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Aart Osinski, Gerard Vreugdenhil, Jan de Koning, Johannes G van der Hoeven
Discussing do-not-resuscitate (DNR) orders is part of daily hospital practice in oncology departments. Several medical factors and patient characteristics are associated with issuing DNR orders in cancer patients. DNR orders are often placed late in the disease process. This may be a cause for disagreements between doctors and between doctors and patients and may cause for unnecessary treatments and admissions. In addition, DNR orders on itself may influence the rest of the medical treatment for patients. We present recommendations for discussing DNR orders and medical futility in practice through shared decision-making...
October 22, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Anuj B Mehta, Colin R Cooke, Ivor S Douglas, Peter K Lindenauer, Renda Soylemez Wiener, Allan J Walkey
RATIONALE: In the United States, approximately 20% of patients hospitalized with pneumonia are readmitted to a hospital within 30 days. Given the significant costs and healthcare system utilization due to unplanned readmissions, pneumonia readmission rates are a target of national quality measures. Patient do-not-resuscitate (DNR) status strongly influences hospital pneumonia mortality measures; however, associations between DNR status and 30-day readmissions following pneumonia are unclear...
October 18, 2016: Annals of the American Thoracic Society
Mary P Henman
BACKGROUND: A suicidal person with a do-not-resuscitate (DNR) order presents an ethical dilemma to the emergency physician. Many believe that suicide is an irrational action, and therefore, all suicide attempts must be treated. Others believe a DNR order should be respected even in the setting of a suicide attempt. CASE REPORT: An elderly woman with a known terminal illness presented to the emergency department after a suspected suicide attempt. She had a DNR order during her previous hospitalization...
October 14, 2016: Journal of Emergency Medicine
Savitha Varatharajan, John C Panetta, Ajay Abraham, Sreeja Karathedath, Ezhilpavai Mohanan, Kavitha M Lakshmi, Nancy Arthur, Vivi M Srivastava, Sandeep Nemani, Biju George, Alok Srivastava, Vikram Mathews, Poonkuzhali Balasubramanian
PURPOSE: Chemotherapy drug resistance and relapse of the disease have been the major factors limiting the success of acute myeloid leukemia (AML) therapy. Several factors, including the pharmacokinetics (PK) of Cytarabine (Ara-C) and Daunorubicin (Dnr), could contribute to difference in treatment outcome in AML. METHODS: In the present study, we evaluated the plasma PK of Dnr, the influence of genetic polymorphisms of genes involved in transport and metabolism of Dnr on the PK, and also the influence of these factors on clinical outcome...
October 13, 2016: Cancer Chemotherapy and Pharmacology
Kaisa Rajala, Juho T Lehto, M Saarinen, E Sutinen, T Saarto, M Myllärniemi
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. METHODS: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death...
October 12, 2016: BMC Palliative Care
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multi-center studies that examine the impact of systematic screening for palliative care and specialty consultation in the ICU. OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was utilized to estimate the conditional probability of receiving a PCC and to balance important covariates...
October 5, 2016: Journal of Pain and Symptom Management
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Xia Sheng, Jonathan Tucci, Jean-Hugues Parmentier, Lingyun Ji, James W Behan, Nora Heisterkamp, Steven D Mittelman
Adipocytes promote cancer progression and impair treatment, and have been shown to protect acute lymphoblastic leukemia (ALL) cells from chemotherapies. Here we investigate whether this protection is mediated by changes in oxidative stress. Co-culture experiments showed that adipocytes protect ALL cells from oxidative stress induced by drugs or irradiation. We demonstrated that ALL cells induce intracellular ROS and an oxidative stress response in adipocytes. This adipocyte oxidative stress response leads to the secretion of soluble factors which protect ALL cells from daunorubicin (DNR)...
September 26, 2016: Oncotarget
Yi-Hsin Liang, Chih-Hsin Wei, Wen-Hui Hsu, Yu-Yun Shao, Ya-Chin Lin, Pei-Chun Chou, Ann-Lii Cheng, Kun-Huei Yeh
PURPOSE: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS: This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups...
October 4, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Kaci Osenga, Andrea Postier, Jill Dreyfus, Laurie Foster, Wrenda Teeple, Stefan J Friedrichsdorf
CONTEXT: Specialized pediatric palliative care (PPC) services have become more common in urban pediatric hospital settings, though little is known about palliative care specialist involvement. OBJECTIVES: The objective of this study was to compare circumstances prior to death in children who spent their last days of life in an inpatient pediatric hospital setting, with or without PPC provider involvement during their inpatient stay. METHODS: Retrospective chart review of medical records of children for the last inpatient stay that resulted in death at a children's hospital setting between January 2012 through June 2013...
September 29, 2016: Journal of Pain and Symptom Management
Brian Clemency, Colleen Clemency Cordes, Heather A Lindstrom, Jeanne M Basior, Deborah P Waldrop
OBJECTIVES: What patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms. PROCEDURES: MOLST forms that accompanied 100 patients who were transported to an ED were collected and their contents analyzed. Data categories included age, gender, if the patient completed the form for themselves, medical orders for life-sustaining treatment including intubation, ventilation, artificial nutrition, artificial fluids or other treatment, and wishes for future hospitalization or transfer...
September 27, 2016: Journal of the American Medical Directors Association
Ian N Olver, Jaklin A Eliott
Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients' views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate...
2016: Cancers
Anaya Raj Pokhrel, Amit Kumar Chaudhary, Hue Thi Nguyen, Dipesh Dhakal, Tuoi Thi Le, Anil Shrestha, Kwangkyoung Liou, Jae Kyung Sohng
The dnrO gene is the first regulator to be activated in the daunorubicin (DNR) biosynthesis pathway of Streptomyces peucetius ATCC 27952. DnrO is known for its self-repression capability while it activates rest of the DNR biosynthesis pathway through cascades of regulatory events. S. peucetius was found to contain no functional copy of bldA-tRNA while a detailed examination of dnrO codons reveals the presence of TTA codon, which is rarely encoded by bldA-tRNA. Therefore, for evaluating the role of dnrO in DNR production, multiple engineered strains of S...
November 2016: Microbiological Research
Chian-Feng Chen, Shiow-Wen Liou, Hsin-Han Wu, Chin-Hui Lin, Li-Shan Huang, Lin-Chung Woung, Ching-Yao Tsai
Objectives: Diabetic retinopathy (DR) is a common microvascular complication in both type I and type II diabetes. Several previous reports indicated the serum centration of some secretary factors were highly associated with DR. Therefore, we hypothesis regulatory SNPs (rSNPs) genotype in secretary factors may alter these gene expression and lead to DR. Methods: At first, pyrosequencing were applying to screen the SNPs which present allele frequency different in DR and DNR. Then individual genotyping was processed by Taqman assays in Taiwanese DR and DNR patients...
2016: International Journal of Medical Sciences
Juan Ruiz-Garcia, Pablo Diez-Villanueva, Ana Ayesta, Vanessa Bruña, Lourdes M Figueiras-Graillet, Laura Gallego-Parra, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol. METHODS & RESULTS: Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C)...
July 2016: Journal of Geriatric Cardiology: JGC
Sun Kyung Baek, Hye Jung Chang, Ja Min Byun, Jae Joon Han, Dae Seog Heo
Purpose: We explored the relationship between the use of each medical intervention and the length of time between DNR consent and death in Korea. Materials and Methods: A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions [e.g., cardiopulmonary resuscitation (CPR), intubation, and hemodialysis], less invasive interventions (e.g., transfusion, antibiotic use, inotropic use and laboratory tests), and the time interval between the DNR order and death were evaluated...
September 1, 2016: Cancer Research and Treatment: Official Journal of Korean Cancer Association
Jason Lambden, Baohui Zhang, Robert Friedlander, Holly G Prigerson
BACKGROUND: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. OBJECTIVE: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. DESIGN: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death...
August 30, 2016: Journal of Palliative Medicine
Ping Liu, Haijun Zhang, Xue Wu, Liting Guo, Fei Wang, Guohua Xia, Baoan Chen, HaiXiang Yin, Yonglu Wang, Xueming Li
Hypoxia is an inseparable component of the solid tumor as well as the bone marrow microenvironment. In this study, we investigated the effect of the novel polyethylene glycol (PEG)-poly L-lysine (PLL)-poly lactic-co-glycolic acid (PLGA) based nanoparticles (NPs) modified by transferrin (Tf) loaded with daunorubicin (DNR) (DNR-Tf-PEG-PLL-PLGA-NPs, abbreviated as DNR-Tf-NPs) on leukemia cells (K562) under hypoxia. In vitro and in vivo tests to determine the effect of the enhanced chemosensitivity were evaluated using the immunofluorescence, flow cytometry, 3,-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-tetrazoliumbromide assay, Western blot analysis, histopathological examination, and immunohistochemistry analysis...
2016: OncoTargets and Therapy
H H Yin, M Wang, Z L Li, C Yao, Z J Hu, J S Wang, G Q Chang, S M Wang
OBJECTIVE: To summarize our experience in the management of stent-graft infection after endo-vascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS: Data of patients who were diagnosed as endo-graft infection following EVAR and admitted in our center between January 2000 and December 2015 were reviewed. Clinical records including causes of infection, medical history, re-operative procedures, and prognostic data were analysed. RESULTS: A total of 10 male patients, aged 45-72 years (averaged 62...
August 9, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Jeffrey P Burns, Robert D Truog
No abstract text is available yet for this article.
August 11, 2016: New England Journal of Medicine
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