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https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#1
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
September 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28914272/a-randomized-controlled-trial-of-a-cpr-decision-support-video-for-patients-admitted-to-the-general-medicine-service
#2
Aimee M Merino, Ryan Greiner, Kristopher Hartwig
BACKGROUND: Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process. OBJECTIVE: We examined the effect of an informational video about CPR on hospitalized patients' code status choices. DESIGN: This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28899678/behavior-of-nitrogen-removal-in-an-aerobic-sponge-based-moving-bed-biofilm-reactor
#3
Xinbo Zhang, Zi Song, Wenshan Guo, Yanmin Lu, Li Qi, Haitao Wen, Huu Hao Ngo
This study aims to investigate the behavior of nitrogen removal in an aerobic sponge based moving bed biofilm reactor by evaluating nitrification and denitrification rates of sponge biocarriers from three aerobic moving bed biofilm reactors (MBBRs) with filling ratios of 10% (R-10), 20% (R-20) and 30% (R-30). Results showed that the highest removal efficiencies of total nitrogen in three reactors were 84.5% (R-10), 93.6% (R-20) and 95.3% (R-30). Correspondingly, simultaneous nitrification and denitrification rate (SND) was 90...
August 19, 2017: Bioresource Technology
https://www.readbyqxmd.com/read/28881383/processes-of-code-status-transitions-in-hospitalized-patients-with-advanced-cancer
#4
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/28875010/anti-apoptotic-effects-of-osteopontin-via-the-up-regulation-of-akt-mtor-%C3%AE-catenin-loop-in-acute-myeloid-leukemia-cells
#5
Mahdi Zahed Panah, Mohsen Nikbakht, Seyed Mehdi Sajjadi, Shahrbano Rostami, Amir Hossein Norooznezhad, Hosein Kamranzadeh Fumani, Ardeshir Ghavamzadeh, Saeed Mohammadi
Background: The conventional chemotherapeutic regimens which applied for treatment of acute myeloid leukemia (AML) mostly target tumor bulk but not leukemic stem cells (LSCs). Aberrant expression or activation of mediators such as osteopontin (OPN) or PI3K/PTEN/Akt/mTOR pathway plays a key role in making prone to develop leukemia. Preventing or treating cancer by curcumin (CUR) has been suggested recently. CUR induces apoptosis and growth inhibition through various mechanisms in leukemic cells. In present study, we tried to measure the toxic response in vitro to CUR for evaluation ofchangesin cell viability, survival and molecular-mediated resistance in primary AML cells...
April 1, 2017: International Journal of Hematology-oncology and Stem Cell Research
https://www.readbyqxmd.com/read/28872978/electing-full-code-in-hospice-patient-characteristics-and-live-discharge-rates
#6
Claire K Ankuda, Evan Fonger, Thomas O'Neil
BACKGROUND: It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. OBJECTIVE: To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. DESIGN: Retrospective cohort study of electronic medical record data. SETTING/SUBJECTS: A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014...
September 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28869294/beta-blocker-therapy-is-not-associated-with-mortality-after-intracerebral-hemorrhage
#7
M Sykora, J Putaala, A Meretoja, T Tatlisumak, D Strbian
BACKGROUND: Beta-blocker therapy has been suggested to have neuroprotective properties in the setting of acute stroke; however, the evidence is weak and contradictory. We aimed to examine the effects of pre-admission therapy with beta-blockers (BB) on the mortality following spontaneous intracerebral hemorrhage (ICH). METHODS: Retrospective analysis of the Helsinki ICH Study database. RESULTS: A total of 1013 patients with ICH were included in the analysis...
September 4, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28851774/does-time-together-increase-quality-of-interaction-and-decrease-stress-a-study-protocol-of-a-multisite-nursing-intervention-in-psychiatric-inpatient-care-using-a-mixed-method-approach
#8
Jenny Molin, Britt-Marie Lindgren, Ulla Hällgren Graneheim, Anders Ringnér
INTRODUCTION: Despite the long-known significance of the nurse-patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process...
August 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/28839364/omega-3-fish-oil-reduces-mortality-due-to-severe-sepsis-with-acute-gastrointestinal-injury-grade-iii
#9
Huaisheng Chen, Wei Wang, Chengying Hong, Ming Zhang, Yingcai Hong, Su Wang, Huadong Zhang
BACKGROUND: Sepsis plays an important role in acute gastrointestinal injury (AGI). Our research was designed to determine the effects of omega-3 fish oil (FO) in patients suffering from severe sepsis combined with AGI III, and the ability of FO to modulate immune function. METHODS: Seventy-eight patients diagnosed with severe sepsis with AGI III and a need for mechanical ventilation were randomized to two groups. In the FO group, 50 g of long chain fatty acid soybean oil (n = 6) and 10 g of FO (n = 3) were administered as total parenteral nutrition (TPN)...
July 2017: Pharmacognosy Magazine
https://www.readbyqxmd.com/read/28789562/patient-outcomes-after-palliative-care-consultation-among-patients-undergoing-therapeutic-hypothermia
#10
Priya Pinto, Tartania Brown, Michael Khilkin, Elizabeth Chuang
OBJECTIVES: To compare the clinical outcomes of patients who did and did not receive palliative care consultation among those who experienced out-of-hospital cardiac arrest and underwent therapeutic hypothermia. METHODS: We identified patients at a single academic medical center who had undergone therapeutic hypothermia after out-of-hospital cardiac arrest between 2009 and 2013. We performed a retrospective chart review for demographic data, hospital and critical care length of stay, and clinical outcomes of care...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28774010/a-natural-bacterium-produced-membrane-bound-nanocarrier-for-drug-combination-therapy
#11
Ruimin Long, Yuangang Liu, Qinglei Dai, Shibin Wang, Qiongjia Deng, Xia Zhou
To minimize the non-specific toxicity of drug combination during cancer therapy, we prepared a new system synthesized from bacteria to deliver the anticancer drugs cytosine arabinoside (Ara-C) and daunorubicin (DNR). In this study, we selected genipin (GP) and poly-l-glutamic acid (PLGA) as dual crosslinkers. Herewith, we demonstrated the preparation, characterization and in vitro antitumor effects of Ara-C and DNR loaded GP-PLGA-modified bacterial magnetosomes (BMs) (ADBMs-P). The results show that this new system is stable and exhibits optimal drug-loading properties...
November 2, 2016: Materials
https://www.readbyqxmd.com/read/28769583/association-of-code-status-discussion-with-invasive-procedures-among-advanced-stage-cancer-and-noncancer-patients
#12
Akinori Sasaki, Eiji Hiraoka, Yosuke Homma, Osamu Takahashi, Yasuhiro Norisue, Koji Kawai, Shigeki Fujitani
BACKGROUND: Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR), and opioid use among inpatients with advanced stages of cancer and noncancer diseases. METHODS: We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28759312/wanted-and-unwanted-care-the-double-edged-sword-of-partial-do-not-resuscitate-orders
#13
Nobuhiro Ariyoshi, Masayuki Nogi, Damon Sakai, Eiji Hiraoka, Daniel Fischberg
BACKGROUND: The interpretation of do-not-resuscitate orders (DNRs) may vary in nonarrest situations. To reduce ambiguity, many hospitals allow patients to elect partial DNRs. OBJECTIVE: To investigate the effect of partial DNRs on physicians' willingness to perform cardiopulmonary resuscitation (CPR) and nonarrest procedures. DESIGN: Cross-sectional study using scenario-based questionnaires between October 2015 and March 2016. A partial DNR was identified as a DNR with Adult Emergency Protocols (AEP) order...
July 31, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28745822/dnri-of-streptomyces-peucetius-binds-to-the-resistance-genes-drrab-and-drrc-but-is-activated-by-daunorubicin
#14
Francis Prija, Padmanabhan Srinivasan, Subhadeep Das, Karuppasamy Kattusamy, Ranjan Prasad
The master regulator, DnrI of Streptomyces peucetius is a member of the family of transcriptional activator, Streptomyces antibiotic regulatory proteins (SARP), which controls the biosynthesis of antitumor anthracycline, daunorubicin (DNR) and doxorubicin (DXR). The binding of DnrI to the heptameric repeat sequence found within the -35 promoter region of biosynthetic gene, dpsE activates it. To combat the increased level of intracellular DNR, the cell has developed self resistance mechanism mediated by drrAB and drrC genes which are regulated by regulatory genes...
July 26, 2017: Journal of Basic Microbiology
https://www.readbyqxmd.com/read/28699936/clinician-attitudes-regarding-icd-deactivation-in-dnr-dni-patients
#15
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
#16
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
#17
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...
August 2017: Pediatrics
https://www.readbyqxmd.com/read/28662781/do-not-resuscitate-orders-in-the-perioperative-environment-a%C3%A2-multidisciplinary-quality-improvement-project
#18
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
#19
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
#20
MULTICENTER STUDY
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...
July 25, 2017: Neurology
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