Families, brain death, and traditional medical excellence

1984 ◽  
Vol 60 (6) ◽  
pp. 1192-1194 ◽  
Author(s):  
Rosa Lynn Pinkus
Keyword(s):  
Brain Death ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Personal Beliefs ◽  
Content Type ◽  
The Past ◽  
Transplant Center ◽  
Fine Print

✓ Staff neurosurgeons and residents at a tertiary care hospital designated as a transplant center were surveyed regarding personal opinions concerning brain death and family conferences. Compared to an extensive survey done in 1976, the responses indicated that, while a professional consensus regarding the definition and meaning of brain death has emerged in the past 10 years, a range of personal beliefs and opinions regarding the concept still exists. In spite of the professional consensus, it is still difficult for the physician to communicate gently, yet firmly, to families both the scientific groundwork that validates the determination of brain death, the concept, and the finality of the information.

scholarly journals Experience with brain death and organ donation in a tertiary care hospital in Riyadh, Saudi Arabia

Critical Care ◽  
10.1186/cc928 ◽  
2000 ◽  
Vol 4 (Suppl 1) ◽  
pp. P209
Author(s):  
W Djazmati ◽  
B Attar ◽  
Y Arabi ◽  
R McIntyre ◽  
FA Shaheen
Keyword(s):  
Saudi Arabia ◽  
Brain Death ◽  
Organ Donation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals Radiological Parameters for Conservative Management of Solid Organ Injuries in a Tertiary Care Hospital

2020 ◽  
Vol 5 (8) ◽  
pp. 672-676
Author(s):  
Hridhay. K.Prit ◽  
Dr. Perumal Boney
Keyword(s):  
Retrospective Analysis ◽  
Conservative Management ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Solid Organ ◽  
Care Hospital ◽  
The Past ◽  
Radiological Parameters ◽  
Hepatic Injuries

The management of solid organ injuries has changed drastically over the past couple of decades, with there being a shift from operative to conservative mode of management. The main purpose of this study is to establish radiological parameters for conservative management in order to make conservative mode of management more efficient. Retrospective analysis of solid organ injuries was done for 50 patients between January 2020 and March 2020 in a tertiary care hospital. It is found that conservative mode of management can be considered for patients belonging to grade I, II and III according to AAST classification of Splenic and Hepatic injuries whereas in Renal injuries it is considered for patients belonging to grade I and II

Apnea testing for the determination of brain death: a modified protocol

1992 ◽  
Vol 76 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Edward C. Benzel ◽  
Jay P. Mashburn ◽  
Steven Conrad ◽  
Denise Modling
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Content Type ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Safe Approach ◽  
Apnea Testing ◽  
Fine Print

✓ The absence of spontaneous respirations at a PaCO2 of 60 mm Hg or above has traditionally been accepted as the respiratory criteria for the determination of brain death. The testing of patients for the presence or absence of apnea has been complicated because the rate of PaCO2 elevation may vary substantially from patient to patient, and a nonlinear relationship exists between the rate of PaCO2 increase and the duration of apnea. In an attempt to refine the apnea test and to further elucidate the physiology of hypercapnia in humans, 11 patients who met all but the respiratory criteria for brain death were evaluated using a modification of a previously utilized apnea testing protocol. All patients were brought to a PaCO2 of 40 mm Hg or above prior to the apnea test. Baseline PaCO2 ranged from 40 to 45 mm Hg in six patients (Group I) and from 46 to 51 mm Hg in five patients (Group II). The mean rate of PaCO2 increase was 5.1 ± 1.4 mm Hg/min in Group I and 6.7 ± 3.1 mm Hg/min in Group II. No problems with cardiovascular instability or hypoxia were encountered during testing in this series. This refinement of the apnea test allows for a streamlined and safe approach to brain death detection.

scholarly journals Outbreak Caused by Enterobacteriaceae Harboring NDM-1 Metallo-β-Lactamase Carried in an IncFII Plasmid in a Tertiary Care Hospital in Mexico City

2015 ◽  
Vol 59 (11) ◽  
pp. 7080-7083 ◽  
Author(s):  
Pedro Torres-González ◽  
Miriam Bobadilla-del Valle ◽  
Estrella Tovar-Calderón ◽  
Francisco Leal-Vega ◽  
Araceli Hernández-Cruz ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Mexico City ◽  
Tertiary Care Hospital ◽  
Bacterial Species ◽  
Tertiary Care ◽  
Enterobacter Cloacae ◽  
New Delhi ◽  
Care Hospital ◽  
Content Type ◽  
Carbapenem Resistant

ABSTRACTCarbapenem-resistantEnterobacteriaceaecarrying New Delhi metallo-β-lactamase 1 (NDM-1) have rarely been reported in Latin America. We report of an outbreak caused by ablaNDM-1-harboring plasmid spread through different bacterial species, includingEscherichia coli(ST617) andEnterobacter cloacae(ST182) isolates from the same patient and threeKlebsiella pneumoniaeisolates (ST22) derived from three epidemiologically related patients. IncFII plasmids were found in all strains. Measures to control the outbreak were applied successfully.

scholarly journals Population Structure of Klebsiella pneumoniae Causing Bloodstream Infections at a New York City Tertiary Care Hospital: Diversification of Multidrug-Resistant Isolates

2015 ◽  
Vol 53 (7) ◽  
pp. 2060-2067 ◽  
Author(s):  
Angela Gomez-Simmonds ◽  
Michelle Greenman ◽  
Sean B. Sullivan ◽  
Joshua P. Tanner ◽  
Madeleine G. Sowash ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Klebsiella Pneumoniae ◽  
York City ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Care Hospital ◽  
Content Type

Despite the growing importance of carbapenem-resistantKlebsiella pneumoniae(CRKP), the clonal relationships between CRKP and antibiotic-susceptible isolates remain unclear. We compared the genetic diversity and clinical features of CRKP, third-generation and/or fourth-generation cephalosporin-resistant (Ceph-R)K. pneumoniae, and susceptibleK. pneumoniaeisolates causing bloodstream infections at a tertiary care hospital in New York City between January 2012 and July 2013. Drug susceptibilities were determined with the Vitek 2 system. Isolates underwent multilocus sequence typing and PCR sequencing of thewziandblaKPCgenes. Clinical and microbiological data were extracted from patient records and correlated with molecular data. Among 223 patients, we identified 272 isolates. Of these, 194 were susceptible, 30 Ceph-R, and 48 CRKP, belonging to 144 sequence types (STs). Susceptible (127 STs) and Ceph-R (20 STs) isolates were highly diverse. ST258 dominated CRKP strains (12 STs, with 63% ST258). There was minimal overlap in STs between resistance groups. TheblaKPC-3gene (30%) was restricted to ST258/wzi154, whereasblaKPC-2(70%) was observed for severalwziallele types. CRKP infections occurred more frequently among solid organ transplant (31%) and dialysis (17%) patients. Mortality rates were high overall (28%) and highest among CRKP-infected patients (59%). In multivariable analyses, advanced age, comorbidities, and disease severity were significant predictors of 30-day mortality rates, whereas theK. pneumoniaesusceptibility phenotype was not. Among CRKP infections, we observed a borderline significant association of increased mortality rates with ST258 and thewzi154 allele. Although the clonal spread of ST258 continues to contribute substantially to the dissemination of CRKP, non-ST258 strains appear to be evolving. Further investigations into the mechanisms promoting CRKP diversification and the effects of clonal backgrounds on outcomes are warranted.

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