improvement Program Pediatric database was performed...
May 11, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28588271/pp2a-inhibition-from-lb100-therapy-enhances-daunorubicin-cytotoxicity-in-secondary-acute-myeloid-leukemia-via-mir-181b-1-upregulation
#13
Chao Hu, Mengxia Yu, Yanling Ren, Kongfei Li, Dominic M Maggio, Chen Mei, Li Ye, Juying Wei, Jie Jin, Zhengping Zhuang, Hongyan Tong
Patients with secondary acute myeloid leukemia (sAML) arising from myelodysplastic syndromes have a poor prognosis marked by an increased resistance to chemotherapy. An urgent need exists for adjuvant treatments that can enhance or replace current therapeutic options. Here we show the potential of LB100, a small-molecule protein phosphatase 2 A (PP2A) inhibitor, as a monotherapy and chemosensitizing agent for sAML using an in-vitro and in-vivo approach. We demonstrate that LB100 decreases cell viability through caspase activation and G2/M cell-cycle arrest...
June 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28583331/a-novel-immunoliposome-mediated-by-cd123-antibody-targeting-to-acute-myeloid-leukemia-cells
#14
Yin Wang, Furong Liu, Qiantao Wang, Honglin Xiang, Hui Jin, Hui Li, Shengjun Mao
The application of the tumor targeting antibody-mediated immunoliposomes (ILP) provides us a potential effective strategy for treating malignancies, such as acute myeloid leukemia (AML). CD123, which is specifically overexpressed on AML cells, plays an important role in cell cycling and enhances the cell resistance to the apoptotic stimuli. Given such a unique role of CD123 in AML cells, we aim to develop a novel drug targeting delivery system using CD123 monoclonal antibody (mAb) in this study. On the basis of the daunorubicin (DNR) loaded PEGylated liposomes (DNR-LP), a post-insertion method was applied to covalently attach the anti-CD123 mAb onto the surface of the liposomes to obtain the anti-CD123 mAb modified immunoliposomes (CD123-ILP)...
June 3, 2017: International Journal of Pharmaceutics
https://www.readbyqxmd.com/read/28574300/anti-cd123-antibody-modified-niosomes-for-targeted-delivery-of-daunorubicin-against-acute-myeloid-leukemia
#15
Fu-Rong Liu, Hui Jin, Yin Wang, Chen Chen, Ming Li, Sheng-Jun Mao, Qiantao Wang, Hui Li
A novel niosomal delivery system was designed and investigated for the targeted delivery of daunorubicin (DNR) against acute myeloid leukemia (AML). Anti-CD123 antibodies conjugated to Mal-PEG2000-DSPE were incorporated into normal niosomes (NS) via a post insertion method to afford antibody-modified niosomes (CD123-NS). Next, NS was modified with varying densities of antibody (0.5 or 2%, antibody/Span 80, molar ratio), thus providing L-CD123-NS and H-CD123-NS. We studied the effect of antibody density on the uptake efficiency of niosomes in NB4 and THP-1 cells, on which CD123 express differently...
November 2017: Drug Delivery
https://www.readbyqxmd.com/read/28566684/quantitative-refractive-index-distribution-of-single-cell-by-combining-phase-shifting-interferometry-and-afm-imaging
#16
Qinnan Zhang, Liyun Zhong, Ping Tang, Yingjie Yuan, Shengde Liu, Jindong Tian, Xiaoxu Lu
Cell refractive index, an intrinsic optical parameter, is closely correlated with the intracellular mass and concentration. By combining optical phase-shifting interferometry (PSI) and atomic force microscope (AFM) imaging, we constructed a label free, non-invasive and quantitative refractive index of single cell measurement system, in which the accurate phase map of single cell was retrieved with PSI technique and the cell morphology with nanoscale resolution was achieved with AFM imaging. Based on the proposed AFM/PSI system, we achieved quantitative refractive index distributions of single red blood cell and Jurkat cell, respectively...
May 31, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28557015/palestinian-community-perceptions-of-do-not-resuscitation-order-for-terminally-ill-patients-a-qualitative-study
#17
Intima Alrimawi, Ahmad Rajeh Saifan, Raghad Abdelkader, Abdul-Monim Batiha
AIM AND OBJECTIVES: This study aims to illustrate the Palestinian community's views, opinions and stances about the concept of do not resuscitate (DNR) for terminally ill patients. BACKGROUND: DNR orders are practiced in many countries worldwide, but there is no consensus on their practice in the Middle East. DNR orders may be applied for terminally ill pediatric patients. Some studies have been conducted describing people's experiences with these DNR orders. However, few studies have considered community perspectives on DNR orders for terminally ill patients in Palestine...
May 30, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28540112/comparison-of-postoperative-outcomes-in-elderly-patients-with-a-do-not-resuscitate-order-undergoing-elective-and-nonelective-hip-surgery
#18
Anair Beverly, Ethan Y Brovman, Richard D Urman
PURPOSE: Emergency hip surgery generally has worse outcomes than elective hip surgery, even when adjusted for patient and surgical factors. Do-not-resuscitate (DNR) status patients are typically at higher perioperative risk and undergo a narrow range of surgical procedures. We aimed to compare the outcomes after hip surgery of differing degrees of urgency in this cohort. MATERIALS AND METHODS: Using National Surgical Quality Improvement Program (NSQIP) data, we conducted univariate and multivariate analyses comparing outcomes of DNR status patients after emergency and nonemergency hip surgery (2007-2013)...
June 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28523117/evaluation-of-pediatric-residents-attitudes-toward-ethical-conflict-a-cross-sectional-study-in-tehran-iran
#19
Maliheh Kadivar, Marjan Mardani-Hamooleh, Shiva Shayestefar
Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014...
2017: Journal of Medical Ethics and History of Medicine
https://www.readbyqxmd.com/read/28513885/biomechanical-function-of-a-balloon-nucleus-pulposus-replacement-system-a-human-cadaveric-spine-study
#20
Taekyeong Lee, Tae-Hong Lim, Sang-Heon Lee, Joo-Han Kim, Junghwa Hong
With recent advances in motion-sparing techniques in spine surgery, disc nucleus replacement (DNR) has been introduced as a viable method to restore the biomechanical functions of the spine. Several methods of DNR have been proposed in the literature. However, the risk of device migration or extrusion is a major issue that should be addressed for a successful DNR. DNR using a balloon nucleus (BN) filled with pressurized fluid may be capable of reducing such risks while preserving the advantages of DNR. The objective of this study was to investigate the biomechanical functionalities of the human cadaveric lumbar motion segments with a custom made BN filled with saline at internal fluid pressure of 0...
May 17, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
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