Ironjustic
Fri, Nov-02-07, 17:16
Patients Denied Admission To Intensive Care Because Of
Doctors' Pessimism Main Category: Respiratory / Asthma News
Article Date: 02 Nov 2007 - 0:00 PDT
Doctors are overly pessimistic about the chances of survival
for patients with COPD related attacks and, as a result, some
patients may be denied admission to hospital for vital help,
according to a study published today on bmj.com.
COPD (chronic obstructive pulmonary disease) causes around
30,000 deaths a year in the UK and many patients who have COPD
attacks can benefit from assisted ventilation, but they have
to be admitted to an intensive care unit (ICU) to be
intubated.
Researchers studied results from 92 intensive care and three
respiratory high dependency units in the UK that dealt with
832 patients aged 45 years and over who had breathlessness,
respiratory failure or change in mental status due to a COPD
attack, asthma or both.
Information gathered over an 18-month period from a database
covering 74% of UK ICUs said there was no significant
difference in outcomes when comparing units that took part in
the study and those that did not.
Overall, 517 (62%) patients survived to 180 days after the
incident, but clinicians prognoses were pessimistic,
predicting a survival rate of just 49%.
For the fifth of patients with the poorest prognosis according
to the clinician, the predicted survival rate was 10% and the
actual rate was 40%
The survival rates were 80% at discharge from ICU or high
dependency units, 70% at discharge from hospital and 62% at
180 days after ICU admission.
The authors say: "Clinicians are generally pessimistic about
the survival of patients with exacerbations of COPD and have
particular problems in identifying those with poor prognosis.
Patients might therefore be inappropriately excluded from
intensive care and the chance of intubation on the basis of a
false prediction of futility."
In an accompanying editorial, US researchers point to a
scarcity of intensive care resources as a possible explanation
for these results.
They say that making decisions about admission to intensive
care is complex, especially in the UK and southern Europe,
where intensive care beds are often lacking. And they call for
further studies to determine whether prognostic pessimism
requires intervention aimed at doctors or at underlying
healthcare systems that have inadequate provision of critical
care services.
Martin Wildman, Consultant in Respiratory Medicine, Northern
General Hospital, Sheffield, UK Click here to view paper.
Editorial: Dale Needham, Assistant Professor, Johns Hopkins
Medical Institutions, Division of Pulmonary and Critical Care
Medicine, Baltimore, USA Click here to view paper
http://www.bmj.com
----------------------------------------
Now rather than simply sending people home to die .. they
should implement the treatment which has shown efficacy of
.. 50% .. ?
Logic ..
The venesection / phlebotomy in those with COPD / emphysema ..
leads to 50% **increased** walking distance and 50%
**increased** exercise tolerance.
It also leads to decreased oxygen usage determined by those in
the **warehouse** who noticed the patients were no longer
ordering oxygen. The doctors and nurses didn't notice ..
surprise .. surprise .. the warehousemen .. did..
Chest 1990 Nov;98(5):1073-7
Exercise performance of polycythemic chronic obstructive
pulmonary disease patients. Effect of phlebotomies.
Chetty KG, Light RW, Stansbury DW, Milne N Department of
Medicine, VA Medical Center, Long Beach, CA 90822.
The purpose of this study was to determine the effects of
phlebotomy on the exercise tolerance and right and left
ventricular ejection fraction of polycythemic patients with
chronic obstructive pulmonary disease. Ten patients with COPD
(mean FEV1 = 1.32 +/- 0.55 L) and polycythemia (mean Hct = 62
+/- 3 percent) were studied before and after their hematocrits
had been reduced to approximately 50 percent. Post-phlebotomy
the maximal oxygen consumption increased from 1.09 +/- 0.34
L/min to 1.26 +/- 0.43 L/min (p less than 0.05) and the
maximum workload increased from 56.5 +/- 32.6 watts to 74.5
+/- 23.4 watts (p less than 0.05). The increase in the
exercise tolerance appeared to be primarily due to an
increased cardiac output at Emax. There was no relationship
between the increases in the upright exercise capacity and
changes in the supine ejection fractions of the right or left
ventricular either at rest or during exercise.
PMID: 2225946, UI: 91030710
_______________________________________________________-
__________
Who loves ya. Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://tinyurl.com/a3cc3
DEAD PEOPLE WALKING http://tinyurl.com/zk9fk
Doctors' Pessimism Main Category: Respiratory / Asthma News
Article Date: 02 Nov 2007 - 0:00 PDT
Doctors are overly pessimistic about the chances of survival
for patients with COPD related attacks and, as a result, some
patients may be denied admission to hospital for vital help,
according to a study published today on bmj.com.
COPD (chronic obstructive pulmonary disease) causes around
30,000 deaths a year in the UK and many patients who have COPD
attacks can benefit from assisted ventilation, but they have
to be admitted to an intensive care unit (ICU) to be
intubated.
Researchers studied results from 92 intensive care and three
respiratory high dependency units in the UK that dealt with
832 patients aged 45 years and over who had breathlessness,
respiratory failure or change in mental status due to a COPD
attack, asthma or both.
Information gathered over an 18-month period from a database
covering 74% of UK ICUs said there was no significant
difference in outcomes when comparing units that took part in
the study and those that did not.
Overall, 517 (62%) patients survived to 180 days after the
incident, but clinicians prognoses were pessimistic,
predicting a survival rate of just 49%.
For the fifth of patients with the poorest prognosis according
to the clinician, the predicted survival rate was 10% and the
actual rate was 40%
The survival rates were 80% at discharge from ICU or high
dependency units, 70% at discharge from hospital and 62% at
180 days after ICU admission.
The authors say: "Clinicians are generally pessimistic about
the survival of patients with exacerbations of COPD and have
particular problems in identifying those with poor prognosis.
Patients might therefore be inappropriately excluded from
intensive care and the chance of intubation on the basis of a
false prediction of futility."
In an accompanying editorial, US researchers point to a
scarcity of intensive care resources as a possible explanation
for these results.
They say that making decisions about admission to intensive
care is complex, especially in the UK and southern Europe,
where intensive care beds are often lacking. And they call for
further studies to determine whether prognostic pessimism
requires intervention aimed at doctors or at underlying
healthcare systems that have inadequate provision of critical
care services.
Martin Wildman, Consultant in Respiratory Medicine, Northern
General Hospital, Sheffield, UK Click here to view paper.
Editorial: Dale Needham, Assistant Professor, Johns Hopkins
Medical Institutions, Division of Pulmonary and Critical Care
Medicine, Baltimore, USA Click here to view paper
http://www.bmj.com
----------------------------------------
Now rather than simply sending people home to die .. they
should implement the treatment which has shown efficacy of
.. 50% .. ?
Logic ..
The venesection / phlebotomy in those with COPD / emphysema ..
leads to 50% **increased** walking distance and 50%
**increased** exercise tolerance.
It also leads to decreased oxygen usage determined by those in
the **warehouse** who noticed the patients were no longer
ordering oxygen. The doctors and nurses didn't notice ..
surprise .. surprise .. the warehousemen .. did..
Chest 1990 Nov;98(5):1073-7
Exercise performance of polycythemic chronic obstructive
pulmonary disease patients. Effect of phlebotomies.
Chetty KG, Light RW, Stansbury DW, Milne N Department of
Medicine, VA Medical Center, Long Beach, CA 90822.
The purpose of this study was to determine the effects of
phlebotomy on the exercise tolerance and right and left
ventricular ejection fraction of polycythemic patients with
chronic obstructive pulmonary disease. Ten patients with COPD
(mean FEV1 = 1.32 +/- 0.55 L) and polycythemia (mean Hct = 62
+/- 3 percent) were studied before and after their hematocrits
had been reduced to approximately 50 percent. Post-phlebotomy
the maximal oxygen consumption increased from 1.09 +/- 0.34
L/min to 1.26 +/- 0.43 L/min (p less than 0.05) and the
maximum workload increased from 56.5 +/- 32.6 watts to 74.5
+/- 23.4 watts (p less than 0.05). The increase in the
exercise tolerance appeared to be primarily due to an
increased cardiac output at Emax. There was no relationship
between the increases in the upright exercise capacity and
changes in the supine ejection fractions of the right or left
ventricular either at rest or during exercise.
PMID: 2225946, UI: 91030710
_______________________________________________________-
__________
Who loves ya. Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://tinyurl.com/a3cc3
DEAD PEOPLE WALKING http://tinyurl.com/zk9fk