Justice in Health Care
Gary Seay, Susana Nuccetelli in Engaging Bioethics, 2017
In Shortland v Northland Health, the judgment that dialysis for Mr. Williams was “clinically inappropriate” was a judgment of medical futility based on the medical team’s assessment of his quality of life. As we saw in Chapter 7, judgments of that sort are open to challenge by those who make a different assessment of the patient’s quality of life, even if they accord with the health authority’s or managed-care company’s regulations—in this case, the New Zealand health authority. Of course, like organ transplantation and heart surgery, renal replacement therapy is a costly medical intervention of known effectiveness in postponing the death of many patients suffering from life-threatening conditions. There is sound evidence, however, that the lives of many more people can be saved when limited health funds are devoted not to rescue seriously ill patients but, for example, to prevent disease.
Practice Paper 5: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
In posterior urethral valve obstruction, remnants of embryological membranes remain in the urethra, causing urinary tract obstruction. The obstruction causes dilatation of the bladder, bilateral vesicoureteric reflux and bilateral hydronephrosis. Patients may be diagnosed antenatally by ultrasonography. Severe disease that is not noticed antenatally is usually discovered during the first days of life with anergia, a palpable bladder and deteriorating renal function. Occasionally, children with posterior urethral valves may not be diagnosed until infancy, when they present with recurrent urinary tract infection, diurnal enuresis or renal failure. Diagnosis is usually based upon the findings of a micturating cystourethrogram, which allows visualization of the valves and demonstrates any bladder and ureteric abnormalities. Treatment is with surgical correction. Severe disease may lead to end-stage renal failure, the need for renal replacement therapy and eventual renal transplantation.
Daptomycin
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Several studies have been performed with patients during continuous renal replacement therapy. Corti et al. (2013) described nine critically ill patients and reviewed the literature. Dosing recommendations varied in this special population; because of the limited data available, therapeutic drug monitoring was recommended. On the other hand, Preiswerk et al. (2013) retrospectively reviewed seven cases of continuous renal replacement therapy and also concluded that the recommended dose should be at least 6 mg/kg/day, but possibly 8 mg/kg/day for critically ill patients. They also recommended therapeutic drug monitoring to prevent underdosing. A summary of these studies is provided in Table 45.3.
Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia
Published in Journal of Obstetrics and Gynaecology, 2023
Esra Aktiz Bıçak, Süleyman Cemil Oğlak
The CT reports of patients interpreted by the radiology unit revealed that 17 (54.8%) had mild pulmonary involvement, 6 (19.4%) had moderate pulmonary involvement and 8 (25.8%) had severe pulmonary involvement (Figures 2, 3). Sixteen (51.6%) patients required HFOT, 6 (19.3%) patients required CPAP, and 5 (16.1%) patients required invasive mechanical ventilation. One intubated patient was extubated, and the others resulted in mortality. Six patients were transferred to the tertiary ICU due to the need for advanced follow-up and treatment. Sepsis complicated by septic shock and multiorgan failure occurred in 4 of those. Renal replacement therapy was performed on two of the patients with acute renal failure. Spontaneous pneumothorax developed in one patient and a left chest tube was inserted. Vasopressor therapy was performed in 3 patients with developed septic shock. The mean length of stay in the ICU and hospital was 4.9 ± 4.3 (1–18) days and 10.4 ± 5.1 (3–21) days, respectively (Table 2).
Outcomes of descending and thoracoabdominal aortic repair in connective tissue disorder patients
Published in Scandinavian Cardiovascular Journal, 2022
Magnus Jonsson, Linus Blohmé, Alireza Daryapeyma, Anders Günther, Göran Lundberg, Lena Nilsson, Carl-Magnus Wahlgren, Anders Franco-Cereceda, Christian Olsson
Patients were managed by the same team of surgeons, anesthesiologists, and perfusionists. Intraoperatively, they were placed in a right decubital position, had a double-lumen endotracheal tube to allow one-lung ventilation, and were routinely provided with a cerebrospinal fluid drain connected to an automated peristaltic pump (LiquoGuard7®, Möller Medical, Fulda, Germany) for monitoring and adjustment of cerebrospinal fluid pressure. Near-infrared spectroscopy (INVOS™ 5100, Medtronic, Minneapolis, Mn, USA) was used for neuromonitoring, with sensors placed bilaterally on the forehead and paraspinally approximately at the level of the 12th thoracic vertebra. All patients had, in addition to central venous lines, a central dialysis catheter placed for rapid volume transfusion and for postoperative continuous renal replacement therapy if needed.
Transcriptional profile changes after treatment of ischemia reperfusion injury-induced kidney fibrosis with 18β-glycyrrhetinic acid
Published in Renal Failure, 2022
Yamei Jiang, Chengzhe Cai, Pingbao Zhang, Yongsheng Luo, Jingjing Guo, Jiawei Li, Ruiming Rong, Yi Zhang, Tongyu Zhu
We noticed that the systemic renal function was inconsistent with single renal function. Creatinine of the insulted left kidney in I/R + vehicle group increased to about three times the baseline, while systemic SCr increased less than twice the baseline. Moreover, GA treatment effect could be detected in single kidney but not systemic. We concluded that, firstly, I/R-induced fibrosis model established successfully according to the worst left renal function and the increasing fibrosis marker. Deng et al. [24] reported similar method for modeling fibrosis. They clamped the left renal pedicle for 30 min to establish acute kidney injury model and from the day 7 after I/R injury, fibrosis could be detected on Masson and Sirius red staining, and α-SMA and Collagen-I were increased significantly in qPCR and western blot. Secondly, using single kidney creatinine rather than systemic SCr was more accurate to monitor renal function for this model. We might say the normal or mild higher creatinine of the contralateral right kidney was temporary. The function of it gradually deteriorated due to the infiltration of a large amount of inflammatory cells [25]. In the long term, both kidneys will fibrotic and SCr will be much higher without any intervention. Just like in many clinical settings, patients with kidney diseases such as glomerulonephritis will have worse and worse renal function, in the end needing renal replacement therapy.
Related Knowledge Centers
- Acute Kidney Injury
- Chronic Kidney Disease
- Hemodialysis
- Hemofiltration
- Kidney Failure
- Peritoneal Dialysis
- Blood
- Kidney Transplantation
- Kidney
- Kidney Dialysis