Articles: critical-illness.
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Critical care medicine · Jun 2022
Observational StudyBrain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield.
Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill patients with neurologic diseases of unknown etiology. We also aimed to compare these endpoints to those of non-ICU patients who underwent a brain biopsy in the same clinical context. ⋯ Brain biopsy in critically ill patients with neurologic disease of unknown etiology is associated with high diagnostic yield, therapeutic modifications and postbiopsy survival advantage. Safety profile seems acceptable in most patients. The benefit/risk ratio of brain biopsy in this population should be carefully weighted.
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Background: The Serious Illness Care Program has been shown to improve quality and feasibility of value-based end-of-life conversations in primary care. Objectives: To elicit patients' perspectives on serious illness conversations conducted by primary care clinicians. Subjects and Methods: Telephone interviews were conducted with patients at an academic center in the United States, who had a recent serious illness conversation with their primary care clinician. ⋯ We identified three major themes: (1) positive emotional experiences are facilitated by established patient-clinician relationships and/or clinicians' skills in navigating emotional challenges, (2) patients appreciate a personalized conversation, and (3) clinicians should orchestrate the experience of the conversation, from preparation through follow-up. Conclusion: Patients appreciate having serious illness conversations in the primary care setting. Future efforts can be focused on improving clinicians' skills in navigating emotional challenges during conversations and implementing system changes to optimize orchestration.
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J Pain Symptom Manage · Jun 2022
The Science of Context: Transforming Serious Illness Care Though In Situ Observation.
There is an expression, often attributed to Einstein, “If I had 60 minutes to save the world, I would spend the first 55 trying to figure out what was wrong with it.” Dr. J. Randall (Randy) Curtis’ approach to improving serious illness care has been so effective for exactly this reason. ⋯ Herein, we highlight Randy’s early work using direct observation and describe the trajectory and impact of his ground-up approach to research. In parallel, we describe the influence of his approach on our own work studying serious illness care in surgery and critical care. Although neither of us has had direct mentorship from Randy, we emulate Randy’s pioneering mentorship model in our work together, demonstrating his far-reaching influence.