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Scott D Casey, Bryn E Mumma
BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427...
March 5, 2018: Resuscitation
Ingvild Haraldstad Skårdal, Reidun Førde
BACKGROUND: In 2009, the Norwegian Directorate of Health published the national guidelines 'Decision-making processes in the limitation of life-prolonging treatment' (1). It is not known whether the recommendations in the guidelines are followed in clinical practice. The purpose of this study was to investigate the decision-making process when a DNR order has been issued to refrain from resuscitation and the patient group for whom such an order is made. MATERIAL AND METHOD: The patients studied were hospitalised in the medical ward of a local hospital in 2012...
March 6, 2018: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
Gregory E Holt, Daniel Kett, Kenneth W Goodman
No abstract text is available yet for this article.
March 1, 2018: New England Journal of Medicine
Gustavo Chavez, Ilana B Richman, Rajani Kaimal, Jason Bentley, Lee Ann Yasukawa, Russ B Altman, Vyjeyanthi S Periyakoil, Jonathan H Chen
IMPORTANCE: Critically ill patients often receive high-intensity life sustaining treatments (LST) in the intensive care unit (ICU), although they can be ineffective and eventually undesired. Determining the risk factors associated with reversals in LST goals can improve patient and provider appreciation for the natural history and epidemiology of critical care and inform decision making around the (continued) use of LSTs. METHODS: This is a single institution retrospective cohort study of patients receiving life sustaining treatment in an academic tertiary hospital from 2009 to 2013...
2018: PloS One
Yong-Chao Qiao, Yan-Hong Pan, Yan Xu, Xiao-Xi Zhang, Hai-Lu Zhao
Background: The objective of this research was to investigate the interaction of RAS gene polymorphisms in Chinese patients with type 1 diabetes mellitus (T1DM) and diabetic retinopathy (DR). Methods: Genomic DNA was extracted from peripheral blood leukocytes and genotyping for the angiotensin converting enzyme (ACE) gene I/D and angiotensinogen (AGT) gene M/T polymorphisms was performed using the polymerase chain reaction method. 311 T1DM patients were recruited for the assessment of ACE and AGT polymorphisms relating to DR...
January 26, 2018: Oncotarget
Jo Raskin, Kristina Vermeersch, Stephanie Everaerts, Pascal Van Bleyenbergh, Wim Janssens
There is growing awareness of the need for advance care planning in patients with chronic obstructive pulmonary disease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice. We retrospectively analysed an observational cohort of 569 COPD patients with 2.5-8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance of DNR order implementation and specification. 345 patients (61%) had no DNR order, of whom 27% died during a median (interquartile range (IQR)) follow-up of 1935 (1290-2448) days...
January 2018: ERJ Open Research
Xiaoying Liu, Ao Zeng, Yatao Wang, Peiju Liu, Yuan Chen, Yinghe Jiang
Low temperature is an important inhibitor for nitrogen removal in the wastewater treatment plants (WWTPs). To ensure low effluent total nitrogen (TN≤15 mg·L-1 ) and NH3 -N(≤5 mg·L-1 ) at low temperatures (8.8-14.7 °C), a pilot-scale A2 /O system with a low return activated sludge (RAS, 200%) was employed to seek the optimal operation strategy. In the 90 days' experiment, the tests were separated into 3 stages (14.2, 11.0, and 9.1 °C), and the nitrogen removal efficiencies of 49 samples were analysed...
February 23, 2018: Environmental Technology
Vinchi Wang, Chieh-Chao Hsieh, Yen-Ling Huang, Chia-Ping Chen, Yi-Ting Hsieh, Tzu-Hao Chao
The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records...
February 2018: Medicine (Baltimore)
Mats Hallgren, Victoria Andersson, Örjan Ekblom, Sven Andréasson
BACKGROUND: Help-seeking for alcohol use disorders (AUDs) is low and traditional treatments are often perceived as stigmatizing. Physical activity has positive effects on mental and physical health which could benefit this population. We propose to compare the effects of aerobic training, yoga, and usual care for AUDs in physically inactive Swedish adults. METHODS: This is a three-group, parallel, single-blind, randomized controlled trial (RCT). In total, 210 adults (aged 18-75 years) diagnosed with an AUD will be invited to participate in a 12-week intervention...
February 14, 2018: Trials
Jie Peng, Bin Fu, Gan Fu, Xielan Zhao, Xiaolin Li, Fangping Chen
Acute myeloid leukemia (AML) is the most malignant myeloid disorder in adults. AML with mutated nucleophosmin (NPM1) is regarded as an independent leukemia subtype. According to previous studies, the role of NPM1 gene A mutation in AML has been well established; however, another major type, NPM1 gene B type mutation (NPM1 MutB) has been rarely reported. In the present study, we found that overexpression of NPM1 MutB enhanced the proliferation and invasion of THP-1 AML cells through the regulation of TIMP-2, MMP-2, Ang-1, c-myc and CCND1; led to no significant change of apoptosis rate with the absence of chemotherapy agents, while enhanced the chemosensitivity of THP-1 AML cells to chemotherapy agents DNR and Ara-C through the regulation of Bax, Bcl-2 and caspase-3...
October 1, 2017: Die Pharmazie
Diego Andolina, Matteo Di Segni, Alessandra Accoto, Luisa Lo Iacono, Antonella Borreca, Donald Ielpo, Nicola Berretta, Emerald Perlas, Stefano Puglisi-Allegra, Rossella Ventura
Recent studies show that microRNA-34 (miR-34) family is critical in the regulation of stress response also suggesting that it may contribute to the individual responsiveness to stress. We have recently demonstrated that mice carrying a genetic deletion of all miR-34 isoforms (triple knockout, TKO) lack the stress-induced serotonin (5-HT) and GABA release in the medial prefrontal cortex (mpFC) and basolateral amygdala (BLA), respectively. Here, we evaluated if the absence of miR-34 was also able to modify the stress-coping strategy in the forced swimming test...
February 7, 2018: Molecular Neurobiology
Farid Sadaka, Amar Jadhav, Jacklyn O'Brien, Steven Trottier
Background: Limited resources warrant investigating models for predicting which stroke tissue-type plasminogen activator (tPA) patients benefit from admission to neurologic intensive care unit (neuroICU). Methods: This model classifies patients who on day 1 of their ICU admission are predicted to receive one or more of 30 subsequent active life supporting treatments. Two groups of patients were compared: low risk monitor (LRM) (patients who did not receive active treatment (AT) on the first day and whose risk of ever receiving active treatment was ≤ 10%) and AT (patients who received at least one treatment on any day of their ICU admission)...
March 2018: Journal of Clinical Medicine Research
Yong-Chao Qiao, Min Wang, Yan-Hong Pan, Xiao-Xi Zhang, Fang Tian, Yin-Ling Chen, Hai-Lu Zhao
AIMS: This study aims to investigate the association between renin-angiotensin system gene polymorphism and diabetic retinopathy (DR) in Chinese patients with type 2 diabetes. METHODS: We consecutively included 1491 patients for the assessment of ACE I/D and AGT M/T gene polymorphisms in 345 DR cases and 1146 patients without retinopathy (DNR). Albuminuria was defined by urine albumin creatinine ratio and albumin excretion rate. RESULTS: Compared with the NDR patients, the DR cases displayed a higher proportion of diabetic nephropathy (32...
January 2018: Journal of the Renin-angiotensin-aldosterone System: JRAAS
Tzu-Chien Shih, Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Tzeng-Ji Chen, Shinn-Jang Hwang
BACKGROUND: In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change. METHODS: Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan...
January 24, 2018: BMC Palliative Care
Meghan Wooster, Alyssa Stassi, Joshua Hill, James Kurtz, Marco Bonta, M Chance Spalding
BACKGROUND: The geriatric trauma population is growing and fraught with poor physiological response to injury and high mortality rates. Our primary hypothesis analyzed how prehospital and in-hospital characteristics affect decision-making regarding continued life support (CLS) versus withdrawal of care (WOC). Our secondary hypothesis analyzed adherence to end-of-life decisions regarding code status, living wills, and advanced directives. MATERIALS AND METHODS: We performed a retrospective review of patients with geriatric trauma at a level I and level II trauma center from January 1, 2007, to December 31, 2014...
January 1, 2018: American Journal of Hospice & Palliative Care
Ethan Y Brovman, Andrew J Pisansky, Anair Beverly, Angela M Bader, Richard D Urman
AIM: To determine morbidity and mortality in hip fracture patients and also to assess for any independent associations between Do-Not-Resuscitate (DNR) status and increased post-operative morbidity and mortality in patients undergoing surgical repair of hip fractures. METHODS: We conducted a propensity score matched retrospective analysis using de-identified data from the American College of Surgeons' National Surgical Quality Improvement Project (ACS NSQIP) for all patients undergoing hip fracture surgery over a 7 year period in hospitals across the United States enrolled in the ACS NSQIP with and without DNR status...
December 18, 2017: World Journal of Orthopedics
Dipesh Dhakal, Si-Kyu Lim, Dae Hee Kim, Byung-Gee Kim, Tokutaro Yamaguchi, Jae Kyung Sohng
Streptomyces peucetius ATCC 27952 is a filamentous soil bacterium with potential to produce anthracyclines such as doxorubicin (DXR) and daunorubicin (DNR), which are potent chemotherapeutic agents for the treatment of cancer. Here we present the complete genome sequence of S. peucetius ATCC 27952, which consists of 8,023,114 bp with a linear chromosome, 7187 protein-coding genes, 18 rRNA operons and 66 tRNAs. Bioinformatic analysis of the genome sequence revealed ∼68 putative gene clusters involved in the biosynthesis of secondary metabolites, including diverse classes of natural products...
January 4, 2018: Journal of Biotechnology
Courtenay R Bruce, Trevor Bibler, Andrew Childress, Savitri Fedson
A few weeks ago, Texas took an unprecedented position on unilateral DNRs by passing Senate Bill (SB) 11, which requires patient/surrogate consent for writing DNR orders. The motivation behind the bill was based on the drafters' beliefs that physicians frequently write unilateral DNR orders. SB 11, however, does not stop at requiring physicians to seek consent for DNR orders. Instead, the legislation uncharacteristically exceeds what is typically within the scope and role boundaries for lawmakers by legislating how physicians discuss and implement DNR orders...
December 18, 2017: Journal of Critical Care
Eric H Bradburn, Brian W Gross, Shreya Jammula, William H Adams, Jo Ann Miller
BACKGROUND: Elderly trauma care is challenging owing to the unique physiology and comorbidities prevalent in this population. To improve the care of these patients, two practice management guidelines (PMGs) were implemented: high-risk geriatric protocol (HRGP), which triages patients based on injury patterns and comorbid conditions for occult hypotension, and the anticoagulation and trauma (ACT) alert, which is designed to streamline the care of geriatric trauma patients on anticoagulants...
February 2018: Journal of Trauma and Acute Care Surgery
Cassandra Barnette Donnelly, Karen Andrea Armstrong, Molly M Perkins, Danielle Moulia, Tammie E Quest, Arthur H Yancey
BACKGROUND: Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. METHODS: We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care...
March 2018: Prehospital Emergency Care
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