Little Chance Of Recovery Research Articles

Predictors of Permanent Vision Loss in Giant Cell Arteritis

ABSTRACT To report on the occurrence and characteristics of eye manifestations and determine the predictors of permanent vision loss (PVL) in patients with giant cell arteritis. Case-control study. Retrospective cohort study of 258 patients diagnosed with giant cell arteritis (GCA) over a 20- year period at a single institution. Eighty nine of 258 patients (34.5%) with GCA had vision symptoms and 56 (21.7%) developed PVL. Acute loss of vision with no preceding ocular symptoms occurred in 28.5%; for those with symptoms, median time to vision loss was 4.5 days. Bilateral clinical eye involvement was present in 38%, mostly anterior ischemic optic neuropathy (AION), rarely vascular occlusions. Vision loss was severe with acuity of count fingers or less or mean deficit −20 decibels or less in at least one eye in 80% of patients with PVL. Following initiation of GC treatment, 23% of patients continued to have further vision loss and only 5% showed improvement. We found predictors of PVL by multivariate analysis to be increased age (OR 1.05, p0.040), jaw claudication (OR 2.29, p = .040), diplopia (OR 2.74, p = .039), increased platelets (OR 2.98, p = .020) and lower CRP (OR 0.63, p = .004). We found there is a 27.3% decrease in the odds of having PVL when CRP value is doubled, keeping all other variables fixed. Permanent vision loss was 3.07 times more likely in the absence of polymyalgia rheumatica and 4.25 times more likely in patients without headaches. Ocular involvement in GCA is common, usually severe with little chance of recovery. Detailed analysis of visual acuity and visual field loss in our PVL cohort adds valuable data to the literature which lacks this information. Older patients with jaw claudication, diplopia, and increased platelets are at higher risk for permanent vision loss, especially when PMR and headache are absent and acute phase reactants lower.

Deciphering the molecular mechanistic paths describing the chemotherapeutic potential and epigenetic regulation of curcumin in lung cancer: a mini review.

In an uncontrolled inflammatory environment, the complex process of lung carcinogenesis occurs. Lung cancer remains the leading cause of cancer-related mortality worldwide. The average 5-year survival rate is still low despite significant advancements in our knowledge of lung carcinogenesis and the development of innovative therapies in recent decades. Research on adjuvant treatment, lung carcinogenesis pathways, and possible prognostic indicators has to be refocused using an innovative approach. The majority of lung cancers are discovered at an advanced stage when there is little chance of recovery. It has grown in popularity in recent years to supplement already available chemotherapeutic therapies with adjuvant herbal medications, which may lessen toxicity and adverse effects without sacrificing therapeutic efficiency. One such prospective contender is curcumin. In-depth research has been done on curcumin as a multi-target anti-tumor and anti-inflammatory molecule. A pharmacologically active polyphenol produced from turmeric is called curcumin. Over the past few decades, curcumin's therapeutic potential has been thoroughly studied, and data indicate that curcumin may play a part in a variety of biological processes, most notably its potent anticancer activity. Being a pleiotropic chemical, curcumin regulates a variety of molecules that are key players in many cell signaling pathways. It has been shown to stifle transformation, restrain proliferation, and trigger apoptosis. Curcumin can reduce the development of non-small cell LC by downregulating Circular RNA hsa_circ_0007580, which in turn controls the expression of integrin subunit beta 1 by adsorbing miR-384. Nevertheless, despite all these advantages, curcumin's effectiveness is still restricted because of its weak bioavailability, poor absorption within the systemic circulation, and quick removal from the body. In an effort to overcome these constraints, scientists from all around the world are working to develop a synthetic and improved curcuminoid by appropriately altering the parent skeleton structurally. These curcuminoids will simultaneously improve the physicochemical properties and efficacy. This review presents evidence from the most recent clinical trials coupled with the molecular mechanisms of curcumin in LC.

Assessment of Need for Recovery and Its Relationship With Work Characteristics and Health in a Sample of Chinese Doctors: A Cross-Sectional Survey.

Background: China is launching an unprecedented health care system reform. However, the long-term interests of doctors seem to have been ignored during this process especially considering that the work environment and work-life balance for doctors have severely deteriorated over the past decade.Their well-being and health are facing substantial threats due to heavy workloads and inadequate recovery opportunities. This study aimed to investigate the extent of need for recovery (NFR) among Chinese doctors and to examine their work-related fatigue. The study also examines the relationship of NFR with workplace satisfaction and health outcomes among Chinese doctors.Methods: A total of 2,617 doctors from 30 administrative regions in China participated in this study to assess the need for recovery and its relationship with work characteristics and health. A cross-sectional survey was conducted using the Chinese version of the Need for Recovery Scale (NFRS). Participants were invited to complete an anonymous online survey during May 2016. Data were analyzed using descriptive statistics, one-way ANOVA, reliability analysis, Pearson correlations, and hierarchical multiple regression analysis.Results: Significant differences in NFR scores were found across demographic characteristics such as age, service years, hospital levels, educational attainment, professional positions, work shifts, and working time. Regardless of any illnesses they might be experiencing, about 70.0% of participants remained at their job even though many doctors (22.1%) must continue working under the policies of the organization, which led to more pronounced NFR (P < 0.001). Further, a higher NFR was negatively related to workplace well-being and self-reported health outcomes of participants.Conclusions: Work-induced fatigue is a growing threat to doctors in China and their recovery opportunities are extremely limited in the workplace. High NFR exerts a considerable effect on their workplace well-being and health. China's hospital managers should pay close attention to the fact that doctors have little chance of recovery, and should offer doctors' positive encouragement and support to enhance well-being. To improve doctors' working conditions, targeted prevention policies must be introduced by policymakers to control this spreading crisis.

Chronic pain: Sources framing of post-traumatic stress in The New York Times

Post-traumatic stress (PTS) is a common reaction after witnessing a violent event, and individuals who have experienced trauma may relive the event, avoid people or situations that remind them of the trauma, or experience negative thoughts and hyperarousal. When symptoms persist, an individual may receive a medical diagnosis of Post-Traumatic Stress Disorder (PTSD). While nearly eight million Americans, including combat veterans, have PTSD in a given year, few studies have explored how the condition is represented in the mass media. This content analysis examines sources’ characterization of PTSD in New York Times articles. Results show that news stories framed PTSD as a long-term problem, with little chance for recovery, a frame that could negatively affect public policy decisions.

Another step towards improving oncofertility counselling of young women with Hodgkin's lymphoma.

Another step towards improving oncofertility counselling of young women with Hodgkin's lymphoma.

PENEGAKAN HUKUM TERHADAP PENGEDAR NARKOTIKA DENGAN BERAT NETTO 36 GRAM (STUDI KASUS: PUTUSAN PENGADILAN NEGERI JAKARTA SELATAN NOMOR 637/Pid.sus/2015/PN.JKT.SEL)

Due to a rise in cases related to narcotics in Indonesia, the government is stiffening penalties for drug offences. Now, anyone who violates certain drug laws in the nation may end up serving a minimum of four years prison time. Depending on the severity of the violations, the government may even sentence more drug offenders to death. Examines the impact of globalization and new technology on the narcotics industry. Examines the challenges that new technologies, such as the internet, pose to drug law enforcement. Illicit trafficking of narcotics has been very widespread in Indonesia, Similarly, what happens in this case, someone who ordered narcotics from America-Indonesia. This transaction is done online, But in this case the judge handed down the rehabilitation decision to the narcotics dealer. The order made by the defendant is narcotics with a net weight of 36.1318 grams. From the results of this study based on interviews conducted if giving narcotics to other people with or without the transaction can already be declared as a dealer. Millions of people are affected by drugs in Indonesia. According to the National Agency for Narcotics (BNN), one million people are addicted to drugs with little chance of recovery. Around 1.6 million people occasionally take drugs while 1.4 million are regularly consumers.

The clinical profile and acute care of patients with traumatic spinal cord injury at a tertiary care emergency centre in Addis Ababa, Ethiopia.

IntroductionTraumatic spinal cord injuries can have catastrophic physical, psychological, and social consequences, particularly in low resource settings. Since many of these injuries result in irreversible damages, it is essential to understand risk factors for them and focus on primary prevention strategies. The objectives of this study are to describe the demographics, injury characteristics, and management of traumatic spinal cord injury victims presenting to the Adult Emergency Centre of Tikur Anbessa Specialised Hospital in Addis Ababa, the tertiary referral centre for emergency care in Ethiopia.MethodsA prospective cross sectional survey was conducted from October 2013 to March 2014 in the Adult Emergency Centre of Tikur Anbessa Specialised Hospital. Patients were identified at triage and followed through admission to discharge from the emergency centre.ResultsEighty-four patients with traumatic spinal cord injuries were identified. The mean age was 33 years and 86% were male. The most common mechanisms of injury were motor vehicle collisions (37%), falls (31%), and farming injuries (11%). The cervical spine (48%) was the most commonly injured region and 41% were complete spinal cord injuries. Most patients (77%) did not receive any prehospital care or medical care at other facilities prior to arrival in the Emergency Centre.ConclusionIn our context, traumatic spinal cord injuries predominantly affect young men, and the majority of victims suffer severe injuries with little chance of recovery. Attention to occupational and road traffic safety is essential to mitigate the personal and societal burdens of traumatic spinal cord injuries. It is also imperative to focus on improving prehospital care and rehabilitation services for traumatic spinal cord injury victims.

Ensuring Insurance for Foster Care: Requiring Foster Parents to Obtain Liability Insurance to Cover Harm Done to Foster Children in their Care

This Note proposes that all states should require that foster parents have liability insurance before children are placed in their care. This Note also proposes that the liability insurance needs to cover not just harm to third parties but also harm to the foster children through the negligent acts of the foster parents. This legislation will allow foster children to have standing to bring claims against their foster parents and insurance companies and give them a greater opportunity for recovery. Currently, the policies and statutes governing the policies in place do not cover all types of harm that can occur during the foster parent–child relationship. Certain policies leave children who are harmed by their foster parents’ negligence unable to recover any damages from the people who have harmed them. Because foster parents can be left to defend the actions themselves, they often become judgment proof due to their low income, leaving the children who are harmed with little chance of recovery. Key Points for the Family Court Community: States need to require foster parents to obtain liability insurance, which covers harm done by the foster children to third parties, harm to the home, and any harm done to the child by the foster parents.

The Burden of Caregiverand Related Factorsof Oncology

Abstract Background: Caregivers of patients with leukemia facing with problems such as little chance of recovery in patients and probability of relapse and patient dependency and high responsibility such as increasing the Leading to increased burden and mental, physical, emotional and social symptom.This study aimed to determine the burden and related factors in caregiver of patients with leukemia. Methods: In descriptivestudy60caregiversof the patients hospitalizedin oncology of Shah Vali Hospital of Yazd city selected by non-random sampling .demographic questionnarrie and caregiver burden scale was completed. Caregiver burden scale validity with content validity and reliability of caregiver burden scale with Cronbach’s alpha coefficient, were calculated92.data analysis were done Spss soft ware whit Pbt-Test, ANOVA and Pearson correlation coefficient. Results: 82.3% Caregivers were female, 30% caregivers were Spouse, 50% caregivers were children .The average of burden in all samples was high. Highest average of burden was related to the care of spouses. There was direct relationship between disease duration (r=0.5) ,age of care giver and age of patient (r =0.6)with burden. caregivers with low socioeconomic status (p=0.04) and patient in 3 phase (p=0.03) were reported high burden. Conclusion: Because of high burden in caregivers of patients with leukemia, identify factors affecting the incidence of pressure care and their needs and design appropriate interventions to reduce stress and improve quality of life in caregivers and improve quality of care is necessary. Keywords: Burden, Informal Caregiver, Leukemia

Chronic subdural hematoma patients aged 90 years and older

Objectives: The American population above 65 years of age will double by 2050, and more nonagenarians will present to neurosurgeons for treatment for subdural hematomas (SDH), common in the elderly. Healthcare providers, and patients’ relatives, often choose treatment when there is little chance of recovery. Hospital mortality is 24% (n = 5) in chronic subdural hematoma (cSDH) patients over 65 years, but there are no studies on cSDH outcomes in patients aged over 90 years. This retrospective study evaluates outcomes in this population. Methods: We reviewed all patients with cSDH between December 2005 and December 2011. We analyzed charts of patients aged 90 years and older. Patient demographics, Glagow Coma Scale (GCS) at presentation, medical co-morbidities, length of stay, disposition, treatment, and radiographic characteristics were abstracted. Results: Twenty-one patients aged 90 or older with 24 admissions for cSDH were identified. Median age was 92 (SD = 2·5); 76% (n = 16) underwent surgery. Median presentation GCS was 14. Disposition to home, rehabilitation facility, nursing home, hospice, or death were not significantly different between conservative and operative groups (P = 0·10), nor was admission GCS (P = 0·59). The size of SDH was significantly (P = 0·02) larger in the operative group. Overall, only 24% (n = 5) of patients were discharged home. Conclusion: Clinical presentation with cSDH is a sentinel event for patients aged 90 years or older; 67% have surgical intervention. Disposition does not vary with surgical or non-surgical treatment. Only 24% of patients of this age group presenting with cSDH return home despite a good admission GCS.

Negligent Tort Liability of the Design Professional

AbstractDesign professionals such as architects and engineers (A/Es) are experiencing increased liability exposure from contractors seeking to recover construction-related damages. Legal action is usually sought based on the principles of tort law, but this area of the law may not be well understood by nonattorneys. As a result, contractors may spend precious financial resources pursuing a claim in which there is little chance of recovery. The purpose of this paper is to present in general terms the main elements of tort liability, specifically negligence. The issues described include the economic loss rule and the implications thereof. Several exceptions to the economic loss rule are described, most notably foreseeability. If a contractor can successfully navigate around the economic loss rule, the contractor must prove that the A/E owed the contractor a legal duty and that duty was breached because of A/E negligence. A/Es must follow the process that other similarly situated A/Es would have followed. Co...

Attitudes of Japanese medical students towards disclosure of a diagnosis of life-threatening illness.

In this study we investigated the attitudes of Japanese medical students toward being informed of a diagnosis of life-threatening illness. Fourth-year medical students from 20 randomly sampled universities were administered questionnaires that examined their opinion about whether they would welcome disclosure of medical information if they were diagnosed as having an ultimately fatal disease. Data from 1,619 students (male 1,074, female 545, effective collection rate 90.6%) were analyzed. With regard to attitudes about disclosure of a diagnosis of life-threatening illness, 87.7% of the students stated that they would wish to be informed even if there was little chance of recovery, and 11.6% expressed a wish to be informed of their condition only if there was a chance of recovery. Students who did not wish to be informed even if there was a chance of recovery accounted for 0.7% of those surveyed. Our study reveals that medical students are more positive than are members of the general population with regard to being informed of the truth. The proportion of those who wished to be informed even if there was little chance of recovery was higher among students from national and public universities than among those from private universities, and the inter-group difference was statistically significant. Among male students, answers to the survey were significantly correlated with 12-item General Health Questionnaire scores and mental health status, suggesting that mental health status may have affected how this study population viewed being informed of their diagnosis.

Hospital Resources for Pandemic Influenza

To the Editor: In their November 2007 article, Pandemic Influenza and Hospital Resources, Nap et al. evaluated hospital resources for pandemic influenza in the northern part of the Netherlands (1). Their results can be compared with those that I have described for the combined suburban communities of Roswell and Alpharetta, Georgia, USA (2). The Netherlands evaluation assumed that antiviral drugs will be available and will reduce hospitalizations by 50% and deaths by 30%. In view of the uncertainty of effective antiviral drugs and timeliness of vaccines, I did not estimate their effects. Nevertheless, several issues warrant comparison. The plan for the Netherlands has no provisions for urgent care, i.e., parenteral fluids or antimicrobial drugs that are administered to ambulatory patients who are not hospitalized. Nap et al. may not perceive a need for enough beds to handle surge capacity. Allowing for 30% of beds to be used for patients with conditions other than influenza, they report a maximum availability of 232 beds per 100,000 population for pandemic influenza patients, and they estimate use of 72 beds per 100,000 in the pandemic model. In contrast, a maximum of 47 beds per 100,000 are available in Roswell/Alpharetta. Availability of beds in intensive care units, however, is identical for both regions, at 8 beds per 100,000 population. The Netherlands plan calls for intensified treatment evaluation in 48 hours to withdraw care from patients who have little chance for recovery. Because most patients can be expected to have pneumonia and 2-organ failure (on average), a 50% mortality rate can be expected. In US hospitals, withdrawing care is difficult, even if mortality rates are expected to be 75% or 90% during acute illness with organ failure. The pandemic influenza resource evaluation from the northern part of the Netherlands provides a useful contrast with at least 1 US hospital. The dramatic difference in bed availability highlights the potential challenges involved in local planning. The surge capacity limits in Roswell/Alpharetta led us to consider an alternative infusion center to provide care during an influenza pandemic.

Analysing Southern African food security: assessing the New Variant Famine hypothesis

This article investigates the New Variant Famine (NVF) hypothesis coined by Alex De Waal during the 2001-2003 Southern African food security crisis, as a tool for analysing food insecurity in the region. The NVF hypothesis depicts a protracted and extensive famine from which there is very little chance of recovery, in which HIV and AIDS are central to the widespread suffering of people. The author suggests that the role of HIV and AIDS on food security be considered as one contributing factor to a dynamic process(es) of vulnerability and not viewed in isolation. In addition it is suggested that analyses focus on underlying processes driving vulnerability and not on specific instances of “famine” or crisis.

‘Just a sharp scratch’: permanent radial, median and ulnar neuropathy following diagnostic venepuncture

An 82-year-old woman was admitted to hospital with acute left ventricular failure following a recent myocardial infarction for which she had been commenced on clopidogrel. An uneventful venepuncture in her left antecubital fossa yielded a normal full blood count and coagulation profile. Diuretics were commenced to which she responded well. Five days later she described pain, swelling and bruising of her left forearm with numbness over her thumb, index and middle fingers. Prophylactic low molecular weight heparin was discontinued and the arm elevated. Nine days later she was unable to move her left hand. Bruising extended from the shoulder to the hand with swelling distal to the antecubital fossa (Figures 1 and 2). Woody subcutaneous oedema was present around the antecubital fossa with forearm tenderness. The radial pulse was present with good capillary circulation in all fingers. Neurological examination revealed complete wrist drop, minimal finger flexion and no small muscle function of the hand. The dorsal aspect of the forearm and hand were hypersensitive, with numbness over the volar aspect of the thumb, index and middle fingers. These findings were consistent with an ischaemic neuropathy of the median, radial and ulnar nerves as a result of compartment syndrome, secondary to a compressive haematoma at the antecubital fossa following venepuncture. Surgery to relieve compartment pressures at this stage was thought to provide little chance of recovery, with the additional risk of supervening infection. Initial treatment was therefore conservative consisting of physiotherapy, vitamin B and gabapentine. An ultrasound scan confirmed the presence of a haematoma occupying the entire flexor compartment of the forearm. Nerve conduction studies revealed completely absent sensory potentials, with motor potentials 1%, 30% and 60% of normal in the radial, median and ulnar nerves respectively. This confirmed a severe subtotal axonotmesis of the radial nerve with partial axonal injury to the median and ulnar nerves. The prognosis was one of permanent major neurological deficit and despite intensive hand physiotherapy there was little functional recovery 1 year later.

Rationale and design of The Delphi Trial – I(RCT)2: international randomized clinical trial of rheumatoid craniocervical treatment, an intervention-prognostic trial comparing 'early' surgery with conservative treatment [ISRCTN65076841

BackgroundRheumatoid arthritis is a chronic inflammatory disease, which affects 1% of the population. Hands and feet are most commonly involved followed by the cervical spine. The spinal column consists of vertebrae stabilized by an intricate network of ligaments. Especially in the upper cervical spine, rheumatoid arthritis can cause degeneration of these ligaments, causing laxity, instability and subluxation of the vertebral bodies. Subsequent compression of the spinal cord and medulla oblongata can cause severe neurological deficits and even sudden death. Once neurological deficits occur, progression is inevitable although the rapidity of progression is highly variable. The first signs and symptoms are pain at the back of the head caused by compression of the major occipital nerve, followed by loss of strength of arms and legs. The severity of the subluxation can be observed with radiological investigations (MRI, CT) with a high sensitivity.The authors have sent a Delphi Questionnaire about the current treatment strategies of craniocervical involvement by rheumatoid arthritis to an international forum of expert rheumatologists and surgeons. The timing of surgery in patients with radiographic instability without evidence of neurological deficit is an area of considerable controversy. If signs and symptoms of myelopathy are present there is little chance of recovery to normal levels after surgery.DesignIn this international multicenter randomized clinical trial, early surgical atlantoaxial fixation in patients with rheumatoid arthritis and radiological abnormalities without neurological deficits will be compared with prolonged conservative treatment. The main research question is whether early surgery can prevent radiological and neurological progression. A cost-effectivity analysis will be performed. 250 patients are needed to answer the research question.DiscussionEarly surgery could prevent serious neurological deficits, but may have peri-operative morbidity and loss of rotation of the head and neck. The objective of this study is to identify the best timing of surgery for patients at risk for the development of neurological signs and symptoms.

Failed Back Syndrome

Failed back syndrome (FBS) is a well-recognized complication of surgery of the lumbar spine. It can result in chronic pain and disability, often with disastrous emotional and financial consequences to the patient. Many patients have traditionally been classified as "spinal cripples" and are consigned to a life of long-term narcotic treatment with little chance of recovery. Recent progress in our understanding of this complex condition, as well as advances in surgical and medical treatment, have offered hope for improved outcomes and quality of life for these patients. This study explores the complex and multifactorial etiology of FBS, including reasons for surgical failure, indications for surgical revision, and adjunctive treatments such as pain management procedures. Despite extensive work in recent years, FBS remains a challenging and costly disorder. Recent advances in surgical reconstruction, rehabilitation, and pain management technique offer hope for patients with this painful and disabling condition.

How do patients and spouses deal with the serious facts of malignant glioma?

Malignant glioma is a severe disease with little chance for recovery. Due to its effect on cerebral function, it is also a disease with an obvious social impact on family life. Brain tumours, therefore, produce much of the anguish associated with cancer diseases. There is a lack of prospective studies concerning how patients and spouses together deal with the serious facts of cancer. In this study, a series of 25 consecutive patients with malignant gliomas and their spouses was followed during the whole course of the disease process by repeated thematic interviews. The spouses were also subjected to a summarizing interview after the patient's death. The interviews were analyzed qualitatively in order to detect the various ways the patient-spouse couples dealt with this severe situation and how they discussed it with each other. Four different social processes were detected: 1) the patient does not seem to be aware, the spouse is aware but pretends not to be; 2) both are aware, but the patient does not want to share; they drift apart; 3) both are aware, they do/do not talk openly about the gravity of the situation; nevertheless, there is a joint platform; and 4) neither patient nor spouse seems to be aware; they carry on living as before. The patients, compared to the spouses, seemed content with received information. A few of the couples openly discussed death and dying. More common, and apparently sufficient, was a mutual acknowledgement of the serious facts, without using the words 'death' and 'dying'. In a sense, the present findings challenge the awareness categories suggested by Glaser and Strauss.

Stress-reinjection 201TI scintigraphy without redistribution imaging

Reinjection of thallium-201 (201Tl) improves the detection of myocardial ischaemia in approximately 50% of irreversible defects present on 3 h redistribution images. Additional reinjection studies, however, may limit the capacity of the nuclear laboratory and they are not patient-friendly Previous studies have suggested that only severe persistent defects with less than 50% of maximal 201Tl uptake are irreversibly damaged, with little chance of recovery following coronary artery bypass grafting (CABG). We examined the ability of a modified stress-reinjection protocol without redistribution imaging to predict subsequent improvement in myocardial perfusion post-CABG. Thirty-seven patients underwent quantitative planar stress/3 h reinjection 201Tl scintigraphy before and after uncomplicated CABG. After stress, segments were classified as normal (> or = 75% maximum 201Tl uptake), moderate defect (50-75%) or severe defect (< 50%). After reinjection, they were classified as completely normalizing (> or = 75%), partially improving moderate defect (increase > or = 10% but < 75%), partially improving severe defect (increase > or = 10% but < 50%), persistent moderate defect (< 10% increase) or persistent severe defect (< 50% initial uptake with < 10% increase). Scintigraphic classification was compared with left ventricular wall motion and post-operative classification. Of 336 initial stress defects, 264 (79%) were moderate defects and 72 (21%) were severe defects. After reinjection, 146 (55%) moderate defects normalized, 25 (9%) improved partially and 93 (35%) persisted. Nineteen (26%) severe defects normalized, 33 (46%) improved to become moderate defects, 7 (10%) improved only slightly and 13 (18%) persisted. Post-CABG, 201T1 uptake was normal in 123 of 146 (84%) completely normalizing moderate defects, 15 of 25 (60%) partially improving moderate defects, 53 of 93 (57%) persistent moderate defects, 11 of 19 (58%) completely normalizing severe defects and 13 of 33 (39%) partially improving moderate defects. None of the partially improving severe defects or persistent severe defects normalized. The sensitivity and specificity of detection of viability with pre-CABG stress-injection scintigraphy were 66% and 72% respectively, with pre-CABG wall motion 80% and 40% respectively, whereas in combination they resulted in a sensitivity and specificity of 94% and 70% respectively. We conclude that stress/3 h reinjection without redistribution imaging is a clinically feasible method for predicting myocardial 201T1 uptake post-CABG. The severity of defects and the pattern of change of uptake after stress-injection are related to the likelihood of normal 201T1 uptake post-CABG. Severe defects after reinjection are very unlikely to recover.

Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists.

This article was written to argue that physicians are not ethically obligated to provide care which they consider futile, unreasonable, or both, either voluntarily or in response to patient or surrogate demands. Data used to prepare this article were drawn from published articles, including original investigations, position papers and editorials in the author's personal files. Articles were selected for their relevance to the subjects of medical ethics, the concepts of futility and medical reasonableness, case law, and healthcare reform. The author extracted all applicable data. Physicians may feel obligated to provide care in all clinical circumstances due to the single master view of medicine and the ethical principle of autonomy. However, care may be considered futile according to several definitions of that word, including that which describes futile treatment as something that does not benefit the patient as a whole. Furthermore, care may be considered unreasonable if it is excessive and not generally agreed upon. Physician refusal to provide futile or unreasonable care is supported by the ethical principles of nonmaleficence, beneficence, and distributive justice. The last principle is particularly relevant in the current climate of healthcare reform. Although the issue of physician refusal of requested care has not been resolved by case law or legal statute, it is supported by compelling ethical principles. Physicians are not ethically required to provide futile or unreasonable care, especially to patients who are brain dead, vegetative, critically or terminally ill with little chance of recovery, and unlikely to benefit from cardiopulmonary resuscitation.