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https://www.readbyqxmd.com/read/28206733/end-of-life-decisions-in-34-slovene-intensive-care-units-a-nationwide-prospective-clinical-study
#1
Miha Orazem, Urh Groselj, Manca Stojan, Neza Majdic, Gaj Vidmar, Stefan Grosek
BACKGROUND: To determine how end-of-life decisions (EOLD) on limitations of life- sustaining treatment (LST) are made in three different types of intensive care units (ICUs) in Slovenia. METHODS: A national multicenter prospective study among 31 adult and three pediatric/neonatal ICUs (PICUs). The questionnaire form on EOLD was designed to assess the clinical practice. Data were collected between January 1, 2013, and March 31, 2013. For statistical analysis we used IBM® SPSS® Statistics 20 software package...
February 15, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28191348/pediatric-posttraumatic-endophthalmitis-in-china-for-twenty-years
#2
REVIEW
Yan Sheng, Wen Sun, Yangshun Gu, Andrzej Grzybowski
Pediatric posttraumatic endophthalmitis (PTE) is a rare but serious disease that frequently has a poor visual prognosis. To date, only a few English studies have focused on this disease. We perform a systematic review of the Chinese literature on pediatric PTE and describe the epidemiology, management, causative organisms, and visual acuity outcomes of reported cases in twenty years. We found that Staphylococcus epidermidis was the most common isolated organism and the use of a disposable syringe needle was the most common cause of ocular injuries in pediatric PTE in China...
2017: Journal of Ophthalmology
https://www.readbyqxmd.com/read/28152793/transitions-in-care-and-reduction-in-discharge-errors
#3
Tara Szyamnski, Megan Begnoche, Carol Chase, Michelle Moreau, Jessica Barnett
: 77 Background: Patients are often overwhelmed at the time of hospital discharge and focus on home rather than the discharge process. Fragmented communication and lack of planning between the hospital team, patient, family and primary oncologist can lead to frustration and delays in implementation of palliative or curative therapies and potential hospital readmission when the plan of care is not followed in a timely manner. Our goal is to avoid medication errors, delays in implementation of a care plan and reemergence of symptoms or new symptoms as a result of a suboptimal discharge transition...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28119312/stoppfrail-screening-tool-of-older-persons-prescriptions-in-frail-adults-with-limited-life-expectancy-consensus-validation
#4
Amanda Hanora Lavan, Paul Gallagher, Carole Parsons, Denis O'Mahony
OBJECTIVE: to validate STOPPFrail, a list of explicit criteria for potentially inappropriate medication (PIM) use in frail older adults with limited life expectancy. DESIGN: a Delphi consensus survey of an expert panel comprising academic geriatricians, clinical pharmacologists, palliative care physicians, old age psychiatrists, general practitioners and clinical pharmacists. SETTING: Ireland. SUBJECTS: seventeen panellists...
January 23, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28111755/nurse-and-medical-provider-perspectives-on-antibiotic-stewardship-in-nursing-homes
#5
Kezia Scales, Sheryl Zimmerman, David Reed, Anna Song Beeber, Christine E Kistler, John S Preisser, Bryan J Weiner, Kimberly Ward, Amy Fann, Philip D Sloane
OBJECTIVES: To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). DESIGN: Cross-sectional survey. SETTING: NHs in North Carolina (N = 31). PARTICIPANTS: Nursing staff (n = 182) and medical providers (n = 50). MEASUREMENTS: Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship...
January 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28032354/end-of-life-treatment-decisions-in-nursing-home-residents-dying-with-dementia-in-the-netherlands
#6
Simone A Hendriks, Martin Smalbrugge, Luc Deliens, Raymond T C M Koopmans, Bregje D Onwuteaka-Philipsen, Cees M P M Hertogh, Jenny T van der Steen
OBJECTIVE: The objective was to describe end-of-life treatment decisions for patients dying with dementia in various stages of dementia in long-term care facilities in the Netherlands with elderly care physicians responsible for treatment and care. METHODS: We present data collected in the nationally representative Dutch End of Life in Dementia study (2007-2011). Within 2 weeks after death, 103 physicians completed questionnaires about the last phase of life in 330 residents with dementia who resided in 1 of 34 participating long-term care facilities...
December 29, 2016: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27845340/plastic-vs-self-expandable-metal-stents-for-palliation-in-malignant-biliary-obstruction-a-series-of-meta-analyses
#7
Majid A Almadi, Alan Barkun, Myriam Martel
OBJECTIVES: Self-expandable metal stents (SEMS) are thought to have an advantage over plastic stents in achieving biliary drainage. METHODS: We performed a systematic search of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of knowledge databases, from January 1980 to September 2015, for randomized-controlled trials (RCTs) comparing SEMS vs. plastic stents in the palliation of malignant biliary obstruction. Primary outcomes were durations of stent patency, patient survival, and 30-day mortality...
November 15, 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27749020/advance-care-planning-in-adolescents-with-cystic-fibrosis-a-quality-improvement-project
#8
Traci M Kazmerski, Daniel J Weiner, Janice Matisko, Diane Schachner, Whitney Lerch, Carol May, Scott H Maurer
INTRODUCTION: Advance care planning (ACP), though recommended, has not been studied in adolescents with cystic fibrosis (CF). This quality improvement project engaged adolescents with advanced CF disease in ACP and assessed patient and CF provider attitudes and preferences regarding ACP discussions and tools. MATERIALS AND METHODS: Patients ≤22 years with advanced CF (FEV1 ≤40% predicted, >2 pulmonary exacerbations requiring IV antibiotics in 1 year, and/or use of home oxygen or non-invasive ventilation) were referred to the pediatric palliative care team (PC)...
December 2016: Pediatric Pulmonology
https://www.readbyqxmd.com/read/27737420/palliative-care-for-patients-with-hiv-aids-admitted-to-intensive-care-units
#9
Paola Nóbrega Souza, Erique José Peixoto de Miranda, Ronaldo Cruz, Daniel Neves Forte
OBJECTIVE: To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. METHODS: This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. RESULTS: Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment...
September 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27729035/end-of-life-care-of-patients-with-idiopathic-pulmonary-fibrosis
#10
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
https://www.readbyqxmd.com/read/27725919/afatinib-associated-cutaneous-toxicity-a-correlation-of-severe-skin-reaction-with-dramatic-tumor-response-in-a-woman-with-exon-19-deletion-positive-non-small-cell-lung-cancer
#11
Lindsay P Osborn, Philip R Cohen
Epidermal growth factor receptor (EGFR) inhibitors are biological factors used in the treatment of non-small-cell lung cancers (NSCLC) that are positive for EGFR mutations. Afatinib is one such drug that has been approved for use in this capacity. Cutaneous toxicity is the second most commonly reported adverse event with the use of afatinib. A 39-year-old woman with inoperative right lung adenocarcinoma was initially treated with afatinib. She not only developed a severe papulopustular eruption but also had a dramatic reduction of her tumor...
September 1, 2016: Curēus
https://www.readbyqxmd.com/read/27685423/secondary-combined-immunodeficiency-in-pediatric-patients-after-the-fontan-operation-three-case-reports
#12
Eva Hlavackova, Martin Liska, Hana Jicinska, Jiri Navratil, Jiri Litzman
The Fontan operation or total cavopulmonal connection (TCPC) is a palliative surgical correction of rare and complex inborn cardiac malformations that are characterized by univentricular circulation. Protein-losing enteropathy (PLE) develops in 4-13% of patients after the Fontan procedure. Fontan-related PLE leads to secondary combined immunodeficiency marked by hypogammaglobulinemia and predominantly CD4+ lymphocytopenia. Here, we present 3 case reports of patients with secondary immunodeficiency after the Fontan operation...
2016: International Archives of Allergy and Immunology
https://www.readbyqxmd.com/read/27672676/metastatic-papillary-serous-uterine-cancer-presenting-as-a-rash
#13
Eric S Chang, William D Baker, Charles N Landen
BACKGROUND: We report diagnosis and management of stage IV papillary serous uterine cancer with initial clinical presentation as a skin rash. CASE: A 62-year-old postmenopausal female developed an erythematous rash beginning on her right lower abdomen and progressively spreading to her left abdomen, vulva, and neck. After a trial of antibiotic treatment, biopsy of left neck and right thigh skin nodules revealed papillary serous carcinoma. Abdominopelvic tomography revealed endometrial thickening and a 5 cm left adnexal mass...
November 2016: Gynecologic Oncology Reports
https://www.readbyqxmd.com/read/27609204/tolerance-of-subcutaneously-administered-antibiotics-a-french-national-prospective-study
#14
Claire Roubaud-Baudron, Emmanuel Forestier, Thibaut Fraisse, Jacques Gaillat, Benoit de Wazières, Leonardo Pagani, Isabelle Ingrand, Louis Bernard, Gaëtan Gavazzi, Marc Paccalin
BACKGROUND/OBJECTIVE: although poorly documented, subcutaneous (SC) administration of antibiotics is common practice in France especially in Geriatrics Departments. The aim of this study was to determine the tolerance of such a practice. DESIGN: prospective observational multicentre study. METHODS: sixty-six physicians accepted to participate from 50 French Infectious Diseases and Geriatrics Departments. From May to September 2014, patients treated at least one day with SC antibiotics could be included...
September 8, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27608043/antibiotic-treatment-in-end-of-life-cancer-patients-a-retrospective-observational-study-at-a-palliative-care-center-in-sweden
#15
Maria Helde-Frankling, Jenny Bergqvist, Peter Bergman, Linda Björkhem-Bergman
BACKGROUND: The aim of this study was to elucidate whether palliative cancer patients benefit from antibiotic treatment in the last two weeks of life when an infection is suspected. METHOD: We reviewed medical records from 160 deceased palliative cancer patients that had been included in previous studies on vitamin D and infections. Patients treated with antibiotics during the last two weeks of life were identified and net effects of treatment (symptom relief) and possible adverse events were extracted from medical records...
September 6, 2016: Cancers
https://www.readbyqxmd.com/read/27574561/an-unusual-presentation-of-carcinomatous-meningitis
#16
Chuan T Foo, Louise M Burrell, Douglas F Johnson
A 67-year old previously well male presented with a 1 week history of confusion on a background of 3 weeks of headache. Past history included two superficial melanomas excised 5 years ago. Treatment for meningoencephalitis was commenced based on lumbar puncture (LP) and non-contrast brain magnetic resonance imaging (MRI) results. Lack of a clinical response to antibiotics resulted in a second LP and contrast brain MRI which demonstrated hydrocephalus and leptomeningeal disease. Ongoing deterioration led to a whole-body computed tomographic and spinal MRI that showed widespread metastatic disease and extensive leptomeningeal involvement of the spinal cord...
August 2016: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/27566075/palliative-radiotherapy-in-cancer-patients-with-increased-serum-c-reactive-protein-level
#17
Carsten Nieder, Bård Mannsåker, Astrid Dalhaug, Adam Pawinski, Ellinor Haukland
BACKGROUND/AIM: Connections exist between inflammation and cancer, for example with regard to disease progression and prognosis. Therefore, we investigated whether systemic inflammatory processes indicated by increased serum C-reactive protein (CRP) provide prognostic information for physicians prescribing palliative radiotherapy. PATIENTS AND METHODS: We analyzed data from 781 patients and evaluated prognostic factors for survival. RESULTS: Only 277 patients (35%) had CRP <8 mg/l before radiotherapy...
September 2016: In Vivo
https://www.readbyqxmd.com/read/27540463/methimazole-induced-insulin-autoimmune-syndrome
#18
REVIEW
Nidhi Jain, Malvi Savani, Manyoo Agarwal, Dipen Kadaria
BACKGROUND: Hypoglycemia in a critical care setting is often multifactorial with iatrogenic insulin use, sulfonylurea (SU) use, sepsis, adrenal insufficiency and insulinoma among the common causes. Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia characterized by the presence of insulin-binding autoantibodies to the sulfhydryl group-containing agents. We report a case of methimazole-induced IAS managed in the intensive care unit. CASE PRESENTATION: A 76-year-old woman with a history of primary hyperthyroidism was sent from a nursing home for unresponsiveness...
August 2016: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27446840/the-palliative-management-of-refractory-cirrhotic-ascites-using-the-pleurx-%C3%A2-catheter
#19
Jason Reinglas, Kayvan Amjadi, Bill Petrcich, Franco Momoli, Thomas Shaw-Stiffel
Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt...
2016: Canadian Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27353273/non-beneficial-treatments-in-hospital-at-the-end-of-life-a-systematic-review-on-extent-of-the-problem
#20
M Cardona-Morrell, Jch Kim, R M Turner, M Anstey, I A Mitchell, K Hillman
PURPOSE: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care. DATA SOURCES: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015). STUDY SELECTION: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL)...
September 2016: International Journal for Quality in Health Care
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