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https://www.readbyqxmd.com/read/28730421/-documentation-of-decisions-to-withhold-or-withdraw-life-sustaining-therapies-recommendation-of-the-ethics-section-of-the-german-interdisciplinary-association-of-critical-care-and-emergency-medicine-divi-in-collaboration-with-the-ethics-section-of-the-german
#1
REVIEW
G Neitzke, B Böll, H Burchardi, K Dannenberg, G Duttge, R Erchinger, P Gretenkort, C Hartog, K Knochel, M Liebig, A Michalsen, G Michels, M Mohr, F Nauck, P Radke, F Salomon, H Stopfkuchen, U Janssens
No abstract text is available yet for this article.
July 20, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28730065/exploring-structural-violence-in-the-context-of-disability-and-poverty-in-zimbabwe
#2
Jennifer T Muderedzi, Arne H Eide, Stine H Braathen, Babill Stray-Pedersen
BACKGROUND: While it is widely assumed that disability, poverty and health are closely linked, research falls short of fully understanding the link. One approach to analysing the links between disability and poverty is through the concept of structural violence, referring to social structures that contribute to the impoverishment of individuals or communities. These structures can be political, ecological, legal and economic, among others. OBJECTIVE: To explore structural violence and how it affects families of children with cerebral palsy among the Tonga ethnic group living in poor rural communities of Binga in Zimbabwe...
2017: Afr J Disabil
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#3
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28728194/-relevance-of-living-wills-during-post-resuscitation-care
#4
Martin Christ, Katharina Isabel von Auenmüller, Martin Grett, Scharbanu Amirie, Michael Brand, Hans-Joachim Trappe
Background There is hardly any evidence about the influence of living wills on acute life-threatening disease like out-of-hospital cardiac-arrest (OHCA). We therefore initiated this study to quantify the percentage of victims of OHCA who's living wills are available during post-resuscitation care. Methods All victims of OHCA who were admitted to our hospital between January 1(st) 2008 and July 31(th) 2016 were identified by analysis of our central admission register. Data from individual patients were collected from the patient's health records and anonymously stored on a central database...
July 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28721432/influence-of-age-on-decision-making-process-to-limit-or-withdraw-life-sustaining-treatment-in-the-intensive-care-unit-a-single-center-prospective-observational-study
#5
G Ducos, O Mathe, L Balardy, S Lozano, M Kurrek, J Ruiz, B Riu-Poulenc, O Fourcade, S Silva, V Minville
BACKGROUND: The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. OBJECTIVES: We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. DESIGN, SETTING, PARTICIPANTS: We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011...
2017: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/28716996/long-term-benzodiazepine-and-z-drugs-use-in-the-uk-a-survey-of-general-practice
#6
James Davies, Todd C Rae, Luke Montagu
BACKGROUND: Current British National Formulary (BNF) guidelines state that benzodiazepines and zolpidem, zopiclone, and zaleplon, commonly known as Z-drugs (BZD), be prescribed for no more than 4 weeks, although anecdotal data suggest that many patients are prescribed BZDs for much longer. As there are no recent, evidence-based estimates of long-term (>12 months) BZD use in the UK, the scale of this potential problem is unknown. AIM: To produce the first reliable, evidence-based estimate of long-term BZD use in the UK...
July 17, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28712356/discontinuing-psychiatric-medications-a-survey-of-long-term-users
#7
Laysha Ostrow, Lauren Jessell, Manton Hurd, Sabrina M Darrow, David Cohen
OBJECTIVE: Individuals undergoing long-term psychiatric treatment frequently choose to stop taking psychiatric medications. To enhance service user choice and prevent undesirable outcomes, this first U.S. survey of a large sample of longer-term users sought to increase knowledge about users' experience of medication discontinuation. METHODS: A sample of 250 U.S. adults with a diagnosis of serious mental illness and a recent goal to stop up to two prescribed psychiatric medications, which they had taken for at least nine months, completed a web-based survey about experiences, strategies, and supports during discontinuation...
July 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28707583/cannabis-an-overview-of-its-adverse-acute-and-chronic-effects-and-their-implications
#8
Talitha C Ford, Amie C Hayley, Luke A Downey, Andrew C Parrott
In many communities, cannabis is perceived as a low-risk drug, leading to political lobbying to decriminalise its use. However, acute and chronic cannabis use has been shown to be harmful to several aspects of psychological and physical health, such as mood states, psychiatric outcomes, neurocognition, driving and general health. Furthermore, cannabis is highly addictive, and the adverse effects of withdrawal can lead to regular use. These in turn have adverse implications for public safety and health expenditure...
July 12, 2017: Current Drug Abuse Reviews
https://www.readbyqxmd.com/read/28705843/headache-tia-and-subarachnoid-haemorrhage-dissecting-an-unusual-cause-for-stroke-like-symptoms
#9
Elliot T Dawson, Desmond A Brown, Alejandro A Rabinstein
We present a case of supraclinoid internal carotid artery dissection. Eleven months prior, the patient developed isolated periorbital pain and was diagnosed with giant-cell arteritis with iritis. The patient experienced recurrent spells concerning for transient ischaemic attacks and was transferred to our institution for endovascular intervention after head CT revealed an embolic infarct with a 'dense middle cerebral artery sign.' Digital subtraction angiography was negative for occlusion, instead demonstrating luminal stenosis and poststenotic dilatation...
July 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28704817/outcome-of-preterm-neonates-with-a-birth-weight-1-500-g-with-severe-hypoxemic-respiratory-failure-rescued-by-inhaled-nitric-oxide-therapy-and-high-frequency-oscillatory-ventilation
#10
Atoosa Golfar, Jagmeet Bhogal, Barbara Kamstra, Ann Hudson-Mason, Mosarrat Qureshi, Georg M Schmölzer, Po-Yin Cheung
BACKGROUND: Despite being an experimental therapy in preterm neonates, inhaled nitric oxide (iNO) is used as a rescue therapy when high-frequency oscillatory ventilation (HFOV) and other conventional therapies fail. OBJECTIVE: We aimed to determine the outcomes of very-low-birth-weight (VLBW) neonates with hypoxemic respiratory failure (HRF) who had received iNO after maximal conventional therapies. METHODS: We retrospectively reviewed preterm neonates (<33 weeks of gestation with a birth weight <1,500 g) who had all received HFOV and then iNO from March 1, 2009 to April 1, 2014 at the Royal Alexandra Hospital...
July 14, 2017: Neonatology
https://www.readbyqxmd.com/read/28701842/quality-of-dying-in-the-medical-intensive-care-unit-comparison-between-thai-buddhists-and-thai-muslims
#11
Veerapong Vattanavanit, Supattra Uppanisakorn, Rungsun Bhurayanontachai, Bodin Khwannimit
BACKGROUND AND AIMS: Religious belief is an important aspect that influences the life of a patient, especially in Asia. We aim to compare the quality of death in an Intensive Care Unit (ICU) between Buddhists and Muslims from the perspectives of the relatives of the patients and the nurses and physicians. SUBJECTS AND METHODS: This was a cohort study of critically ill patients who died after admission to a medical ICU in Songklanagarind Hospital in Thailand between 2015 and 2016...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28701412/the-effect-of-blinding-on-estimates-of-mortality-in-randomised-clinical-trials-of-intensive-care-interventions-protocol-for-a-systematic-review-and-meta-analysis
#12
Carl Thomas Anthon, Anders Granholm, Anders Perner, Jon Henrik Laake, Morten Hylander Møller
INTRODUCTION: Evidence exists that unblinded randomised clinical trials (RCTs) overestimate intervention effects compared with blinded RCTs. It has been suggested that this is less pronounced for objective (ie, not subject to interpretation) outcome measures, including mortality. This may not apply in the intensive care unit (ICU), as most deaths are preceded by decisions to withhold or withdraw treatments. Lack of blinding of physicians in RCTs of ICU interventions may potentially influence the decision towards a higher threshold for discontinuing treatment in patients who receive the investigational treatment and/or a lower threshold for discontinuing treatment in patients who receive the comparator (control)...
July 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28699845/development-and-implementation-of-an-alcohol-withdrawal-protocol-using-a-5-item-brief-alcohol-withdrawal-scale-baws
#13
Darius A Rastegar, Dinah Applewhite, Anika A H Alvanzo, Christopher Welsh, Timothy Niessen, Edward S Chen
BACKGROUND: The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. METHODS: We initially piloted a 6-item withdrawal scale developed at another institution...
July 12, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28694343/non-withdrawal-of-beta-blockers-in-acute-decompensated-chronic-and-de-novo-heart-failure-with-reduced-ejection-fraction-in-a-prospective-multicentre-study-of-patients-with-acute-heart-failure-in-the-middle-east
#14
Charbel Abi Khalil, Kadhim Sulaiman, Ziyad Mahfoud, Rajvir Singh, Nidal Asaad, Khalid F AlHabib, Alawi Alsheikh-Ali, Mohammed Al-Jarallah, Bassam Bulbanat, Wael AlMahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Husam Al Faleh, Abdelfatah Elasfar, Prashanth Panduranga, Jassim Al Suwaidi
OBJECTIVES: Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. DESIGN: Analysis of prospectively collected data. SETTING: The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. PARTICIPANTS: 5005 patients with acute HF. OUTCOME MEASURES: We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%...
July 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28693445/older-persons-existential-loneliness-as-interpreted-by-their-significant-others-an-interview-study
#15
Helena Larsson, Margareta Rämgård, Ingrid Bolmsjö
BACKGROUND: In order to better understand people in demanding medical situations, an awareness of existential concerns is important. Studies performed over the last twenty years conclude that when dying and death come closer, as in the case with older people who are stricken by infirmity and diseases, existential concerns will come to the fore. However, studies concerning experiences of existential loneliness (EL) are sparse and, in addition, there is no clear definition of EL. EL is described as a complex phenomenon and referred to as a condition of life, an experience, and a process of inner growth...
July 10, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28688059/a-case-of-severe-refractory-hypotension-after-amlodipine-overdose
#16
Melissa Chudow, Kevin Ferguson
Calcium channel blockers (CCBs) are responsible for a substantial portion of the mortality associated with cardiovascular medication overdose cases. Amlodipine, a dihydropyridine CCB, can cause prolonged hypotension in overdose. This report describes a severe amlodipine overdose case that was refractory to multiple therapeutic approaches. A 53-year-old male presented after ingesting eighty 10 mg amlodipine tablets in a suicide attempt. The patient was initially managed with calcium boluses, glucagon, multiple vasoactive agents, lipid emulsion infusions and hyperinsulinemic euglycemic therapy...
July 7, 2017: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/28682317/a-management-strategy-that-reduces-nicu-admissions-and-decreases-charges-from-the-front-line-of-the-neonatal-abstinence-syndrome-epidemic
#17
S Loudin, J Werthammer, L Prunty, S Murray, J I Shapiro, T H Davies
OBJECTIVE: The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage. STUDY DESIGN: Data were analyzed from inborn neonates >35 weeks' gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal-Wallis and Mann-Whitney as well as χ(2) for trend...
July 6, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28679017/a-comparison-of-qtc-intervals-in-alcohol-withdrawal-patients-versus-acute-coronary-syndrome-patients
#18
Timothy Chu, Keith Azevedo, Amy A Ernst, Dusadee Sarangarm, Steven J Weiss
OBJECTIVES: Patients with an alcohol use disorder experiencing acute intoxication or withdrawal may be at risk for electrocardiograph (ECG) abnormalities, including prolongation of repolarization (long QTc [corrected QT]) that may contribute to arrhythmias and may be associated with a threefold increase in the likelihood of sudden cardiac events. Patients with acute coronary syndrome may have prolonged QTc as well. To our knowledge, no previous studies have compared the QTc of ACS with acute ethanol (EtOH) withdrawal syndromes in the emergency department (ED)...
July 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28675982/oncologists-and-intensivists-attitudes-toward-the-care-of-critically-ill-patients-with-cancer
#19
Antonio Paulo Nassar, Aldo Lourenço Abadde Dettino, Cristina Prata Amendola, Rodrigo Alves Dos Santos, Daniel Neves Forte, Pedro Caruso
BACKGROUND: Patients with cancer represent an important proportion of intensive care unit (ICU) admissions. Oncologists and intensivists have distinct knowledge backgrounds, and conflicts about the appropriate management of these patients may emerge. METHODS: We surveyed oncologists and intensivists at 2 academic cancer centers regarding their management of 2 hypothetical patients with different cancer types (metastatic pancreatic cancer and metastatic breast cancer with positive receptors for estrogen, progesterone, and HER-2) who develop septic shock and multiple organ failure...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28675916/-termination-of-reimbursement-of-arthroscopy-in-osteoarthritis-of-the-knee-is-this-decision-based-on-scientific-grounds
#20
Thoralf Randolph Liebs, Steffen Berger
Background In Germany, arthroscopy of the knee used to be an accepted procedure in the treatment of osteoarthritis of the knee. However, as of April 1, 2016 reimbursement for this procedure has been discontinued. This was a decision of the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA). That decision was based on a report of the German Institute for Quality and Efficiency in Health Care (IQWiG). This report is essentially based on a few studies, three of which have been published in the renowned New England Journal of Medicine...
July 4, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
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