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Seriously ill patients who indicate they want resuscitation are more likely to get physician involvement during cardiac arrest.
The results of a study were published in the Dec. 22/29 issue of The Journal of the American Medical Association. Further, resuscitation was likely in patients who had more than a two-month survival expectancy, according to the results.
Other factors, including medical practice at a particular facility also play a role in the decision to resuscitate, notes Sarah J. Goodlin of LDS Hospital in Salt Lake City, who was the lead researcher for the study.
Get patients involved in decisions
Goodlin and colleagues analyzed the outcomes of 2,505 seriously ill patients whose hearts stopped beating while hospitalized. Of those, 514 patients received cardiopulmonary resuscitation (CPR) in efforts to revive them. Approximately 18% of those who received resuscitation survived for the duration of the hospital stay. "Patients who had CPR were younger, more often African American, and more often male," the researchers observe.
The remaining patients who died without resuscitation attempts had do-not-resuscitate orders in place. At the same time, 9% of the patients who died without CPR gave no indication that CPR should not be attempted, while 42 patients indicated they wanted CPR to be attempted but didn’t receive it. Some clinical situations, however, appear to offer little hope of CPR effectiveness and physicians therefore don’t attempt it, the researchers note.
Goodlin and colleagues say it’s important for patients with serious illnesses to discuss with their physicians the situations in which they would and would not like to have resuscitation attempted. "One thing we found was that two-thirds of the patients died within a day or two of an attempted CPR, and this may mean they die a less comfortable death than they would have if care were directed at maintaining comfort," states Goodlin.
Recent media reports of the successful cloning of a Japanese bull disproves the notion that cells become too stale to duplicate. Ear cells were taken from the 17-year-old bull, frozen, then cultured in a lab over several months.
Until now, cells used for cloning have been implanted either fresh or after fewer than 10 passages, which are periods in a culture medium, researchers note. In this study, however, cells from the bull went through up to 15 passages over three months before being used to clone the calves. A total of six calves were cloned, but only two survived.
The experiment was conducted jointly through the University of Connecticut in Storrs and the Kogashima Cattle Breeding Develop ment Institute in Japan. Researchers involved in the experiment suggest that cells eventually could be used to create clones at any time, even after the original animals are dead.
More importantly, however, it means clones could be made from cells that have been kept in labs long enough to manipulate genes, which can be a lengthy and meticulous process.
Physicians lack completeness for informed decision making when it comes to involving patients. That’s according to research published in the Dec. 22/29 issue of The Journal of the American Medical Association.
"We found that only 9% of all clinical decisions met our criteria of completeness for informed decision making," says Clarence Braddock, MD, MPH. Braddock is assistant professor of medi -cine at the University of Washington School of Medicine in Seattle and was the lead author of the study.
Braddock says even when less-stringent criteria was used, only about one in five discussions were complete by the minimum measure.
More than 1,000 audiotapes of interactions between physicians and patients in an outpatient setting were studied. The presence of seven markers were considered part of a completely informed decision process. They are:
• the patient’s role in decision making;
• the nature of the decision;
• pros (benefits) and cons (risks) of the alternatives;
• uncertainties associated with the decision;
• an assessment of the patient’s understanding of the decision;
• an exploration of the patient’s preferences.
Discussions were rated as basic, intermediate, or complex. Patients often were told about the nature of a problem, but physicians infrequently explored whether patients understood the decision, notes Braddock.
Physicians cite time, according to Braddock, as the major reason they don’t involve patients in the process. "There’s a perception that it will take too much time, be too onerous, and patients won’t understand. It’s easier to write a prescription and say, Take this.’"
The nation’s largest pro-life educational organization wants the National Institutes of Health (NIH) to correct what it calls "misinformation" in the NIH’s recent draft guidelines for human stem cell research.
American Life League president Judie Brown, in a letter to the NIH, calls for a complete ban on stem cell research and states "anything less would be the intentional promotion of criminal acts by the National Institutes of Health." American Life League comprises more than 375,000 families whose goal is to educate the public on stem cell research.
"It is clear that the guidelines sanction the deliberate destruction of these tiny human beings. The guidelines are based on a utilitar - ian code of ethics through which the weak are sacrificed for the good of the strong," Brown says.