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Factors predicting futility of liver transplant in elderly recipients:A single-center experience

World Journal of Transplantation 2021年第10期11卷 421-431页

作者： Cerise Kleb Muhammad Salman Faisal Cristiano Quintini Charles M Miller K V Narayanan Menon Jamak Modaresi Esfeh Department of Internal Medicine Cleveland Clinic FoundationClevelandOH 44195United States Department of General Surgery Cleveland Clinic FoundationClevelandOH 44195United States Department of Gastroenterology&Hepatology Cleveland Clinic FoundationClevelandOH 44195United States

BACKGROUND As the population of the United States ages,there has been an increasing number of elderly patients with cirrhosis listed for *** studies have shown variable results in terms of the relative survival benefit for elderly liver transplant(LT)*** may be factors that are associated with a poor post-transplant outcome which may help determine which elderly patients should and should not be listed for *** To identify factors associated with futility of transplant in elderly *** This was a retrospective study of all patients above the age of 45 who underwent liver transplantation at our tertiary care center between January 2010 and March 2020(n=1019).“Elderly”was defined as all patients aged 65 years and *** outcome was defined as death within 90 d of *** regression analysis was performed to determine what variables,if any were associated with futile outcome in elderly *** outcomes such as one year mortality and discharge to facility(such as skilled nursing facility or long-term acute care hospital)were analyzed in the entire sample,compared across three age groups(45-54,55-64,and 65+years).RESULTS There was a total of 260 elderly patients who received LT in the designated time period.A total of 20 patients met the definition of“futile”*** mean Model of End-Stage Liver Disease scores in the futile and non-futile group were not significantly different(21.78 in the futile group vs 19.66 in the“non-futile”group).Of the variables tested,only congestive heart failure was found to have a statistically significant association with futile outcome in LT recipients over the age of 65(P=0.001).Of these patients,all had diastolic heart failure with normal ejection fraction and at least grade I diastolic dysfunction as measured on *** aged 65 years and older were more likely to have the outcomes of death within 1 year of LT[hazard ratio:1.937,confidence interval(C

关键词： Liver transplantation Liver cirrhosis Heart failure Diastolic medical futility Liver diseases Organ transplantation

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Difficult Conversations and Painful Decisions: When Should Patients with Progressive Cancer Stop Chemotherapy?

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Journal of Cancer Therapy 2022年第1期13卷 20-47页

作者： Jeanine Staples Varvara Mazina Bethany-Rose Daubman Annekathryn Goodman Sibley Memorial Hospital Johns Hopkins Medicine Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery ashington USA Massachusetts General Hospital Harvard Medical School Division of Gynecologic Oncology Boston USA Massachusetts General Hospital Harvard Medical School Division of Palliative Care and Geriatric Medicine Boston USA

Introduction: The decision to stop anti-cancer treatment is fraught with many challenges for the oncologist, the patient, and their caregivers. This review examines the special considerations surrounding the decision to cease chemotherapy in terminally ill cancer patient. Methods: A comprehensive literature search was conducted to find relevant publications on chemotherapy cessation. A total of 2700 records were retrieved and 141 were identified as eligible for inclusion in this review. Results: Palliative chemotherapy does not achieve the goal of tumor-related symptom reduction for patients who have experienced progressive disease with more than two prior lines of chemotherapy. ECOG performance status is a crucial predictor of response to therapy and chemotherapy-related complications. Challenges to stopping chemotherapy at the end of life are multifactorial and are both patient and physician-driven. Racial, ethnic, and income-based disparities are seen in the timing and quality of end-of-life conversations offered by physicians to their patients. Conclusions: The decision to cease chemotherapy is one that should be approached with careful consideration and accurate information. Clear communication, compassion and empathy are important components to the therapeutic relationship. Early involvement of palliative care and clear conversations about prognosis and the expected utility of further chemotherapy is essential to conduct the best possible care for cancer patients at the end of life.

关键词： Chemotherapy Chemotherapy Resistance Chemotherapy Cessation Palliative Chemotherapy Recurrent Cancer and Prognosis Best Supportive Care medical futility End-of-Life

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Who decides in withdrawal of treatment in a critical care setting? A case study on ethical dilemma

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International Journal of Nursing Sciences 2018年第3期5卷 310-314页

作者： Chunmei Lyu Li Zhang The First People's Hospital of Foshan Affiliated with Sun Yat-Sen UniversityChina Department of Nursing The First People's Hospital of FoshanAffiliated with Sun Yat-Sen UniversityChina

Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered *** case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction *** such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do ***,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do *** ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ***,the associated literature relative to this case are analysed before the *** decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining *** his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for ***:In Danny's case,health professionals opted to respect his decision to withdraw *** medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.

关键词： Codes of ethics Critical care Decision-making Ethical dilemmas medical futility Morals

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