Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016.

Importance: End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.

Objective: To determine the changes in end-of-life practices in European ICUs after 16 years.

Design, Setting, And Participants: Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000).

Agreement With Consensus Statements on End-of-Life Care: A Description of Variability at the Level of the Provider, Hospital, and Country.

Objectives: To develop an enhanced understanding of factors that influence providers' views about end-of-life care, we examined the contributions of provider, hospital, and country to variability in agreement with consensus statements about end-of-life care.

Design And Setting: Data were drawn from a survey of providers' views on principles of end-of-life care obtained during the consensus process for the Worldwide End-of-Life Practice for Patients in ICUs study.

Subjects: Participants in Worldwide End-of-Life Practice for Patients in ICUs included physicians, nurses, and other providers.

Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.

Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate.

Comparison of diagnostic and prognostic performance of two assays measuring thymidine kinase 1 activity in serum of breast cancer patients.

Background: We compared two recently developed immunoassays for serum thymidine kinase 1 (TK1) activity: one manual assay (DiviTum, Biovica(®)) and one fully automated assay (Liaison, Diasorin(®)).

Methods: The study included 368 women: 149 healthy blood donors (control), 59 patients with benign breast disease (BBD) and 160 patients with primary breast cancer (BC).

Results: A regression analysis of the Liaison (y) and DiviTum (x) assays for all three groups yielded the equation y=3.

Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study.

Purpose: This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).

Methods: In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.

The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.

Rationale: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.

Objective: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.

The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage Scores.

Objective: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decision rule based on 28-day mortality rates of admitted and refused patients.

Patterns of adult tobacco use in Uzbekistan.

Background: Little is known about the prevalence of tobacco use in Uzbekistan, a country targeted intensively by the international tobacco industry.

Methods: A national household survey elicited information about cigarette smoking and nasway use (a form of smokeless tobacco).

Results: Prevalence of past-month smoking and nasway use among men (N=1795) was 19.

Mature Results of a Prospective Randomized Trial Comparing 5-Flourouracil with Leucovorin to 5-Flourouracil with Levamisole as Adjuvant Therapy of Stage II and III Colorectal Cancer- The Israel Cooperative Oncology Group (ICOG) Study.

Objective: Survival benefit with adjuvant therapy was shown in patients with Stage III colorectal cancer (CRC). This study evaluates long-term (10-year) outcome in patients with CRC randomly assigned to adjuvant 5-Fluorouracil/Leucovorin (5FU+LV) or 5-FU/Levamisole (5FU+LEV).

Methods: Between 1990 and 1995, 398 patients with curatively resected Stage II-III CRC were randomly assigned to adjuvant 5FU+LV or 5FU+LEV for 12 months.

Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis.

Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case.

Calcification in retinoblastoma: histopathologic findings and statistical analysis of 302 cases.

Aim: To evaluate the histopathologic factors statistically associated with the presence of calcification in eyes with retinoblastoma.

Methods: Retrospective, consecutive and observational case series. Three hundred and two enucleated eyes with retinoblastoma examined between the years 1960 and 2008.

Reasons for refusal of admission to intensive care and impact on mortality.

Purpose: To identify factors influencing triage decisions and investigate whether admission to the intensive care unit (ICU) could reduce mortality compared with treatment on the ward.

Methods: A multicentre cohort study in 11 university hospitals from seven countries, evaluating triage decisions and outcomes of patients referred for admission to ICU who were either accepted, or refused and treated on the ward. Confounding in the estimation of the effect of ICU admission on mortality was controlled by use of a propensity score approach, which adjusted for the probability of being admitted.

Relieving suffering or intentionally hastening death: where do you draw the line?

Objective: End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process.

Design: Secondary analysis of a prospective, observational study.

Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study.

Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs).

Design: A prospective observational study.

Setting: Thirty-seven ICUs in 17 European countries.

Trabecular bone gradient in rat long bone metaphyses: mathematical modeling and application to morphometric measurements and correction of implant positioning.

Unlabelled: The distribution of trabecular structures in mammalian long bone metaphyses has been insufficiently explored. We show in rats that the trabecular bone structural parameters display a decreasing gradient, toward the diaphysis, that can be defined mathematically. This gradient is applicable for optimizing the reference volume in metabolic studies and for retrospective correction of implant positioning.

The importance of religious affiliation and culture on end-of-life decisions in European intensive care units.

Objective: To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units (ICUs).

Design And Setting: A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy. Prospectively defined end-of-life practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000 were compared for frequencies, patterns, timing, and communication by religious affiliation of physicians and patients and regions.

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study.

Objective: To evaluate attitudes of Europeans regarding end-of-life decisions.

Design And Setting: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment.

Measurements And Results: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%).

Neonatal transport of very low birth weight infants in Jerusalem, revisited.

Background: Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocated. Since a substantial number of premature deliveries still occur in hospitals with level I and level II nurseries, it is imperative to find means to improve their outcome.

Objectives: To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very low birth weight infants, accounting for sociodemographic, obstetric and perinatal variables, with reference to earlier published data.

Nurse involvement in end-of-life decision making: the ETHICUS Study.

Objective: The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.

Design: This study was part of a larger study sponsored by the Ethics Section of the European Society of Intensive Care Medicine, the ETHICUS Study. Physicians described whether they thought nurses were involved in such decisions, whether nurses initiated such a discussion and whether there was agreement between physicians and nurses.

Communication of end-of-life decisions in European intensive care units.

Objective: To examine end-of-life (EOL) practices in European ICUs: who makes these decisions, how they are made, communication of these decisions and questions on communication between the physicians, nurses, patients and families.

Design: Data collected prospectively on EOL decisions facilitated by a questionnaire including EOL decision categories, geographical regions, mental competency, information about patient wishes, and discussions with patients, families and health care professionals.

Setting: 37 European ICUs in 17 countries.

Prediction of coronary artery disease severity in patients referred for coronary angiography.

Background: Diagnostic coronary angiography is often followed by coronary stenting. Therapy with aspirin and clopidogrel is currently the standard treatment for patients undergoing coronary stenting. Clopidogrel loading is usually given prior to the procedure.

A "smoke-free" hospital in Israel--a possible mission.

Background: A revised antismoking law in Israel (August 2001) called for a complete ban of smoking in hospitals. An evaluation of a hospital process and short-term outcome of implementing such policy may guideline its sustainability.

Methods: Two cross-sectional, random-sample surveys of employees 3 months before policy implementation, and 6-9 months post-implementation.

A longitudinal, community-based study of low back pain outcomes.

Objectives: To assess the report of low back pain (LBP) over 1 year and its predictors in individuals reporting symptoms during an initial cross-sectional survey.

Study Design: A longitudinal community-based study.

Summary Of Background Data: The natural history of LBP is poorly understood.