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At least 19 recordsLinked to original sources
PubMed1991

[Clinical course of amyotrophic lateral sclerosis during life support care].

The authors provide the data on lateral amyotrophic sclerosis (LAS) in 11 patients whose life was extended during respiratory failure by respiratory resuscitation and intensive care. The disease was established to run a cyclic course. The following clinical disease periods were distinguished: period of precursors, local motor disorders period, and period of initial and marked generalization. De-efferentation was the final period. The latter one was characterized by the arrest of all motor functions, namely by total paralysis with the exception of the function of oculomotor nerves. Motoneurons of the truncus cerebri nuclei disintegrated much more slowly than those of the spinal cord. The phase of de-efferentation lasted 8 years whereas the total disease period reached 23 years. Intellectual functions were preserved whatever the disease periods. Slow progress of motoneuronal disintegration enables using the respiratory systems both inpatiently and at home. Respiratory resuscitation and intensive care can be employed, if the patient and his relatives give their consent.

Adolescent↗
PubMed1990

[Between therapeutic life support care and passive euthanasia: objective factors of intensive care in aged patients].

High medical environment in our society is related to an increase of intensive care in old patients. This situation could be looked unappropriate trying to survive people who are finishing their life. An appropriate medical evaluation and management is thus necessary in order to quantifie as fairly as possible both prognosis and specific risk. Factors at the source of mortality in elderly patients are multiple and additive. However two classes of risk can be distinguished. On the one hand some of the risk factors are intrinsic depending on the patient (i.e., neurologic impairement, age, severity of acute illness, previous health status). On the other hand some of the risk are extrinsic related to medical environment (i.e. length of stay in intensive care units, care quality...). This latter risks are improveable and thus are important to be pinpointed. Time is also powerful to assess the best prediction of outcome in old patient. Unlikely mortality rate in elderly is twofold higher (about 35%) as compared as young patients. Evaluation of intensive care unit outcome on 6 months survival make this rate worse as 10% to 20% secondary died. However most of the published studies show that duration in intensive care is similar undepending of age and outcome of the patient. It is also noted that quality of live after intensive care is the same in young or old patient. It is concluded that individual's and society's views concerning cost and effectiveness of intensive care in old patient do not always coincide with objective results. If medical motivation has to be preserved, specific care strategy remained to be established.

Age Factors↗
PubMed1992

Use of extracorporeal life support in patients with congenital heart disease.

OBJECTIVES: To review a large experience with extracorporeal life support in patients with congenital heart disease. To determine the major causes of mortality and morbidity in order to improve the results of using this technology in this patient population. DESIGN: Retrospective chart review. PATIENTS: Twenty-five patients between the ages of 1 day and 8 yrs. These patients had congenital heart disease and were clinically felt to be at high risk for death caused by cardiac failure or by respiratory failure complicated by congenital heart disease. INTERVENTIONS: All patients in this report were placed on extracorporeal life support to allow recovery of myocardial or pulmonary function. MEASUREMENTS AND MAIN RESULTS: Of these 25 patients, 52% were weaned from bypass support and 40% survived to discharge. Patients who were not weaned from extracorporeal life support characteristically suffered from irreversible neurologic injury, multiple organ failure, or bleeding complications. Only one patient died of irreversible cardiac failure. CONCLUSIONS: Extracorporeal life support can be useful in supporting patients with congenital heart disease with life-threatening cardiac or pulmonary failure. Improvements in limiting neurologic and bleeding complications may lead to improvements in the use of extracorporeal life support for this indication. However, prospective, randomized studies are needed to appreciate the role of extracorporeal life support in these patients.

Child↗
PubMed1986

Maternal and environmental factors affecting developmental outcome of infants of adolescent mothers.

The effect of maternal and environmental factors on the developmental outcome of infants with low medical risk born to adolescent and non-adolescent, primiparous, Caucasian mothers was studied. Twenty-one were adolescent mothers (less than or equal to 17 years of age) and 21 were non-adolescent (21-29 years of age). Assessment of child care support, life stress, and home environment were carried out at 4 months. Infants were examined at 8 months, and child care support and life stress were reassessed. Adolescent mothers reported less child care support at both 4 and 8 months and more life stress at 8 months than non-adolescent mothers. Adolescent mothers were also found to be less responsive, used restriction and punishment more often, and were less involved with their infants during the home observation. Infants of adolescent mothers had lower Bayley Mental Development Indices at 8 months. A theoretical model, whereby the mother's age, education, and socioeconomic status (SES) were conducive to less optimal child care support and life stress, which in turn affected the infant's cognitive status, was supported by this data. Thus, within a low medical risk population, we have documented the significant role of maternal and environmental factors in determining the infant's cognitive status.

Adolescent↗
PubMed1991

Monitoring EMS protocol deviations: a useful quality assurance tool.

STUDY OBJECTIVE: To determine the incidence, type, and outcome of protocol deviations in an emergency medical services (EMS) system. DESIGN: Retrospective consecutive case series. SETTING: Seven advanced life support ambulance services servicing five area hospital emergency departments. PATIENTS: 1,246 patients requiring advanced life support care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Advanced life support ambulance runs during a two-month period were examined for protocol deviations. Of 1,246 runs examined, 16% had deviations. Approximately 55% of these deviations were minor, 38% were serious, and 7% were very serious in nature. The effects of the errors were evaluated using hospital records. Results showed that 89.5% of patients were unaffected, 5.0% improved, and 5.5% suffered complications from deviations. Emergency medical technicians committed 69% of the deviations without the consent of medical control, medical control committed an additional 18%, and both were responsible in 13% of cases. Incomplete histories were found in 8% of cases. CONCLUSION: Protocol deviations committed in prehospital care do not usually cause direct harm to patients. On review of these deviations, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control. This type of quality assurance study has the ability to identify areas of strength and weakness in an EMS system, allowing planning of ongoing educational efforts in the system.

Clinical Protocols↗
PubMed1984

Home care for life-supported persons in England. The Responaut Program.

Home care for persons who depend upon life-supportive technology represents a complex situation for analysis and planning. As a case-example, the ventilator-dependent patient illustrates a formidable health care challenge for all sectors of society. England provides an established model for study. The "Responaut Program" (London) is a hospital-based home ventilator care system of services established in 1965 at St. Thomas' Hospital by Dr. G. Spencer. The elements of success of the English program presented herein are applicable to some of the current political, social, and economic realities of the United States. Operational home care concepts abroad are available for scrutiny as we in the United States plan pioneering efforts in this field.

Community Health Services↗
PubMed1992

Patients' preferences for intensive care.

OBJECTIVES: To determine patients' preferences for intensive care and to evaluate the influence of a recent ICU experience on preferences for future ICU treatment. DESIGN: Survey of nonrandomized patient sample using structured interviews. SETTING: Large, urban, tertiary academic medical center. PATIENTS: Eighty-four adult inpatients discharged from the medical ICU between June and August 1990. MEASUREMENTS: Agreement with life-supportive care under each of four potential outcome scenarios was assessed on a 5-point scale. An overall preference score was created by summing scores for the four items. Patients were also asked about their recent experiences in the ICU. RESULTS: Patients identified sources of stress associated with their ICU stay, yet most (76%) rated their ICU experience positively. Preferences for future intensive care varied with perceived outcome, and were strongest for health restoration and weakest for persistent vegetative states. No significant relationships were found between ICU preferences and any demographic or clinical variable except race. CONCLUSIONS: Patients tolerate intensive care well and desire it to restore health. Most patients modify their desire for intensive care if less favorable outcomes are likely. Patients' preferences for intensive care cannot be predicted from demographic features or previous ICU experiences.

Academic Medical Centers↗
PubMed1976

Life-support system: emergency medical care for conventions.

The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented.

Adult↗
PubMedDate not supplied

Home care for life-supported persons: the French system of quality control, technology assessment, and cost containment.

Home care for persons who require the prolonged use of life-supportive medical technology is a reality in several nations. France has had more than a quarter of a century of experience with providing home care for patients with chronic respiratory insufficiency and with a system to evaluate the patients' outcomes. The French approach features decentralized regional organizations which offer grassroots involvement by the beneficiaries who participate directly in the system. Since June 1981, a national organization has provided patients, professionals, and others concerned with direct access to national funding authorities and governmental officials and has created a data base for evaluation of the experience. This system permits direct input by current users of the services and creates informed opinion among members of the general public, governmental officials, and others involved (health care professionals and service providers). This is essential for the development of responsive public policy and for the determination of the relevancy of programs. In the United States, increasing demands are being made upon expensive hospital services by patients with diseases such as AIDS and other catastrophic, long-term care conditions. Cost-saving, community-oriented home care models serving complex medical-societal needs abroad are worthy of study to discern possible applications to health and social problems in our nation.

Financing, Government↗