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Background: Palliative extubation (PE) is the cessation of mechanical ventilation (MV) during terminal illness. Although PE is widely practiced in many countries, it remains illegal in others. Attitudes toward PE of patients at the highest risk for MV were scarcely explored before. Objective: To assess the attitudes of patients with advanced chronic illnesses (ACI) toward PE and other end-of-life decisions in a country where PE is illegal. Design: A prospective observational study using questionnaire-based interviews. Setting/Subjects: Patients with ACI hospitalized between 2021 and 2022 in a large tertiary center. Attitudes toward PE and mechanical ventilation were evaluated. Predictors for favoring/opposing PE were analyzed using multivariate logistical regression models. Results: A total of 152 (40% female, 75 ± 11 years) patients were included. The most common ACIs were advanced heart failure (32%), metastatic malignancy (32%), and chronic obstructive pulmonary disease (22%). Around 132 patients (87%) supported the legalization of PE, and their main reason was to avoid pain and suffering (87%). Legalization of PE would change the decision to avoid mechanical intubation in 34% of the cases. Most patients thought that the decision to perform PE should be made by the patient's physician and primary caregiver collaboratively (64%). Religious observance was an independent predictor for opposing PE (adjusted odds ratio 0.18; 95% confidence interval 0.06–0.59; p < 0.01), whereas the type of ACI was not. Conclusion: Most admitted patients with ACIs support the legalization of PE. Such policy change could have major impact on patients' end-of-life preferences. At-risk patients should be the focus of future studies in this area. [ABSTRACT FROM AUTHOR]

Background: Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates than the passive subdural drainage. We consequently changed clinical practice from using the passive subdural drainage to the active subgaleal drainage. Objective: The aim of the present study was to assess a potential change in reoperation rates for CSDH after conversion to the active subgaleal drainage. Methods: This single-center cohort study compared the reoperation rates for recurrent same-sided CSDH and postoperative complication rates between patients treated during two study periods (passive subdural drainage cohort versus active subgaleal drainage cohort). Results: In total, 594 patients were included in the study. We found no significant difference in reoperation rates between the passive subdural drain group and the active subgaleal drain group (21.6%, 95% CI 17.5–26.4% vs. 18.0%, 95% CI 13.8–23.2%; p = 0.275). There was no statistical difference in the rate of serious complications between the groups. The operating time was significantly shorter for patients operated with the active subgaleal drain than patients with the passive subdural drain (32.8 min, 95% CI 31.2–34.5 min vs. 47.6 min, 95% CI 44.7–50.4 min; p < 0.001). Conclusions: Conversion from the passive subdural to the active subgaleal drainage did not result in a clear reduction of reoperation rates for CSDH in our center. [ABSTRACT FROM AUTHOR]

The Hippocratic oath is such an enduring icon of medical morality that physicians in Nazi Germany invoked it to protest Euthanasie , the systematized killing of weak or sick children, people with incurable diseases, hospitalized criminals (a category applicable to gays), geriatric patients, long-term patients, patients not of German blood (Jews and Romani), and people with disabilities. Several expert witnesses at the 1945 Nuremberg Medical Trial also cited the oath to condemn Nazi physicians' abuse of human research subjects. Noting these invocations, in 1947 the physicians who founded the World Medical Association modernized the Hippocratic oath to convey to future medical students its foundational precepts: benefitting the sick, not harming them, not breaching confidentiality, and not treating patients unjustly, irrespective of their gender or social status. This article presents a historically accurate reading of the oath's strange-seeming passages to show that it does not prohibit abortion, euthanasia (medical aid in dying), or surgery. The article also contends that oath-swearing remains an important asset in teaching clinicians their role responsibilities, and that its ethics supports women's rights to reproductive health care and can valorize challenges to venture-capitalist and for-profit managements that prioritize profitability over providing quality health care for patients. [ABSTRACT FROM AUTHOR]

This study aims to explore circumstances affecting patients' euthanasia and medically assisted suicide (MAS) decisions from the perspectives of patients, relatives, and healthcare professionals. A qualitative systematic review was performed following PRISMA recommendations. The review protocol is registered in PROSPERO (CRD42022303034). Literature searches were conducted in MEDLINE, EMBASE, CINAHL Complete, Eric, PsycInfo, and citation pearl search in Scopus from 2012 to 2022. In total, 6840 publications were initially retrieved. The analysis included a descriptive numerical summary analysis and a qualitative thematic analysis of 27 publications, resulting in two main themes—Contexts and factors influencing actions and interactions, and Finding support while dealing with resistance in euthanasia and MAS decisions—and related sub-themes. The results illuminated the dynamics in (inter)actions between patients and involved parties that might both impede and facilitate patients' decisions related to euthanasia/MAS, potentially influencing patients' decision-making experiences, and the roles and experiences of involved parties. [ABSTRACT FROM AUTHOR]

Morphologically, cell death can be divided into apoptosis and necrosis. Apoptosis, which is a type of regulated cell death, is well tolerated by the immune system and is responsible for hemostasis and cellular turnover under physiological conditions. In contrast, necrosis is defined as a form of passive cell death that leads to a dramatic inflammatory response (also referred to as necroinflammation) and causes organ dysfunction under pathological conditions. Recently, a novel form of cell death named regulated necrosis (such as necroptosis, pyroptosis, and ferroptosis) was discovered. Distinct from apoptosis, regulated necrosis is modulated by multiple internal or external factors, but meanwhile, it results in inflammation and immune response. Accumulating evidence has indicated that regulated necrosis is associated with multiple diseases, including diabetes. Diabetes is characterized by hyperglycemia caused by insulin deficiency and/or insulin resistance, and long-term high glucose leads to various diabetes-related complications. Here, we summarize the mechanisms of necroptosis, pyroptosis, and ferroptosis, and introduce recent advances in characterizing the associations between these three types of regulated necrosis and diabetes and its complications. [ABSTRACT FROM AUTHOR]

The article discusses a study on distinguishing ethical from diagnostic concerns about NRP-cDCD, conducted by Kyle E. Karches and Jason T. Eberl, published in the journal "The American Journal of Bioethics." It examines arguments by Bernat and Busch regarding the diagnostic certainty of death in NRP-cDCD, while also addressing ethical objections related to the intentionality of actions performed during NRP.

Background: Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates than the passive subdural drainage. We consequently changed clinical practice from using the passive subdural drainage to the active subgaleal drainage. Objective: The aim of the present study was to assess a potential change in reoperation rates for CSDH after conversion to the active subgaleal drainage. Methods: This single-center cohort study compared the reoperation rates for recurrent same-sided CSDH and postoperative complication rates between patients treated during two study periods (passive subdural drainage cohort versus active subgaleal drainage cohort). Results: In total, 594 patients were included in the study. We found no significant difference in reoperation rates between the passive subdural drain group and the active subgaleal drain group (21.6%, 95% CI 17.5–26.4% vs. 18.0%, 95% CI 13.8–23.2%; p = 0.275). There was no statistical difference in the rate of serious complications between the groups. The operating time was significantly shorter for patients operated with the active subgaleal drain than patients with the passive subdural drain (32.8 min, 95% CI 31.2–34.5 min vs. 47.6 min, 95% CI 44.7–50.4 min; p < 0.001). Conclusions: Conversion from the passive subdural to the active subgaleal drainage did not result in a clear reduction of reoperation rates for CSDH in our center. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients. [ABSTRACT FROM AUTHOR]

In Colombia, there is a constitutional guarantee to carry out dignified death. However, despite having been developed from various resolutions of the Ministry of Health and Social Protection (MinSalud), the practice can be complex due to the intervention of various actors with whom there may even be a conflict of rights. This article raises questions such as: what should be done when a euthanasia procedure is requested and the fundamental rights of the actors involved come into conflict? Are the regulations on the subject clear, complete, precise, and effective? Do the actors involved in these conflicts -- such as health service providers, patients, doctors -- see their rights in conflict in the euthanasia procedure in Colombia? To answer these questions, a study of the concepts of the right to a dignified death, conscientious objection, active and passive euthanasia, assisted suicide, and mercy killing was carried out, as well as the test of reasonableness and the principle of proportionality. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical considerations surrounding conscientious objection to teaching medical aid in dying (MAID), with a specific examination of the challenges faced by a palliative care consultation service team that included training on MAID. It mentions David Wendler, PhD, and colleagues explore the ethics of conscientious objection to teaching physician-assisted death to trainees in palliative care programs.

Despite the motivation of oncology patients to take part in clinical trials, only a minority of them are enrolled in clinical trials. Implementation of new practical procedures can become a barrier that withholds patients from participating in clinical trials. Treating physicians are crucial in augmenting trial accrual. The drivers that promote physicians to allocate patients for clinical trials need further assessment. We conducted two separate cross-sectional surveys, addressing patients with a haematological disease in one survey and haematologists in another survey. The patient survey was filled out by 420 patients. Significant relationships between the willingness to participate in a trial and trial knowledge (p < 0.001) and between doctor–patient relationship and participation willingness (p = 0.007) were noted. Patients above 60 years were less willing to use an electronic consent procedure vs. patients younger than 60 (p < 0.001). The physician questionnaire was completed by 42 participants of whom most (83%) were active in and (94%) motivated for clinical trials. Apart from the patient benefit and scientific interest, prestige was an equal motivator closely followed by financial remunerations. First goal was not to harm the patient. Our study confirms the high willingness of patients for trial participation and the need to rethink the structure of trial organisation. The e-consent procedure is not the method preferred by most patients above 60 years old. [ABSTRACT FROM AUTHOR]

Self‐initiated movements are accompanied by an efference copy, a motor command sent from motor regions to the sensory cortices, containing a prediction of the movement's sensory outcome. Previous studies have proposed pre‐motor event‐related potentials (ERPs), including the readiness potential (RP) and its lateralized sub‐component (LRP), as potential neural markers of action feedback prediction. However, it is not known how specific these neural markers are for voluntary (active) movements as compared to involuntary (passive) movements, which produce much of the same sensory feedback (tactile, proprioceptive) but are not accompanied by an efference copy. The goal of the current study was to investigate how active and passive movements are distinguishable from premotor electroencephalography (EEG), and to examine if this change of neural activity differs when participants engage in tasks that differ in their expectation of sensory outcomes. Participants made active (self‐initiated) or passive (finger moved by device) finger movements that led to either visual or auditory stimuli (100 ms delay), or to no immediate contingency effects (control). We investigated the time window before the movement onset by measuring pre‐movement ERPs time‐locked to the button press. For RP, we observed an interaction between task and movement. This was driven by movement differences in the visual and auditory but not the control conditions. LRP conversely only showed a main effect of movement. We then used multivariate pattern analysis to decode movements (active vs. passive). The results revealed ramping decoding for all tasks from around −800 ms onwards up to an accuracy of approximately 85% at the movement. Importantly, similar to RP, we observed lower decoding accuracies for the control condition than the visual and auditory conditions, but only shortly (from −200 ms) before the button press. We also decoded visual vs. auditory conditions. Here, task is decodable for both active and passive conditions, but the active condition showed increased decoding shortly before the button press. Taken together, our results provide robust evidence that pre‐movement EEG activity may represent action‐feedback prediction in which information about the subsequent sensory outcome is encoded. [ABSTRACT FROM AUTHOR]

The article "Euthanasia and fundamental rights" analyzes the legal regulation of euthanasia and its compatibility with the fundamental rights of individuals. It examines the most significant decisions of constitutional courts and the European Court of Human Rights that have modified the current law on euthanasia in the name of respecting the fundamental rights of patients. Two basic forms of euthanasia are addressed: voluntary passive euthanasia and voluntary active euthanasia. The article highlights the importance of protecting the fundamental rights of patients in relation to the regulation of euthanasia. The debate on the right to die and assisted suicide is also discussed from a constitutional perspective. Judicial cases in different countries addressing this issue are mentioned. In general, it is concluded that the prohibition of assisted suicide does not violate fundamental rights, although states have some margin of appreciation to balance this right with other interests at stake. The article provides information on judicial decisions related to euthanasia in different European and American countries. Three recent judgments of the constitutional courts of Portugal and Italy are also mentioned, as well as the first position of the European Court of Human Rights on active euthanasia in Belgium. The article discusses the issue of euthanasia and the fundamental rights of patients. It mentions that there is a fundamental right of the patient to refuse any medical treatment. The discussion on passive and active euthanasia is also raised, and different legal and constitutional positions on the matter are addressed. Finally, a judgment of the Spanish Constitutional Court is mentioned, which questions the compatibility of euthanasia legislation with fundamental rights. [Extracted from the article]

The excessive and uncontrolled use of pyrethroids, such as cypermethrin (CP), for pest control in Nigeria could adversely affect humans. This study aimed to investigate the oxidative stress response to cypermethrin exposure, focusing on measuring the parameters (i.e., malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT)) and the potential therapeutic effects of single and co-administration of ascorbate and alpha-tocopherol. The lungs and hearts of the animals were histologically examined for cypermethrin-induced cytopathic changes. Twenty-five adult male Wistar rats weighing 180–200 g were randomly assigned to five groups, each consisting of five animals. Group I was the control group that was not subjected to any treatment. Group II was orally exposed to cypermethrin at a dosage of 10 mg/kg bw without any additional treatment. Groups III, IV, and V received cypermethrin at standard doses of 10 mg/kg bw and were orally administered with ascorbate (5,000 mg/kg bw), alpha-tocopherol (3,000 mg/kg bw), and a coadministration of ascorbate (5,000 mg/kg bw) and alpha-tocopherol (3,000 mg/kg bw), respectively. The animals were euthanized after 28 days, and samples were processed for histological analysis using hematoxylin and eosin staining. Analysis of variance (ANOVA) and Duncan's multiple range test were used to compare categorical variables of the biochemical parameters and determine the levels of MDA, SOD, GPx, and CAT. The data analysis revealed that the cypermethrin-exposed, untreated rats had elevated MDA levels and a concurrently marked decrease in SOD, GPx, and CAT activities (p<0.05). Additionally, the histopathological examination of the organs indicated inflammation and congestion. The co-administration of ascorbate and alpha-tocopherol restored the biochemical parameters more effectively compared to when the substances were administered individually. In conclusion, co-administration of ascorbic acid and alphatocopherol ameliorates cypermethrin-induced oxidative damage more effectively than a single administration of either substance. This may be due to the synergistic antioxidant properties of the substances. [ABSTRACT FROM AUTHOR]

Background: Ventilation during cardiopulmonary resuscitation (CPR) has long been a part of the standard treatment during cardiac arrests. Ventilation is usually given either during continuous chest compressions (CCC) or during a short pause after every 30 chest compressions (30:2). There is limited knowledge of how ventilation is delivered if it effects the hemodynamics and if it plays a role in the occurrence of lung injuries. The aim of this study was to compare ventilation parameters, hemodynamics, blood gases and lung injuries during experimental CPR given with CCC and 30:2 in a porcine model. Methods: Sixteen pigs weighing approximately 33 kg were randomized to either receive CPR with CCC or 30:2. Ventricular fibrillation was induced by passing an electrical current through the heart. CPR was started after 3 min and given for 20 min. Chest compressions were provided mechanically with a chest compression device and ventilations were delivered manually with a self-inflating bag and 12 l/min of oxygen. During the experiment, ventilation parameters and hemodynamics were sampled continuously, and arterial blood gases were taken every five minutes. After euthanasia and cessation of CPR, the lungs and heart were removed in block and visually examined followed by sampling of lung tissue which were examined using microscopy. Results: In the CCC group and the 30:2 group, peak inspiratory pressure (PIP) was 58.6 and 35.1 cmH2O (p < 0.001), minute volume (MV) 2189.6 and 1267.1 ml (p < 0.001), peak expired carbon dioxide (PECO2) 28.6 and 39.4 mmHg (p = 0.020), partial pressure of carbon dioxide (PaCO2) 50.2 and 61.1 mmHg (p = 0.013) and pH 7.3 and 7.2 (p = 0.029), respectively. Central venous pressure (CVP) decreased more over time in the 30:2 group (p = 0.023). All lungs were injured, but there were no differences between the groups. Conclusions: Ventilation during CCC resulted in a higher PIP, MV and pH and lower PECO2 and PaCO2, showing that ventilation mode during CPR can affect ventilation parameters and blood gases. [ABSTRACT FROM AUTHOR]

Introduction Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been developed that can be easily administered by a medic in austere settings to temporarily tamponade noncompressible torso hemorrhage. The purpose of this study was to assess the long-term safety and physical characteristics of using Fast Onset Abdominal Management (FOAM; Critical Innovations LLC) in swine. Materials and Methods Yorkshire swine (40-60 kg) were sedated, intubated, and placed on ventilatory support. An external jugular catheter was placed for sampling of blood. Continuous heart rate, temperature, saturation of peripheral oxygen, end-tidal carbon dioxide, and peak airway pressures were monitored for a 4-hour period after intervention (i.e. FOAM agent injection or a sham introducer without agent delivery). The FOAM agent was injected to obtain an intra-abdominal pressure of 60 mmHg for at least 10 minutes. After 4 hours, the animals were removed from ventilatory support and returned to their housing for a period of 7-14 days. Group size analysis was not performed, as this was a descriptive safety study. Blood samples were obtained at baseline and at 1-hour post-intervention and then on days 1, 3, 7, and 14. Euthanasia, necropsy, and harvesting of samples for histologic analysis (from kidneys, terminal ilium, liver, pancreas, stomach, spleen, and lungs) were performed upon expiration. Histologic scoring for evidence of ischemia, necrosis, and abdominal compartment sequela was blinded and reported by semi-quantitative scale (range 0-4; 0 = no change, 1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). Oregon Health & Science University's Institutional Animal Care and Use Committee, as well as the U.S. Army Animal Care and Use Review Office, approved this protocol before the initiation of experiments (respectively, protocol numbers IP00003591 and MT180006.e002). Results Five animals met a priori inclusion criteria, and all of these survived to their scheduled endpoints. Two animals received sham injections of the FOAM agent (one euthanized on day 7 and one on day 14), and three animals received FOAM agent injections (one euthanized on day 7 and two on day 14). A transitory increase in creatinine and lactate was detected during the first day in the FOAM injected swine but resolved by day 3. No FOAM agent was observed in the peritoneal cavity upon necropsy at day 7 or 14. Histologic data revealed no clinically relevant differences in any organ system between intervention and control animals upon sacrifice at day 7 or 14. Conclusions This study describes the characteristics, survival, and histological analysis of using FOAM in a porcine model. In our study, FOAM reached the desired intra-abdominal pressure endpoint while not significantly altering basic hematologic parameters, except for transient elevations of creatinine and lactate on day 1. Furthermore, there was no clinical or histological relevant evidence of ischemia, necrosis, or intra-abdominal compartment syndrome. These results provide strong support for the safety of the FOAM device and will support the design of further regulatory studies in swine and humans. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of Bio-Electro-Magnetic-Energy-Regulation (BEMER) on recovery and performance parameters in anaerobic exercise compared to active and passive recovery. Method: Fifteen recreationally active participants completed four sessions separated by 2–5 days between each session. The first visit involved one Wingate Anaerobic Test (WAnT; 30-s cycling sprint on a Monark ergometer) to familiarize participants with testing procedures. The three subsequent sessions involved four repeated WAnTs. Each sprint was followed by 4 min of either passive recovery (laying supine), active recovery (pedaling at 50 rpm at 20% of sprint workload), or BEMER recovery (laying supine on the BEMER body pad at intensity level "5-Plus."). The same recovery method was used within each testing session, and recovery method order was randomized across participants. Results: There was no difference in peak power, average power, fatigue index, or average work performed between recovery conditions. Active recovery resulted in a statistically significant decrease in ratings of pain intensity (M = −0.767, SD = 0.928) and pain unpleasantness (M = −0.608, SD = 0.915), from the first minute to the fourth minute of recovery, compared to both BEMER (Intensity: M = 0.675, SD = 0.745, Unpleasantness: M = 1.125, SD = 0.862) and passive (Intensity: M = 0.542, SD = 0.774, Unpleasantness: M = 1.018, SD = 0.872) recoveries, where pain ratings increased. Conclusions: Although no recovery method resulted in increased performance, active recovery led to a more comfortable exercise experience while still allowing comparable exercise performance. [ABSTRACT FROM AUTHOR]

Aim: To synthesise the qualitative evidence regarding the role of critical care nurses in the decision‐making process of withdrawing life‐sustaining treatment in critically ill adults. Design: Qualitative systematic review. Review Methods: This qualitative systematic review employed the guidelines of Bettany‐Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis. Data Sources: CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021. Results: Twenty‐three studies were included. Three analytical themes were synthesised: performing ethical decision‐making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision‐making process; and taking on the role of the middleman by performing coordination. Conclusion: The role of the critical care nurses in the decision‐making process in withdrawal of life‐sustaining treatment requires experience and the development of the clinical perspective of critical care nurses. Implications for the profession and/or patient care: Enhanced knowledge of the decision‐making process of withdrawing life‐sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit. Impact: The literature reveals the complex and challenging role of critical care nurses during the decision‐making process of withdrawing life‐sustaining treatment. Critical care nurses perform ethical decision‐making to safeguard patients' concerns, guide the family's decision‐making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing. Patient or Public Contribution: No patient or public contribution was included. [ABSTRACT FROM AUTHOR]

The idea of commercial‐assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial‐assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service‐provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician‐assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will. [ABSTRACT FROM AUTHOR]

Practice testing is a highly robust learning strategy that promotes long-term retention, especially in comparison to more passive strategies such as restudying—a finding referred to as the testing effect. However, learners do not always appreciate the memorial benefits of practice testing over restudying, which could limit their use of practice testing during self-regulated learning. The current investigation explored the extent to which learners' metacognitive judgments about the testing effect can be improved via test experience, direct instruction, or a combination of both techniques. Prolific participants underwent two learning cycles. In the first cycle, participants were randomly assigned to either (a) experience a testing effect in their own memory performance (i.e., study unrelated word pairs, practice half the pairs through restudying and half through testing with correct-answer feedback, complete a critical test on the pairs, and receive feedback regarding their performance after using each strategy); (b) imagine they had to learn word pairs and read a passage on the purported benefits of practice testing; or (c) undergo both procedures. In the second cycle, all participants learned a novel set of word pairs. Across both learning cycles, participants estimated memory performance for material learned through testing versus restudying. Both test experience and direct instruction—independently and in combination—led to more accurate memory estimates across learning cycles, but no technique was more effective than the other. In summary, people can learn about the memorial benefits of practice testing when they experience a testing effect on their own memory performance and/or when they receive instruction about its benefits. [ABSTRACT FROM AUTHOR]

The objective is to describe the outcome and complications of two cats treated with a hemi plus rostral part contralateral mandibulectomy (1 ½ mandibulectomy) technique for the management of oral squamous cell carcinoma (SCC) with bone infiltration. Mandibulectomy can be performed in cats but unlike canine patients, they may require additional supportive care. Two cats were presented for progressive mass growing on the mandible. Both had bone invasion and were diagnosed with SCC by biopsy examination. The procedure involved a left/right mandibulectomy and the rostral part of the right/left hemimandible caudal to the lower canine tooth (1 ½ mandibulectomy), at least 1 cm far from the macroscopically visible lesions. Both cats had feeding tubes placed. The surgical outcome for one of the two cats was excellent, surpassing 302 days of survival, the other cat did not regain the ability to eat and the owners opted for euthanasia 35 days after surgery. Both histopathological reports confirmed SCC and clean margins. The hypothesis of the study reported here was that 1 ½ mandibulectomy would be effective for control of superficial subcentimetrical, caudal to the canine tooth oral SCC with bone invasion in cats but could also lead to permanent loss of feeding function and compromised quality of life. [ABSTRACT FROM AUTHOR]

Previous research suggests that people, especially religious people, are more opposed to active euthanasia, such as a lethal injection, than to passive euthanasia, such as withdrawing life support. The current research proposes a possible explanation for this finding--that active euthanasia is viewed as interfering with the natural course of life and death, but passive euthanasia is viewed as allowing it to take place. Two studies yielded results consistent with this hypothesis and found that how people think about the natural course of life and death substantially explained the greater opposition to active euthanasia among more religious people. [ABSTRACT FROM AUTHOR]

The recent inventions in the Information Technology (IT) have transformed the world into a global village wherein the geographical boundaries have vanished significantly. The recent pandemic Covid-19 has again proved the affiliation of the world. IT coupled with the Artificial Intelligence has revolutionized the medical science. It has demystified various terminal diseases; however, the "man is still mortal". A good number of diseases are still terminal and cause incurable, unbearable pain, mental and financial trauma for the victims and their family. The surety of death in near-term originated the thought of Euthanasia or mercy killing. Euthanasia in simple words refers to a voluntary/consent as given by the patient to terminate the life in a dignified manner to get relieved from sufferings. Different countries have different variation of Euthanasia. This Article aims to study the euthanasia practice in Netherlands, Canada, and India. India is a country where recently Supreme Court has recognized passive Euthanasia and Living Will. [ABSTRACT FROM AUTHOR]

Human beings cannot function without the categorical (human) mind. The human mind, via cognition, functions in a both-and manner, affording the dynamic exchange between the categories of person and environment. However, the categorical human mind has never been examined dialectically from a Daoist Psychology perspective. While dialectical thinking is universal both in the East and West, little attention has been paid to the categorical human mind from a Daoist yin and yang approach (i.e., opposite but interconnected). We explore the relationship between the human mind and the envirnoment, as informed by a dialectical Daoist yin-yang perspective. Like the Daoist yin and yang, the unfolding of mind and environment can be understood as passive (yin) and, equally as much, as active (yang). The categorical human mind can influence the environment and experience (i.e., active mind), and also may be influenced itself (i.e., passive mind) by the environment or experience. Both the mind and environment operate across active (yang) and passive (yin) processes that are independent yet interconnected forces which mutually arise (like yin and yang). We discuss this dialectical Daoist yin-yang perspective of mind by focusing on categorical cognition and perception, social totemic cognition, stereotyping, and human development. These examples help to illustrate the both-and processes that underlie the categorical human mind, emphasizing the mind as dialectical (i.e., Daoist yin-yang view); that is, independent while also interdependent and interactive, and featuring both active and passive capacities at the same time. The dialectical Daoist yin-yang view teaches us that human categorical mind is dependent on, as well as independent of, the situation and ecological environment. [ABSTRACT FROM AUTHOR]

Aim. The aim of this review was to support nursing management in creating frameworks for the care of people requesting hastened death, based on the best available evidence on the experiences of nurses. Background. The legalisation of hastened death presents nurses with a complex set of ethical and moral risks. The largely unregulated role of nurses in the politics of hastened death can lead to moral distress and burnout. Evaluation. A systematic database search was conducted in CINAHL, LIVIVO, Medline, OVID, and Web of Science. The meta-aggregative approach was used to synthesise the findings. Quality appraisal was done using criteria of the Joanna Briggs Institute. Key Issues. Sixteen studies from four different countries were included. Interview data were from 200 nurses. Meta-aggregation resulted in ten synthesised findings including the need for guidelines; time resources; a supporting team; and professional, social, and personal skills. Conclusions. A working environment with clear guidelines, sufficient resources, structured professional adjustment programmes, and educational measures is supportive for nurses. Implications for Nursing Management. Nursing management should create a professional strategy, guidelines, promote good team culture, implement education, and training activities. [ABSTRACT FROM AUTHOR]

Chang claims that this bit of dogma should be abandoned, in much the same way (although Chang does not make this point) that the analogous claims about distance had to be abandoned with the theory of general relativity. They are still reasons, just bad ones.) The possibility of bad reasons renders the difference between Chang's view and the one that I sketched more than merely terminological because it shows another role for rational agency, one that Chang does not consider. Ruth Chang presents three "dogmas of normativity" that she believes underlie a great deal of current thought and theorizing, leading to mistakes and confusions.[1] For my part, I believe the use of the word "normativity" is, itself, something like a bit of dogma doing damage; it has become a technical term lacking precision, which I find best to avoid, at least when speaking in my own voice - and so I am ready to believe that any number of subdogmas are also doing damage. Footnotes 1 Chang, Ruth. [Extracted from the article]

OBJECTIVES: The objectives were to describe mortality and causes of death in children with intraventricular hemorrhage (IVH) and to study neurodevelopmental outcomes. METHODS: The study was a secondary analysis of the French national prospective and population-based cohort EPIPAGE-2. Children were recruited in 2011. A standardized assessment was conducted at age 5. Children born before 32 weeks' gestation and admitted to a NICU were eligible. Exposure was IVH defined by the Papile classification. Main outcomes were mortality, causes of death, and neurodevelopmental outcomes at age 5. RESULTS: Among the 3468 children included, 578 (16.7%) had grade 1 IVH, 424 (12.2%) grade 2 IVH, and 114 (3.3%) grade 3 IVH; 144 (4.1%) had intraparenchymal hemorrhage (IPH). Mortality was 29.7% (36 of 114) for children with grade 3 IVH and 74.4% (109 of 144) for those with IPH; 67.6% (21 of 31) and 88.7% (86 of 97) of deaths, respectively, were because of withholding and withdrawing of life-sustaining treatment. As compared with no IVH, low-grade IVH was not associated with measured neurodevelopmental disabilities at age 5. High-grade IVH was associated with moderate and severe neurodevelopmental disabilities, reduced full-scale IQ, and cerebral palsy. CONCLUSIONS: Rates of neurodevelopmental disabilities at age 5 did not differ between children without IVH and those with low-grade IVH. For high-grade IVH, mortality rate was high, mostly because of withholding and withdrawal of life-sustaining treatment, and we found a strong association with overall neurodevelopmental disabilities in survivors. [ABSTRACT FROM AUTHOR]

Musician's dystonia presents with a persistent deterioration of motor control during musical performance. A predominant hypothesis has been that this is underpinned by maladaptive neural changes to the somatotopic organization of finger representations within primary somatosensory cortex. Here, we tested this hypothesis by investigating the finger-specific activity patterns in the primary somatosensory and motor cortex using functional MRI and multivariate pattern analysis in nine musicians with dystonia and nine healthy musicians. A purpose-built keyboard device allowed characterization of activity patterns elicited during passive extension and active finger presses of individual fingers. We analysed the data using both traditional spatial analysis and state-of-the art multivariate analyses. Our analysis reveals that digit representations in musicians were poorly captured by spatial analyses. An optimized spatial metric found clear somatotopy but no difference in the spatial geometry between fingers with dystonia. Representational similarity analysis was confirmed as a more reliable technique than all spatial metrics evaluated. Significantly, the dissimilarity architecture was equivalent for musicians with and without dystonia. No expansion or spatial shift of digit representation maps were found in the symptomatic group. Our results therefore indicate that the neural representation of generic finger maps in primary sensorimotor cortex is intact in musician's dystonia. These results speak against the idea that task-specific dystonia is associated with a distorted hand somatotopy and lend weight to an alternative hypothesis that task-specific dystonia is due to a higher-order disruption of skill encoding. Such a formulation can better explain the task-specific deficit and offers alternative inroads for therapeutic interventions. [ABSTRACT FROM AUTHOR]

Acoustic myography (AMG) noninvasively probes muscle activity. We explored whether AMG captures abnormal motor activity in patients with Parkinson's disease (PD) and how this activity is modulated by antiparkinsonian medication. Twenty patients with PD underwent AMG of the biceps, triceps, extensor carpi radialis longus, and adductor policis muscles of the more affected arm during active and passive movements, using a mobile AMG device (CURO, Denmark). AMG and assessment of motor symptoms were performed in a pragmatic off‐medication state, as well as one and 3 h after oral intake of 200 mg levodopa. Three AMG parameters were calculated using the CURO analysis system. Motor efficiency was expressed by the E‐score, muscle fiber recruitment by the temporal T‐score, spatial summation by the S‐score, and S/T ratio. Twenty age‐ and sex‐matched healthy subjects served as controls. Group mean values were statistically compared using unpaired two‐tailed adjusted t‐test and ANOVA with Tukey´s correction for multiple comparison (p ≤ 0.05). For the biceps and extensor carpi radialis longus muscles, the active movement S:T ratio was lower in PD relative to healthy controls. The E‐score was also lower during active and passive flexion/extension movements in the off‐medication state. No significant between‐group differences in the AMG scores were noted for the triceps muscle during active or passive movements. The active S:T ratio and the E‐score during active elbow flexion and extension may offer a useful means to quickly assess abnormal motor activity and the effect of drug treatment in PD. [ABSTRACT FROM AUTHOR]

In Agnotology: The Making and Unmaking of Ignorance, edited by Robert Proctor and Londa Schiebinger, 90 - 107. This timely work provides the fullest account to date of "agnotology" - the study of ignorance - and how much of this ignorance is produced by science whether intended or unintended.[1] Whether it be global warming, the health risks of smoking, the pros and cons of prescription drugs or environmental pollution, public opinion remains confused, uninformed or variously misinformed and in each case this ignorance - as is compellingly argued here - has been created, manipulated and exploited by an increasingly "politicized" if not commercialized science industry.[2] According to this revisionist perspective, ignorance has acquired a new dimension of complexity: now defined no longer as the void that precedes knowledge or even the result of shifting concentrations but also as something socially constructed: "the confusion produced, for instance, when special interests block access to information or even create misinformation" (3). In Agnotology, edited by Robert Proctor and Londa Schiebinger, 1 - 36. [Extracted from the article]

Background: Surgical abdominal emergencies in calves are associated with a guarded prognosis and have the potential for complex metabolic derangements including acid‐base imbalances. Objectives: To perform a comprehensive analysis of acid‐base status and to assess the prognostic relevance of preoperative clinicopathologic variables in calves undergoing abdominal surgery. Animals: Hospital‐based study samples of 535 (dataset 1; DS1) and 83 calves (dataset 2; DS2). Methods: Retrospective (DS1) and prospective (DS2) case series. Results: In DS1, acidemia (pH <7.33) was present in 49.9%, whereas alkalemia (pH >7.37) was present in 30.7% of calves. Plasma L‐lactate, chloride, and serum inorganic phosphorus concentration accounted for 51.9%, 11.6% and 9.4% of the variation of venous blood pH, respectively. Classification tree analysis indicated that a negative outcome (death or euthanasia during hospitalization) was associated with venous pO2 ≤33.6 mm Hg, anion gap >18.3 and >22.9 mEq/L, serum albumin concentration ≤36.5 and ≤29.4 g/L, serum urea concentration >4.4 mmol/L, and plasma ionized calcium concentration ≤1.26 mmol/L. The area under the receiver operating characteristic curve of this model was 0.85 (95% CI: 0.82‐0.89, P <.001) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut‐point of 0.5 was 89.8% and 65.7%, respectively. In DS2 the model had a similar sensitivity and specificity of 90.5% and 70%, respectively. Conclusions and Clinical Importance: Clinicopathologic imbalances and associated changes of acid‐base status are common in calves with surgical abdominal emergencies and have clinical utility for the prediction of a negative postoperative outcome. [ABSTRACT FROM AUTHOR]

Introduction: Surgical replacement of dysfunctional cardiac muscle with regenerative tissue is an important option to combat heart failure. But, current available myocardial prostheses like a Dacron or a pericardium patch neither have a regenerative capacity nor do they actively contribute to the heart's pump function. This study aimed to show the feasibility of utilizing a vascularized stomach patch for transmural left ventricular wall reconstruction. Methods: A left ventricular transmural myocardial defect was reconstructed by performing transdiaphragmatic autologous transplantation of a vascularized stomach segment in six Lewe minipigs. Three further animals received a conventional Dacron patch as a control treatment. The first 3 animals were followed up for 3 months until planned euthanasia, whereas the observation period for the remaining 3 animals was scheduled 6 months following surgery. Functional assessment of the grafts was carried out via cardiac magnetic resonance tomography and angiography. Physiological remodeling was evaluated histologically and immunohistochemically after heart explantation. Results: Five out of six test animals and all control animals survived the complex surgery and completed the follow-up without clinical complications. One animal died intraoperatively due to excessive bleeding. No animal experienced rupture of the stomach graft. Functional integration of the heterotopically transplanted stomach into the surrounding myocardium was observed. Angiography showed development of connections between the gastric graft vasculature and the coronary system of the host cardiac tissue. Conclusions: The clinical results and the observed physiological integration of gastric grafts into the cardiac structure demonstrate the feasibility of vascularized stomach tissue as myocardial prosthesis. The physiological remodeling indicates a regenerative potential of the graft. Above all, the connection of the gastric vessels with the coronary system constitutes a rationale for the use of vascularized and, therefore, viable stomach tissue for versatile tissue engineering applications. [ABSTRACT FROM AUTHOR]

Introduction: The medical fraternity now has more control over the processes of life and death due to advances in medical technology and equipment. Euthanasia has been debated around the world for more than half a century and it continues to raise important questions in medical ethics, moral theology, civil rights and liberty. Physicians' attitudes to life and death emerge to relate their end-of-life decision-making, although usually carried out at the request of ailing person. Physicians' contemplation on euthanasia is a vital building block in the path towards any change, in the euthanasia situation in a country. Aim: To determine perception and attitude towards passive euthanasia among doctors in Regional Institute of Medical Sciences, Manipur, India and to evaluate the association between attitude and variables favourable to passive euthanasia. Materials and Methods: A cross-sectional survey in the Regional Institute of Medical Sciences (tertiary care hospital), Manipur, India, between October 2018 and September 2020, in Northeast was carried out among 673 doctors. A selfadministered questionnaire was designed and approved by three specialists with expertise in palliative care and medical ethics. The questionnaire had a total of 46 questions in English language, of which 15 questions were on socio-demographic profile, 13 were attitude questions and 18 were questions on perception towards passive euthanasia. Attitude questions were scored using 5-point Likert scale from strongly disagree (-2) to strongly agree (+2). Total attitude score ranges from -26 to +26. Score above zero was considered to have positive attitude and vice-versa. There was no scoring to determine perception towards euthanasia. The questionnaires were given to the doctors and postgraduate trainees of clinical and non clinical specialities in a tertiary care hospital in North Eastern India during their work hours. Data were summarised using descriptive statistics. Chi-square test was used to assess factors favouring attitudes toward passive euthanasia. Results: Age of the respondents ranged from 24 years to 63 years, with a mean age of 37.1±10.7 years and mean duration of experience was eight years. Out of 577 respondents, 368 (63.8%) were postgraduate trainees and 209 (36.2%) were doctors. Majority (463, 80.2%) of the respondents had positive attitude, 97 (16.9%) had negative attitude and 17 (2.9%) had neutral attitude. Total 543 (94.1%) respondents agreed that declaration from patient/family members must be obtained before the act of passive euthanasia. Also, the quality of life as viewed by the patient himself (452, 78.3%) and humanitarian basis (372, 64.4%) were the important factors in influencing decision making regarding passive euthanasia on a terminally ill patient. There was no significant association between sex, religion, specialisation, Intensive Care Unit (ICU) experience and attitude towards passive euthanasia. Conclusion: Majority of the respondents had positive attitude towards passive euthanasia in the face of intractable suffering and terminal illness. Hastened death looks easier to the patients and family because of physical suffering and financial burdens they are subjected to. The doctors got request for euthanasia by the patients and relatives which reflects the public awareness on euthanasia. [ABSTRACT FROM AUTHOR]

Crohn's disease affects many women of childbearing age. Fecundity rates are often lower than in the general population due to reduced fertility during active inflammation, effects of pelvic surgery or voluntary childlessness. Many women have concerns regarding the effects of pregnancy on their Crohn's, any potential effect of medication on the fetus, and passing on Crohn's disease to the offspring. International guidelines on reproduction for women with Crohn's disease provide evidence-based advice to patients and health care professionals. There is an increasing literature on the safety of advanced medication for Crohn's disease during pregnancy. This review article therefore focuses on obstetric considerations beyond medication safety. We provide information on fertility, factors affecting pregnancy and fetal outcomes, obstetric complications, factors influencing mode of delivery, management of intestinal stomas during pregnancy and general considerations around breast feeding. [ABSTRACT FROM AUTHOR]

Background: To evaluate whether insertion of self-biodegradable stent into the pylorus to prevent delayed-gastric emptying after pylorus-preserving gastrectomy is feasible and safe through porcine experiment. Methods: Self-biodegradable dumbbell-shaped pyloric stents were designed from absorbable suture materials: poly(glycolide-co-caprolactone) (PGCL) or poly-p-dioxanone (PPDO). After gastrotomy on ten pigs, each stent was inserted: two shams, four PGCL stents, and four PPDO stents. Body weight (Bwt), body temperature (BT), complete blood cell (CBC) count, and plain X-ray were evaluated. On postoperative day (POD) 13, euthanasia was performed for histologic evaluation. Results: Operation was successfully performed in all ten pigs. Without tagging suture, both stents migrated before POD 3. The migration was delayed up to POD 13, when the tagging sutures (-t) were applied between stent and stomach wall. Self-degradation of PGCL started from POD 3, and stents were completely excreted from the abdomen by POD 8. Although PPDO were also weakened as self-degradation progressed, its shape was maintained in gastrointestinal tract for 13 days. Unexpected sudden death occurred in the pig with PPDO-t2 on POD 10, which is more likely due to acute volvulus rather than stent-related complication. There was no significant difference between three groups in terms of Bwt, BT, CBC, and histology (sham vs. PGCL vs. PPDO, all p > 0.05). Conclusion: The concept of biodegradable stents made of absorbent suture material seems feasible in porcine experiment. Among them, PGCL which has shown rapid absorption, appears to be a more suitable material for transient pyloric absorbable stent when considering safety aspect. [ABSTRACT FROM AUTHOR]

Euthanasia is an act of intentionally not doing something aimed at prolonging someone's life or intentionally doing something to shorten or also end the life of a patient which is carried out to hasten his death, while enabling a good death without unnecessary suffering. Thus, in practice, in a terminal condition, a doctor may or may not perform an act that may result in the death of a patient in accordance with the written request of the patient/family. This dilemmatic condition requires legal certainty in order to uphold justice and humanity as well as legal protection. The problems are 1) How is passive euthanasia applied for terminal patients? 2) How is legal certainty in the application of euthanasia in Indonesia? 3) How is the implementation of euthanasia that meets the community's sense of justice? To answer these problems, a research using normative juridical methods is needed through primary data collection in the form of empirical data from interviews and filling out questionnaires about knowledge and level of agreement on euthanasia. Secondary data in the form of research on primary, secondary and tertiary legal materials. 8The results of the study show that the implementation of regulations in the Act and Ministerial Regulations that lead to the implementation of euthanasia has so far been applied, especially to terminal patients. However, the legal certainty of the act has not been clearly described because there are rules that are not in line. Euthanasia cannot be equated with ordinary homicide. To fulfill justice and humanity as well as legal protection, euthanasia regulations are needed in a harmonious positive law. [ABSTRACT FROM AUTHOR]

Advanced directives (AD's) have been legalized by the Supreme Court of India, in Common Cause vs Union of India. These are written witnessed legal documents by which patients can give explicit instructions as to the nature and extent of medical intervention to be given in a pre-defined and presupposed situation when they may not be in a position to communicate consent. Physicians have been demanding legalization of Do Not Attempt Resuscitation (DNAR) from time to time and various associations have put forwards their statements and policy documents for the same. However, the Supreme Court of India while recognizing passive euthanasia as a means of upholding patient autonomy, has remained silent on DNAR. Legally no difference exists between act of commission and act of omission, if acting is a duty. Causing death of a person by an act, provided the act has hastened death and death would not have occurred in the absence of that act, is same as not helping him. Even with regards to passive euthanasia, the Supreme Court has issued directions that are hard to follow in principle by both the common man and the physicians. There is a need to rationalise the process and make it user friendly. The present guidelines on passive euthanasia seem to be impracticable and too cumbersome to be effectively adhered to. And, there needs to be a legal clarity on the status of DNAR. [ABSTRACT FROM AUTHOR]

Background: Providing palliative care to patients who withdraw from life-sustaining treatments is crucial; however, delays or the absence of such services are prevalent. This study used natural language processing and network analysis to identify the role of medications as early palliative care referral triggers. Methods: We conducted a retrospective observational study of 119 adult patients receiving specialized palliative care after endotracheal tube withdrawal in intensive care units of a Taiwan-based medical center between July 2016 and June 2018. Patients were categorized into early integration and late referral groups based on the median survival time. Using natural language processing, we analyzed free texts from electronic health records. The Palliative trigger index was also calculated for comparison, and network analysis was performed to determine the co-occurrence of terms between the two groups. Results: Broad-spectrum antibiotics, antifungal agents, diuretics, and opioids had high Palliative trigger index. The most common co-occurrences in the early integration group were micafungin and voriconazole (co-correlation = 0.75). However, in the late referral group, piperacillin and penicillin were the most common co-occurrences (co-correlation = 0.843). Conclusion: Treatments for severe infections, chronic illnesses, and analgesics are possible triggers for specialized palliative care consultations. The Palliative trigger index and network analysis indicated the need for palliative care in patients withdrawing from life-sustaining treatments. This study recommends establishing a therapeutic control system based on computerized order entry and integrating it into a shared-decision model. [ABSTRACT FROM AUTHOR]

The article discusses the current status of euthanasia laws in Chile, Peru, Ecuador, and Colombia. In Chile, a law from 2012 prohibits euthanasia and assisted suicide, and a bill to legalize euthanasia is currently pending in the senate. However, it is expected to be dismissed due to other pressing issues. In Peru and Ecuador, euthanasia is also prohibited but has been allowed in single cases by high courts. Colombia is the only country that has decriminalized medically assisted suicide and active euthanasia, but implementation may be challenging due to the influence of the Catholic Church and conservative politics. The author supports permissive regulation on euthanasia but emphasizes the need to move beyond rhetoric and focus on unbiased lawmaking. [Extracted from the article]

The article discusses decision-making for these patients should be based on similar considerations as for other fragile critically ill patients facing uncertain futures. But this is not the case. Topics include the quality of life of survivors is acceptable to them and their families in the vast majority of cases.

Palliative care (PC) teams commonly encounter patients with disorders of consciousness (DOC) following anoxic or traumatic brain injury (TBI). Primary teams may consult PC to help surrogates in making treatment choices for these patients. PC clinicians must understand the complexity of predicting neurologic outcomes, address clinical nihilism, and appropriately guide surrogates in making decisions that are concordant with patients' goals. The purpose of this article was to provide PC providers with a better understanding of caring for patients with DOC, specifically following anoxic or TBI. Many of the tips acknowledge the uncertainty of DOC and provide strategies to help tackle this dilemma. [ABSTRACT FROM AUTHOR]

During the first wave of the COVID-19 pandemic in Italy, practitioners had to make tragic decisions regarding the allocation of scarce resources in the ICU. The Italian debate has paid a lot of attention to identifying the specific regulatory criteria for the allocation of resources in the ICU; in this paper, however, we argue that deciding such criteria is not enough for the implementation of fair and transparent allocative decisions. In this respect, we discuss three ethical issues: (a) in the Italian context, the treating physician, rather than a separate committee, was generally the one responsible for the allocation decision; (b) although many allocative guidelines have supported moral equivalence between withholding and withdrawing treatments, some health professionals have continued to consider it a morally problematic aspect; and (c) the health workers who have had to make the aforementioned decisions or even only worked in ICU during the pandemic often experienced moral distress. We conclude by arguing that, even if these problems are not directly related to the above-mentioned issues of distributive justice, they can nevertheless directly affect the quality and ethics of the implementation of allocative criteria, regardless of those chosen. [ABSTRACT FROM AUTHOR]

Aims: Although extracorporeal cardiopulmonary resuscitation (ECPR) improves survival outcomes in refractory cardiac arrest, morbidity and mortality remain significantly high. Information on causes of death in ECPR is limited; however, some evidence suggests withdrawal of life sustaining therapy (WLST) is a major factor in ECPR-associated mortality. We sought to describe the patients experiencing WLST after ECPR.Methods: The international Extracorporeal Life Support Organization (ELSO) Registry was retrospectively queried for patients more than 18 years old supported with ECPR who underwent WLST due to family request from 2007 to 2017. These patients were split into groups for descriptive and multivariable analysis: early (WLST < 72 hours from cannulation) and routine WLST.Results: Overall, 411 ECPR patients experienced WLST (median age 42 years IQR = 28-51; 31.7% female) over the 10-year period. 55.5% (n = 228) underwent early WLST with a median ECPR duration of 24 hours (IQR = 7-48) versus routine WLST (median = 147 hours; IQR = 105-238). In multivariable regression analysis, lower arterial blood gas pH (aOR = -3.1; 95% CI = 2.18-2.8; p = 0.04), arterial oxygen saturation (aOR = 1.12; 95% CI = 1.01-1.23; p = 0.02), and higher peak inspiratory pressure (aOR = 0.84; 95% CI = 0.71-1.00; p = 0.05) were independently associated with early WLST. Early WLST patients experienced higher rates of all ECMO-related complications except for infections.Conclusions: More than half of ECPR patients experienced early WLST within 72 hours. The patients with early WLST had worse markers of severe critical illness at 24 hours and experienced higher rates of complications. Further research should include an appropriate control group to better adjust confounders for ECPR-associated death and focus on prognostication. [ABSTRACT FROM AUTHOR]

End-of-life decision-making is a complex process and more challenging when decisions are made for others. Little is known about Thai family members' involvement in decision-making to withdraw life-sustaining treatments (LSTs) from loved ones with serious illnesses. This qualitative study explores the experiences of family caregivers in Southern Thailand regarding decisions related to LST withdrawal. In-depth interviews were used to gather data from fifteen primary caregivers, who were involved in LST withdrawal decision-making. Content analysis was applied, and several techniques, such as member-checking and peer debriefing, were used to enhance trustworthiness. Four main themes were identified: facing dilemmas, weighing up options, making a consensual decision, and accepting the reality of life. The findings pointed out the significant roles played by family meetings and early end-of-life discussion in the process of decision-making to withdraw LSTs from loved ones. Further research on communication among patients' family members and health care providers is recommended. [ABSTRACT FROM AUTHOR]

Background: Assisted dying for adults with psychiatric conditions (APC) is highly controversial but legally possible in a few countries, including Belgium. Previous research has suggested that the complex euthanasia assessment procedure may cause additional suffering in APC but may also induce positive experiences. This study reports on the impact of the euthanasia assessment procedure as experienced by APC on three counts: 1) their mental state, including death ideation; 2) their treatment trajectory; 3) their social relationships. Methods: We performed an in-depth qualitative interview study with 16 APC in Flanders, Belgium, who had voiced a euthanasia request between 2016–2020. Thematic coding was used. Findings: We interviewed 16 APC. Euthanasia assessment procedures brought out a plethora of experiences in APC, both favourable and unfavourable. Whereas thoughts of suicide remain present to a certain extent, being in the assessment procedure allows some APC to reconsider alternatives towards life, and also to attempt new treatment options. However, many APC experience ambivalence about the supposedly inherent desirability and dignity in euthanasia. Worries also surfaced about the rationale behind and effects of involvement of APCs' social circle, and about the impact it could have on them. Conclusion: Further research, including other stakeholder perspectives, is recommended with a view to maximising favourable and minimising unfavourable impacts for all involved. In clinical practice attention to these impacts is paramount, and clear communication and management of expectations between physician and patient, seems appropriate to address the many ambivalent experiences that accompany APC during the euthanasia assessment procedure. Policy attention could in this regard go to clarifying certain sources of ambivalence and issues that are insufficiently addressed, such as modalities of relatives' involvement. [ABSTRACT FROM AUTHOR]

Introduction: Proprioceptive neuromuscular facilitation (PNF) is the preferred method of treatment to improve patient’s well-being by several physiotherapists in Malaysia. It is a stretching technique practiced improving muscle elasticity, increasing muscle thickness, improve dynamic balance and to produce positive effects on active and passive range of motions. The objective of this study is to investigate the immediate effects of PNF stretching exercises on heart rate, blood pressure & electrical conduction of the heart among young adults. Method: Young adults (50 participants) were selected to undergo the hold-relax PNF stretching exercise for upper limbs (biceps muscle) and lower limbs (hamstring muscle). All the participants were assigned four sets of a combination of passive movement, isometric contraction, and passive stretching for both upper and lower limbs. Preliminary data (before exercise) and post-data (after exercise) for heart rate and blood pressure were measured and recorded. The data were statistically evaluated by Paired-sample T test and Non-parametric Sign test at (p<0.05) level of confidence (using SPSS 23.0). Result: A paired samples t-test was performed to compare lower limb pre-testing (SBP_LL_pre-test) and post-testing (SBP_LL_post-test). The results showed that there was a significant difference in the scores for SBP_LL_pre-test (M=114.98, SD=8.714) and SBP_LL_post-test (M=118.86, SD=9.94); t (49) =-2.28, p=0.027. Conclusion: There are no significant changes for heart rate, diastolic blood pressure, pre-interval lower limb and QT interval post-PNF stretching exercise. Significant changes are found in systolic blood pressure for the upper limb post-PNF stretching exercise. The PNF stretching exercises are safe in clinical practice. [ABSTRACT FROM AUTHOR]

Should prisoners be allowed to access assisted suicide? Whereas the ethical and legal issues regarding assisted suicide have now been extensively discussed in the literature, surprisingly scarce attention has been given to the pressing issue of inmates requesting assistance in dying. Through an analysis supported by the Swiss legal framework, I first argue that the principle of equivalence in prison medicine, which states that prisoners ought to receive the same level of health care as the general population does not prove a solid basis in arguing for prisoners' right to assisted suicide. Over the course of the paper, I defend the view that the right to access assisted suicide is to be understood as a liberty that cannot be removed from incarcerated individuals. I argue that removing such a liberty cannot be consistently held within a legal framework where the death penalty does not exist, for doing so necessarily forgoes the State's ability to decide on when and how prisoners' lives end, in turn necessarily leaving them the liberty to end theirs when they decide so. I finally argue against the position that the capacity for autonomous choice is lacking in inmates by disentangling the particular features of the prison‐setting and show that the context of incarceration is not so substantially different from regular cases of suicide assistance that it warrants a difference in treatment. The position I propose proves important in order to both respect prisoners' rights and ensure they retain a minimum level of control over their existences. [ABSTRACT FROM AUTHOR]

Voluntary assisted dying (VAD) is a provocative and ethically charged subject that will potentially be an increasing component of our clinical practice. This paper aims to give the history of VAD, ethical principles, controversies and international perspectives regarding the laws in each jurisdiction. It provides a discussion on the topic with respect to gynaecological oncology to enable clinicians to feel more comfortable with this difficult subject. [ABSTRACT FROM AUTHOR]

Objectives: Differences in decisions to limit life-sustaining therapy are often supported by perceptions that patients receive unnecessary and expensive treatment which provide negligible survival benefit. However, the assumption behind those beliefs-that is, that life-sustaining therapy provides no significant marginal survival benefit-remains unproven. Our objective was to quantify the effects of variations in decisions to withdraw or withhold life-sustaining treatment on 180-day mortality in critically ill patients.Design: Retrospective observational cohort study of a national clinical database.Setting: Adult ICUs participating in the Intensive Care National Audit and Research Center Case Mix Program in the United Kingdom.Patients: Adult patients admitted to general ICUs between April 1, 2009, and March 31, 2016.Measurements and Main Results: During the study period, 795,721 patients were admitted to 247 ICUs across the United Kingdom. A decision to withdraw or withhold life-sustaining treatment was made for 92,327 patients (11.6%). A multilevel model approach was used to estimate ICU-level practice variation. The ICU-level practice variation was then used as an instrument to measure the effects of decision to withdraw or withhold life-sustaining treatment on 180-day mortality. The marginal population was estimated to be 5.9% of the total cohort. A decision to withdraw or withhold life-sustaining treatment was associated with a marginal increase in 180-day mortality of 25.6% (95% CI, 23.2-27.9%).Conclusions: Decision to withdraw or withhold life-sustaining treatment in critically ill adults in the United Kingdom was associated with increased 180-day mortality in the marginal patients. The increased mortality from a decision to withdraw or withhold life-sustaining treatment in the marginal patient may be informative when establishing patients' preferences and evaluating the cost-effectiveness of intensive treatments. [ABSTRACT FROM AUTHOR]

The case of Alta Fixsler, where a judge ruled that withdrawing life sustaining care was in her best interest rather than transferring her to Israel, as her parents wanted, is the latest in a series of controversial paediatric best interest decisions. Using this case, as well as some other recent cases, I argue that the UK exhibits a high degree of medico-legal paternalism in best interest decisions, even though paternalism seems to be ubiquitously negatively perceived in medical ethics. Firstly, I explain what I mean by medico-legal paternalism and defend my claim that this phenomenon is present in the UK. I then argue that at least philosophically (rather than legally) such a situation is impossible to justify in a secular state and that how we treat paediatric best interest decisions is very different from other areas of medical law. Lastly, I discuss proposals that aim to rectify this situation. [ABSTRACT FROM AUTHOR]