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https://www.readbyqxmd.com/read/29776701/nonstandard-advance-directives-in-emergency-medicine-what-should-we-do
#1
Kenneth V Iserson
BACKGROUND: Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. DISCUSSION: Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation...
May 16, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29764324/baby-m-turns-30-the-law-and-policy-of-surrogate-motherhood
#2
Eric A Feldman
This article marks the 30th anniversary of the Supreme Court of New Jersey's Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature. First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can be taken to minimize the potential exploitation of women who are willing to rent their wombs for income? Third, what criteria should govern the eligibility to serve as a surrogate mother and an intended parent? Fourth, what principle(s) should serve as the basis for determining the parentage of children born through surrogacy? Fifth, is regulatory uniformity in the surrogacy realm desirable? Is it achievable? The article concludes that courts and legislatures should accept the validity of surrogacy contracts, determine parentage according to intent, and identify transparent criteria for the eligibility of both surrogates and intended parents...
March 2018: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29733938/cutaneous-toxicity-as-a-predictive-biomarker-for-clinical-outcome-in-patients-receiving-anticancer-therapy
#3
REVIEW
Alexandra K Rzepecki, Haiying Cheng, Beth N McLellan
The relationship between treatment outcome and cutaneous toxicity induced by anticancer therapy has gained attention in the past decade. In this article, we provide an overview of the three main classes of anticancer agents-specifically, molecularly-targeted kinase inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapeutics-and describe the data evaluating the association between cutaneous toxicity induced by these agents and survival benefit. Although preliminary studies are promising about the potential role of cutaneous toxicities as a surrogate biomarker of treatment efficacy, larger prospective studies are needed to confirm this relationship...
May 4, 2018: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/29687559/-no-evidence-of-disease-activity-is-it-an-appropriate-surrogate-in-multiple-sclerosis
#4
Harald Hegen, Gabriel Bsteh, Thomas Berger
The increasing number of disease-modifying treatments available for multiple sclerosis (MS) has broadened treatment options for patients, but also challenges clinicians to select the best therapy for each individual at the appropriate stage of the disease. Early prediction of treatment response still remains one of the main difficulties in the management of MS patients. The concept of "no evidence of disease activity"(NEDA) has been proposed as surrogate for treatment response based on the absence of relapses, disability progression and radiological activity...
April 24, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29676952/associations-between-patient-characteristics-and-a-new-early-do-not-attempt-resuscitation-order-after-intracerebral-hemorrhage
#5
Jessica McFarlin, Claire E Hailey, Wenjing Qi, Peter G Kranz, Weiping Sun, Wei Sun, Marisa Gray, Nicolas King, Daniel T Laskowitz, Michael L James
BACKGROUND: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognosis, understanding prognostic indicators that influence clinical judgment of outcomes is critical. OBJECTIVE: The purpose of this study was to understand the patient variables and comorbid illnesses associated with DNR orders placed on patients within 72 hours after ICH...
April 20, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29608394/surrogate-decision-makers-perspectives-on-family-members-prognosis-after-intracerebral-hemorrhage
#6
Darin B Zahuranec, Renee R Anspach, Meghan E Roney, Andrea Fuhrel-Forbis, Daniel M Connochie, Emily P Chen, Bradford B Thompson, Panayiotis N Varelas, Lewis B Morgenstern, Angela Fagerlin
BACKGROUND: Surrogate communication with providers about prognosis in the setting of acute critical illness can impact both patient treatment decisions and surrogate outcomes. OBJECTIVES: To examine surrogate decision maker perspectives on provider prognostic communication after intracerebral hemorrhage (ICH). DESIGN: Semistructured interviews were conducted and analyzed qualitatively for key themes. SETTING/SUBJECTS: Surrogate decision makers for individuals admitted with ICH were enrolled from five acute care hospitals...
April 2, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29595129/assessing-the-validity-of-surrogate-endpoints-in-the-context-of-a-controversy-about-the-measurement-of-effectiveness-of-hepatitis-c-virus-treatment
#7
Claudia C Dobler, Rebecca L Morgan, Yngve Falck-Ytter, Victor M Montori, M Hassan Murad
Surrogate endpoints are often used in clinical trials, as they allow for indirect measures of outcomes (eg, shorter trials with less participants). Improvements in surrogate endpoints (eg, reduction in low density lipoprotein cholesterol, normalisation of glycated haemoglobin) achieved with an intervention are, however, not always associated with improvements in patient-important outcomes. The common tendency in evidence-based medicine is to view results based on surrogate endpoints as less certain than results based on long term, final patient-important outcomes and rate them as 'lower quality evidence'...
April 2018: BMJ evidence-based medicine
https://www.readbyqxmd.com/read/29579506/a-preliminary-psychometric-evaluation-of-the-eight-item-cognitive-load-scale
#8
Grant A Pignatiello, Emily Tsivitse, Ronald L Hickman
AIM: The aim of this article is to report the psychometric properties of the eight-item cognitive load scale. BACKGROUND: According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions...
April 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29564855/-the-intentions-affecting-the-medical-decision-making-behavior-of-surrogate-decision-makers-of-critically-ill-patients-and-related-factors
#9
Szu-Huei Su, Li-Min Wu
BACKGROUND: The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE: To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS: A cross-sectional, correlation study design was used...
April 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29507719/the-patient-needing-prolonged-mechanical-ventilation-a-narrative-review
#10
REVIEW
Nicolino Ambrosino, Michele Vitacca
Background: Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients...
2018: Multidisciplinary Respiratory Medicine
https://www.readbyqxmd.com/read/29496535/refractory-schizophrenia-attempted-suicide-and-withdrawal-of-life-support-a-clinical-ethics-case-report
#11
Cory Taylor, Jamie C Fertal, Solomon Liao
BACKGROUND: Withdrawal of life support for an individual with refractory schizophrenia after attempted suicide remains controversial. Discussion regarding prognosis of mental illness and the distinction between somatic and mental illness brings out many ethical issues. This article will examine the role and weight of severe persistent mental illness in the withdrawal of life support after attempted suicide. CASE DESCRIPTION: A 30-year-old gentleman with deafness and schizophrenia was admitted with multiple self-inflicted visceral stab wounds...
February 26, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29462004/how-surrogate-decision-makers-for-patients-with-chronic-critical-illness-perceive-and-carry-out-their-role
#12
Lingsheng Li, Judith E Nelson, Laura C Hanson, Christopher E Cox, Shannon S Carson, Emily J Chai, Kristine L Keller, James A Tulsky, Marion Danis
OBJECTIVES: Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. DESIGN: Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. SETTINGS: Medical ICUs at four U.S. hospitals. PARTICIPANTS: Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study...
May 2018: Critical Care 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
#13
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/29413727/addressing-spirituality-during-critical-illness-a-review-of-current-literature
#14
REVIEW
Barbara S Gordon, Maggie Keogh, Zachary Davidson, Stephen Griffiths, Vanshdeep Sharma, Deborah Marin, Stephan A Mayer, Neha S Dangayach
OBJECTIVES: The purpose of this review is to provide an overview of research on spirituality and religiosity in the intensive care setting that has been published since the 2004-2005 American College of Critical Care Medicine (ACCM) Clinical Practice Guidelines for the Support of Family in the Patient-Centered Intensive Care Unit with an emphasis on its application beyond palliative and end-of-life care. MATERIALS AND METHODS: ACCM 2004-2005 guidelines emphasized the importance of spiritual and religious support in the form of four specific recommendations: [1] assessment and incorporation of spiritual needs in ICU care plan; [2] spiritual care training for doctors and nurses; [3] physician review of interdisciplinary spiritual need assessments; and [4] honoring the requests of patients to pray with them...
January 31, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29380954/mechanical-ventilation-strategies-alter-cardiovascular-biomarkers-in-an-infant-rat-model
#15
Philipp Baumann, Susanne Wiegert, Francesco Greco, Sven Wellmann, Pietro L'Abate, Vincenzo Cannizzaro
Mechanical ventilation (MV) is routinely used in pediatric general anesthesia and critical care, but may adversely affect the cardiocirculatory system. Biomarkers are increasingly measured to assess cardiovascular status and improve clinical treatment decision-making. As the impact of mechanical ventilation strategies on cardiovascular biomarkers in ventilated infants is largely unknown, we conducted this retrospective study in a healthy in vivo infant rat ventilation model using 14-days old Wistar rats. We hypothesized that 2 h of mechanical ventilation with high and low positive end-expiratory pressure (PEEP), hyperoxemia, hypoxemia, hypercapnia, and hypocapnia would significantly impact B-type natriuretic peptide (BNP), vascular endothelial growth factor (VEGF), and endothelin-1 (ET-1)...
January 2018: Physiological Reports
https://www.readbyqxmd.com/read/29375078/nurturing-futility-in-the-nicu-the-dutch-perspective
#16
A A Eduard Verhagen
Requests for life-prolonging treatments can cause irresolvable conflicts between health-care providers and surrogates. The Multiorganization Policy Statement (Bosslet et al. 2015) with recommendations to prevent and manage these conflicts creates a good opportunity to examine how end-of-life decisions are made in Dutch neonatal intensive care units and how medical futility is defined. The Dutch equivalent of medical futility in the context of NICU care has grown and developed rather independently, within the typical legal, ethical, and cultural framework of Dutch society...
2018: Perspectives in Biology and Medicine
https://www.readbyqxmd.com/read/29375068/futile-and-potentially-inappropriate-interventions-semantics-matter
#17
Alexander A Kon
In 1997, the Society for Critical Care Medicine (SCCM) published a statement regarding futile and inadvisable treatments. Recently, five critical care organizations published a consensus statement supporting and expanding upon the 1997 SCCM statement, and the SCCM issued a companion statement defining futile and potentially inappropriate interventions. In all of these statements, there is agreement that the term futile should be used only when an intervention cannot accomplish the intended physiologic goal...
2018: Perspectives in Biology and Medicine
https://www.readbyqxmd.com/read/29311623/basal-p53-expression-is-indispensable-for-mesenchymal-stem-cell-integrity
#18
Siddaraju V Boregowda, Veena Krishnappa, Jacqueline Strivelli, Christopher L Haga, Cori N Booker, Donald G Phinney
Marrow-resident mesenchymal stem cells (MSCs) serve as a functional component of the perivascular niche that regulates hematopoiesis. They also represent the main source of bone formed in adult bone marrow, and their bifurcation to osteoblast and adipocyte lineages plays a key role in skeletal homeostasis and aging. Although the tumor suppressor p53 also functions in bone organogenesis, homeostasis, and neoplasia, its role in MSCs remains poorly described. Herein, we examined the normal physiological role of p53 in primary MSCs cultured under physiologic oxygen levels...
March 2018: Cell Death and Differentiation
https://www.readbyqxmd.com/read/29302597/ethical-challenges-involved-in-obtaining-consent-for-research-from-patients-hospitalized-in-the-intensive-care-unit
#19
Fiona Ecarnot, Jean-Pierre Quenot, Guillaume Besch, Gaël Piton
Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU). A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29260613/documentation-of-crucial-information-relating-to-critically-ill-patients
#20
Alexandria Bear, Elizabeth Thiel
BACKGROUND: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. OBJECTIVE: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation...
January 2018: Journal of Palliative Care
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