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Medical decision making for older adults： an international perspective comparing the United States and India

Journal of Geriatric Cardiology 2015年第4期12卷 329-334页

作者： ankur kalra Daniel E Forman Sarah J Goodlin Division of lnterventional Cardiology Beth lsrael Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA Division of Cardiology Department of Medicine Kalra Hospital SRCNC Pvt. Ltd. New Delhi India Section of Geriatric Cardiology University of Pittsburgh Medical Center Pittsburgh PA USA Geriatrics Research Education and Clinicai Center VA Pittsburgh Healthcare System Pittsburgh PA USA Department of Medicine-Geriatrics Oregon Health & Sciences University and Veterans Affairs Portland Health Care System Portland Oregon USA

There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.

关键词： Advance care planning Advance directive End-of-life India Surrogate decision-making

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Foundations of medical decision-making for older adults with cardiovascular disease

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Journal of Geriatric Cardiology 2015年第4期12卷 335-339页

作者： Hannah I Lipman ankur kalra James N Kirkpatrick Department of Medicine Divisions of Geriatrics and Cardiology Montefiore Medical Center of the Albert Einstein College of Medicine Bronx N~ USA Minneapolis Heart Institute at Abbott Northwestern Hospital Department of Medicine Division of Cardiology Hennepin County Medical Center Minneapo- lis MN USA Cardiovascular Division Department of Medicine University of Pennsylvania' Department of Medical Ethics and Health Policy University of Pennsylvania Philadelphia PA USA

In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical ex- amples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.

关键词： Cardiovascular disease Medical decision-making Older adults

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Rethinking an Algorithm: The Utility of the Techinicium 99 m Labeled Red Cell (RBC) Scanning for Lower Gastrointestinal Bleeding (LGIB)

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International Journal of Clinical Medicine 2012年第2期3卷 110-114页

作者： Shaffer R. S. Mok Chijioke Ojiako ankur kalra Mithil Gajera Sri Sujanthy Rajaram Division of Critical Care Medicine Department of Internal Medicine Cooper University Hospital Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey Camden USA Division of Internal Medicine Department of Internal Medicine Cooper University Hospital Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey Camden USA Mulica Hill Medical Associates Mullica Hill USA

Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy. Methods: Records of patients admitted to Cooper University Hospital from January 2001-December 2005 with LGIB who had 99mTc scan were analyzed. Results: 164 of 170 patients were eligible to be evaluated. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of 45 patients with positive scans had angiography. 7 patients (33.3%) had positive and 14 (66.6%) negative angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99 m Tc scan (p = 0.125). 20 patients, in the positive scan group, required surgery. In 15 (75%) the findings at surgery correlated with the scan result (p = 0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p < 0.001). The patients with (+) scan received a total of 372 (8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (–) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (–) scans had similar rates of colonoscopy (73.35% vs 76.4%), hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%) respectively, Conclusion: 99 m Tc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.

关键词： Technicium 99 m Lower Gastrointestinal Bleed LGIB Tc-99 m

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A review on conventional and herbal drug approach to peptic ulcer

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Gastroenterology & Hepatology Research 2023年第2期5卷 32-38页

作者： Divya Kiran ankur Rohilla Naresh kalra Department of Pharmaceutical Sciences Lords UniversityAlwar301028India Department of Pharmaceutical Sciences Universal Group of InstitutionsDera Bassi140501India

Peptic ulcer,a common digestive ailment,has been considered as an inflammatory response and necrotic lesions of the gastric *** ulcer reaches intensely to the mucosal muscle layer in the stomach and *** factors have been documented to be involved in the pathogenesis of peptic ulcers like Helicobacter pylori,nonsteroidal anti-inflammatory drugs(NSAIDs),acid and pepsin,genetics,and *** conventional use of drugs like proton pump inhibitors(PPIs),histamine(H_(2))receptor antagonists,antacids,potassium competitive acid blockers,and antibiotics has shown antiulcer ***,various researches have shown that herbal drugs can successfully treat peptic ulcers in preclinical and clinical models by different *** herbal drugs and their extracts from different parts like root,stem,leaf,flower,and seed showed potent ulcerprotective effects in the experimental *** review critically discusses the factors involved in the pathogenesis of peptic *** addition,the potential of herbal drug extracts has been highlighted in the present review.

关键词： peptic ulcer ulcerprotective

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