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withdrawal of care

Bettina von Dessauer, Carmen Benavente, Emilia Monje, Jazmina Bongain, Nadia Ordenes
OBJECTIVE: Describe the frequency and characteristics of PICU patients who undergo a process of withholding or withdrawing life-sustaining treatment (LTSV), between 2004 y 2014. PATIENTS AND METHOD: A retrospective, observational descriptive study, using two documents for quality assessment in the PICU of Hospital Roberto del Río: 1) daily individual patient tracking log and 2) daily record of quality indicators, including LTSV, both updated daily at the morning visit...
December 2017: Revista Chilena de Pediatría
Manon Auffret, Sophie Drapier, Marc Vérin
Apomorphine is now recognized as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed in Europe for patients with advanced Parkinson's disease (PD) with motor fluctuations. However, its history is far from being limited to movement disorders. This paper traces the history of apomorphine, from its earliest empirical use, to its synthesis, pharmacological development, and numerous indications in human and veterinary medicine, in light of its most recent uses and newest challenges...
March 15, 2018: Drugs in R&D
V Clergue-Duval, E Pot, J Azuar
BACKGROUND: General practitioners (GPs) are fully concerned with the care of patients suffering from addiction and must have the support of a specialized network. The aim of the study was to evaluate the prevalence of the addict follow-up care by GPs, their use of addictological care facilities and their needs in communicating with specialists. METHODS: Private and salaried GPs working in the 9th, 10th, 18th and 19th districts of Paris were contacted by phone, and a questionnaire was sent to those who agreed to respond...
March 12, 2018: Revue D'épidémiologie et de Santé Publique
Charlene Eliza Thornton, Hannah Grace Dahlen
OBJECTIVES: To determine incidence, associated factors, outcomes and geographical occurrence of born before arrival (BBA) in New South Wales, Australia. DESIGN: A linked population data study involving population-based surveillance systems was undertaken for the years 2000-2011. SETTING: New South Wales, Australia. PARTICIPANTS: All women who underwent BBA compared with women who birthed in hospital/birth centre settings...
March 14, 2018: BMJ Open
Po-Chi Chan, Wei-Lun Chang, Min-Hsien Hsu, Chung-Hsin Yeh, Chih-Hsin Muo, Ko-Shih Chang, Chung Y Hsu, Bor-Tsang Wu, Ching-Hsiang Lai, Ching-Hsiao Lee, Hua Ting, Fung-Chang Sung
No study has investigated the role of pancreatic cancer in the stroke risk using population data. We used claims data obtained from a universal health insurance program of Taiwan to evaluate the stroke risk in pancreatic cancer patients.From the catastrophic disease registry of the insurance, we identified 7479 patients with pancreatic malignancy without stroke history from 2000 to 2009. The comparison cohort consisted of 29,916 individuals identified from 1 million insured people without cancer and stroke history, matching with the cancer cohort by propensity score...
March 2018: Medicine (Baltimore)
Rebekah C Kennedy, Russell R Fling, Michael S Robeson, Arnold M Saxton, Liesel G Schneider, John L Darcy, David A Bemis, Ling Zhao, Jiangang Chen
Widely used as an antimicrobial in antibacterial bar soaps, triclocarban (3,4,4'-trichlorocarbanilide; TCC) is effective against Gram-positive bacteria but shows little efficacy against Gram-negative strains, potentially altering the composition of indigenous microflora within and on the human body. To date, the consequence of continuous or previous nonprescription antimicrobial exposure from compounds in personal care products on commensal microflora is still elusive. Previous research has shown that TCC exposure during gestation and lactation induced dysbiosis of gut microbial communities among exposed dams and neonates...
March 13, 2018: Environmental Science and Pollution Research International
Xavier Tchetnya, Calypse Asangbe Ngwasiri, Tiayah Munge, Leopold Ndemnge Aminde
BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare life threatening dermatological disorder characterized by extensive epidermal detachment and erosion of mucous membranes. It is typically a side effect of some medications. Nevirapine, a nonnucleoside reverse transcriptase inhibitor (NNRTI) is one of the frequently used components of highly active antiretroviral therapy (HAART). Skin rash is its common adverse reaction, usually mild and rarely progressing to TEN. Ophthalmic involvement is common as well but rarely progresses to blindness especially in the pediatric population...
March 13, 2018: BMC Pediatrics
Cecilia Bartholdson, Bert Molewijk, Kim Lützén, Klas Blomgren, Pernilla Pergert
BACKGROUND: In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included 'increased understanding', 'group strengthening' and 'decision grounding'. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions...
March 2018: Nursing Ethics
Julia M Lappin, Muhammad H Ayub, David Rogers, Madeleine Morgan, Jean-Yves Kanyamibwa, Anthony Shakeshaft
OBJECTIVE: To evaluate the effectiveness of a routine screening and triage tool for alcohol withdrawal syndrome (AWS) in improving clinical care delivery in an ED setting. METHODS: In a regional ED in Australia, a screening and triage tool for AWS was introduced to routine ED assessment for a 13 week period. Subjects were all presentations to ED aged 16 and above with relevant presenting problems during the pre-intervention phase (1 January 2015-31 December 2016) and the post-intervention phase (8 August 2016-4 November 2016)...
March 12, 2018: Emergency Medicine Australasia: EMA
Abhishek De, Sudip Das, Aarti Sarda, Dayamay Pal, Projna Biswas
Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is attributed to drugs in more than 90% of cases. It is a rare disease, with an estimated incidence of 1-5 patients per million per year. The clinical manifestations characterised by the rapid development of sterile pustular lesions, fever and leucocytosis. Number of drugs has been reported to be associated with AGEP, most common being the antibiotics. Histopathologically there is intraepidermal pustules and papillary dermal oedema with neutrophilic and eosinophilic infiltrations...
January 2018: Indian Journal of Dermatology
Arvind Chopra, Manjit Saluja, Toktam Kianifard, Deepa Chitre, Anuradha Venugopalan
BACKGROUND: Data on long term use of Ayurvedic drugs is sparse. They may prove useful if combined with modern medicine in certain clinical situations (integrative medicine). We present the results of a long term observational study of RA-1 (Ayurvedic drug) used in the treatment of rheumatoid arthritis (RA). MATERIALS AND METHODS: On completion of a 16 week randomized controlled study, 165 consenting volunteer patients were enrolled into a three year open label phase (OLP) study...
March 8, 2018: Journal of Ayurveda and Integrative Medicine
Adam W A Geraghty, Rosie Stanford, Beth Stuart, Paul Little, Lisa C Roberts, Nadine E Foster, Jonathan C Hill, Elaine M Hay, David Turner, Wansida Malakan, Linda Leigh, Lucy Yardley
OBJECTIVE: To determine the feasibility of a randomised controlled trial of an internet intervention for low back pain (LBP) using three arms: (1) usual care, (2) usual care plus an internet intervention or (3) usual care plus an internet intervention with additional physiotherapist telephone support. DESIGN AND SETTING: A three-armed randomised controlled feasibility trial conducted in 12 general practices in England. PARTICIPANTS: Primary care patients aged over 18 years, with current LBP, access to the internet and without indicators of serious spinal pathology or systemic illness...
March 9, 2018: BMJ Open
Xiujuan Xu, Geng Zhang, Mahong Hu, Chunlian Ji, Jianbiao Meng, Zhizhen Lai, Muhua Dai, Lisha Pang, Wei Zhang
OBJECTIVE: To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. METHODS: A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Prabin Sharma, Rodrigo Aguilar, Mark Abi Nader, Shaheryar Siddiqui, Ramkaji Baniya, Sanjeeb Sudarshan Bhandari, Carmen Elena Cervantes, Ricardo Correa, Amir Masoud
OBJECTIVE: This study aimed to assess the difference in overall outcomes between weekend admissions for acute pancreatitis (AP) and weekday admissions. METHODS: Between 2005 and 2012, data were extracted from the Nationwide Inpatient Sample on adult patients with AP. Exclusion criteria were applied for chronic pancreatitis and other pancreatic and biliary malignancies. In-hospital mortality, length of stay, hospitalization costs, comorbidities, complications, and intervention rates were compared between the weekend and weekday admissions...
April 2018: Pancreas
Farid Froghi, Rahul Koti, Kurinchi Gurusamy, Susan Mallett, Douglas Thorburn, Linda Selves, Sarah James, Jeshika Singh, Manuel Pinto, Christine Eastgate, Margaret McNeil, Helder Filipe, Fatima Jichi, Nick Schofield, Daniel Martin, Brian Davidson
BACKGROUND: Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation...
March 7, 2018: Trials
Jennifer Yurkovich, Debra S Burns, Tondi Harrison
Background: Although evidence suggests music therapy lowers the heart rate of ill adults undergoing painful procedures and premature infants in the NICU, the effect of music therapy interventions on physiologic response in infants with congenital heart disease (CHD) being cared for in the cardiac intensive care unit (CICU) has not been explored. Objective: The purpose of this study was to explore the effect of the music therapy entrainment on physiologic responses of infants with CHD in the CICU...
March 5, 2018: Journal of Music Therapy
Marilyn Kendall, Eileen Cowey, Gillian Mead, Mark Barber, Christine McAlpine, David J Stott, Kirsty Boyd, Scott A Murray
BACKGROUND: Case fatality after total anterior circulation stroke is high. Our objective was to describe the experiences and needs of patients and caregivers, and to explore whether, and how, palliative care should be integrated into stroke care. METHODS: From 3 stroke services in Scotland, we recruited a purposive sample of people with total anterior circulation stroke, and conducted serial, qualitative interviews with them and their informal and professional caregivers at 6 weeks, 6 months and 1 year...
March 5, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Anneli Uusküla, Mait Raag, Sigrid Vorobjov, Don Des Jarlais
BACKGROUND: Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception...
March 5, 2018: Harm Reduction Journal
Luca Bors, Ágnes Bajza, Dorottya Kocsis, Franciska Erdő
Coffee consumption had already been described in the 15th century. The spreading of coffee drinking was not only a consequence of its delicious aromatic taste, but also of its pharmacological effects, especially due to its caffeine content. In this review, the mechanisms behind its complex stimulatory effects and the latest studies on the possible new therapeutic indications of caffeine are summarized. Several papers reported the neuroprotective (in Alzheimer's and Parkinson's disease) and hepatoprotective profiles of caffeine, and we show the most promising new results about its preventive properties in dermal malignancies...
March 2018: Orvosi Hetilap
Lionel Velly, Vincent Perlbarg, Thomas Boulier, Nicolas Adam, Sebastien Delphine, Charles-Edouard Luyt, Valentine Battisti, Gregory Torkomian, Charlotte Arbelot, Russell Chabanne, Betty Jean, Carol Di Perri, Steven Laureys, Giuseppe Citerio, Alessia Vargiolu, Benjamin Rohaut, Nicolas Bruder, Nadine Girard, Stein Silva, Vincent Cottenceau, Thomas Tourdias, Olivier Coulon, Bruno Riou, Lionel Naccache, Rajiv Gupta, Habib Benali, Damien Galanaud, Louis Puybasset
BACKGROUND: Prediction of neurological outcome after cardiac arrest is a major challenge. The aim of this study was to assess whether quantitative whole-brain white matter fractional anisotropy (WWM-FA) measured by diffusion tensor imaging between day 7 and day 28 after cardiac arrest can predict long-term neurological outcome. METHODS: This prospective, observational, cohort study (part of the MRI-COMA study) was done in 14 centres in France, Italy, and Belgium...
February 27, 2018: Lancet Neurology
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