1) A prospective study of 344 cardiac arrest survivors in the Netherlands found that 62 (18%) reported having a near-death experience (NDE).
2) Occurrence of NDE was not associated with duration of cardiac arrest, unconsciousness, medication, or pre-arrest fear of death. Factors affecting frequency included age, multiple resuscitations, previous NDE, and memory problems after prolonged CPR.
3) Depth of NDE was affected by sex, location of resuscitation, and pre-arrest fear, with significantly more patients who reported deep NDE dying within 30 days of CPR compared to those without NDE.
Artículo de Pim Van Lommel donde reflexiona en profundidad sobre las experiencias cercanas a la muerte y acude a la mecánica cuántica como forma de explicar esa otra “dimensión” donde se hallaría la consciencia.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
To describe the frequency, type, and clinical course
of hearing loss in Wegener’s granulomatosis and assess hearing
loss as an indicator of disease activity.
Artículo de Pim Van Lommel donde reflexiona en profundidad sobre las experiencias cercanas a la muerte y acude a la mecánica cuántica como forma de explicar esa otra “dimensión” donde se hallaría la consciencia.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
To describe the frequency, type, and clinical course
of hearing loss in Wegener’s granulomatosis and assess hearing
loss as an indicator of disease activity.
Management of headaches - an evidence based approach. Presented by Dr. George Koshy Vilanilam M.B.B.S as a part of research topic presentation for clinical rotation, July 2017
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Austin Anesthesiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Anesthesia & Anesthesiology. The renowned editorial team ensures a balanced, expert assessment of the articles published with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in all areas of anesthesiology.
Austin Anesthesiology accepts original research articles, review articles and short communication covering all aspects of Anesthesia for review and possible publication.
Austin Anesthesiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Management of headaches - an evidence based approach. Presented by Dr. George Koshy Vilanilam M.B.B.S as a part of research topic presentation for clinical rotation, July 2017
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Austin Anesthesiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Anesthesia & Anesthesiology. The renowned editorial team ensures a balanced, expert assessment of the articles published with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in all areas of anesthesiology.
Austin Anesthesiology accepts original research articles, review articles and short communication covering all aspects of Anesthesia for review and possible publication.
Austin Anesthesiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
ABSTRACT
Heat/light/electrical energy is out today’s necessity and has scarcity also. Energy conservation is key requirement of any industry at all times.
In general, industries use heat energy for conservation of raw material to finished product. The source of heat energy is generally saturated or super heated steam. The steam generation is common use one boiler with carity of fuels. Whatever may be the fuel the generation should be as economy as possible which adds to the product cost. Further the usage of steam and recycling steam condensate back to boiler is an art depending on plant layouts.
In this project the steam generator is water tube boiler fired with rice husk. The steam is transferred to the tyre/tube moulds where tyres/tubes are cured while the heat is rejected to the tyres the condensate forms and this condensate is put back to the boiler. While doing so the steam is also stopped back to boiler without rejecting complete heat to the product. This gets flashed into atmosphere at feed water tank. The science of separation of condensate from steam saves energy. Better the separation more the fuel conservation.
In the steam generator the fuel is burnt to heat the water and form steam. This fuel burnt flue gas carries lot of energy, out through chimney. Prior to exhausting through the heat left in flue need to be recovered, through heat recovery mechanisms’. In this project an air-preheater condensate heat recovery unit is the major energy consuming station.
A qualitative and quantitative study of the incidence, features and aetiology...José Luis Moreno Garvayo
Resultados del estudio piloto de 2001 diseñado para evaluar la frecuencia en que se daban experiencias cercanas a la muerte en personas que habían sobrevivido a paros cardíacos, así como para determinar las características de estas experiencias. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: C...Ahmed Elaghoury
A case study presented at the 2nd International Brain Stimulation in Barcelona.
Cite as: Gad, M., & Elaghoury, A. (2017). Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: Case report. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 419.
http://dx.doi.org/10.1016/j.brs.2017.01.244
Heart failure refers to a condition whereby the heart fails to pump sufficiently to maintain a
blood flow which will meet the body’s need, and is the common final pathway for various cardiac
diseases. Despite advances in heart failure treatment, the prognosis remains poor with high rates of
hospitalisation, morbidity and mortality. Recent data has reported that all-cause mortality is up to
32.1% at 2 years and 54% at 5 years for heart failure patients [1].These data highlight the importance
of identifying all modifiable conditions that may aggravate heart failure in these patients.
Debra K. Katzman, MD ABSTRACT The purpose of the current article .docxedwardmarivel
Debra K. Katzman, MD* ABSTRACT The purpose of the current article is to summarize the evidence-based medical complications and treatments that are both common and unique to adolescents with anorexia nervosa (AN). Recent literature relating to the cardiovascular complications,refeedingsyndrome, alterations in linear growth, impaired bone mineralaccretion,and structuralandfunctional brain changes was reviewed. The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these
complications underscore the need for early identification and treatment of AN in adolescents. AN is a serious disorder with significant and often life-threatening medical complications. The increasing growth of evidence highlights the importance of early identification and treatment by an interdisciplinary team of health care providers who have expertise in managing adolescents with AN and their medical sequelae. ª 2005 by Wiley Periodicals, Inc.
Keywords: medical complications; adolescents; anorexia nervosa
(Int J Eat Disord 2005; 37:S52–S59
Introduction
Anorexia nervosa (AN) in adolescents can cause significant medical complications in every organ system in the growing and developing body.1 Critical to the ongoing advancement of our understanding of AN in adolescents is the steady growth of evidence on the identification and management of the multitude of medical complications. Although many of these medical complications improve with nutritional rehabilitation and recovery from the eating disorder, some are potentially irreversible. As such, the long-term implications of these medical complications that typically begin in the formative years of adolescence are unknown. The current article summarizes the evidence-based literature on common medical complications that have been specifically studied in adolescent populations with AN over the past 20 years. We will focus on the cardiovascular and metabolic complications with a particular emphasis on refeeding syndrome, alterations in linear growth, impaired bone mineral accretion, and reference to structural and functional brain
changes, all of which have been studied in adolescents with AN.
Cardiovascular Complications
AN is a life-threatening condition, with significant risk of death due to cardiac complications. One third of the deaths in adults with eating disorders are due to cardiac complications.2 There are no such data regarding adolescents with AN. Cardiac involvement is present in the early stages of the disorder in adolescents with AN.3,4 In fact, even with a short duration of illness, there are both functional and structural cardiac abnormalities that appear to be reversible with early identification and treatment.3 Upon reviewing the adolescent eating disorder literature, the most common reported cardiovascular complications include electrocardiographic abnormalities such as.
Late onset mania is a kind of Psychiatric illness in which Manic symptoms develops for the first time after the age of 60 years or the continuation of recurrent bipolar illness.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Nde
1. ARTICLES
Near-death experience in survivors of cardiac arrest: a
prospective study in the Netherlands
Pim van Lommel, Ruud van Wees, Vincent Meyers, Ingrid Elfferich
Summary Introduction
Some people who have survived a life-threatening crisis
Background Some people report a near-death experience report an extraordinary experience. Near-death
(NDE) after a life-threatening crisis. We aimed to establish experience (NDE) occurs with increasing frequency
the cause of this experience and assess factors that because of improved survival rates resulting from
affected its frequency, depth, and content. modern techniques of resuscitation. The content of
NDE and the effects on patients seem similar
Methods In a prospective study, we included 344 worldwide, across all cultures and times. The subjective
consecutive cardiac patients who were successfully nature and absence of a frame of reference for this
resuscitated after cardiac arrest in ten Dutch hospitals. We experience lead to individual, cultural, and religious
compared demographic, medical, pharmacological, and factors determining the vocabulary used to describe and
psychological data between patients who reported NDE and interpret the experience.1
patients who did not (controls) after resuscitation. In a NDE are reported in many circumstances: cardiac
longitudinal study of life changes after NDE, we compared arrest in myocardial infarction (clinical death), shock in
the groups 2 and 8 years later. postpartum loss of blood or in perioperative
complications, septic or anaphylactic shock,
Findings 62 patients (18%) reported NDE, of whom 41 electrocution, coma resulting from traumatic brain
(12%) described a core experience. Occurrence of the damage, intracerebral haemorrhage or cerebral
experience was not associated with duration of cardiac infarction, attempted suicide, near-drowning or
arrest or unconsciousness, medication, or fear of death asphyxia, and apnoea. Such experiences are also
before cardiac arrest. Frequency of NDE was affected by reported by patients with serious but not immediately
how we defined NDE, the prospective nature of the life-threatening diseases, in those with serious
research in older cardiac patients, age, surviving cardiac depression, or without clear cause in fully conscious
arrest in first myocardial infarction, more than one people. Similar experiences to near-death ones can
cardiopulmonary resuscitation (CPR) during stay in occur during the terminal phase of illness, and are called
hospital, previous NDE, and memory problems after deathbed visions. Identical experiences to NDE, so-
prolonged CPR. Depth of the experience was affected by called fear-death experiences, are mainly reported after
sex, surviving CPR outside hospital, and fear before cardiac situations in which death seemed unavoidable: serious
arrest. Significantly more patients who had an NDE, traffic accidents, mountaineering accidents, or isolation
especially a deep experience, died within 30 days of CPR such as with shipwreck.
(p<0·0001). The process of transformation after NDE took Several theories on the origin of NDE have been
several years, and differed from those of patients who proposed. Some think the experience is caused by
survived cardiac arrest without NDE. physiological changes in the brain, such as brain cells
dying as a result of cerebral anoxia.2–4 Other theories
Interpretation We do not know why so few cardiac patients encompass a psychological reaction to approaching
report NDE after CPR, although age plays a part. With a death,5 or a combination of such reaction and anoxia.6
purely physiological explanation such as cerebral anoxia for Such experiences could also be linked to a changing
the experience, most patients who have been clinically state of consciousness (transcendence), in which
dead should report one. perception, cognitive functioning, emotion, and sense of
identity function independently from normal body-
Lancet 2001; 358: 2039–45 linked waking consciousness.7 People who have had an
See Commentary page 2010 NDE are psychologically healthy, although some show
non-pathological signs of dissociation.7 Such people do
not differ from controls with respect to age, sex, ethnic
origin, religion, or degree of religious belief.1
Studies on NDE1,3,8,9 have been retrospective and very
selective with respect to patients. In retrospective
studies, 5–10 years can elapse between occurrence of the
experience and its investigation, which often prevents
accurate assessment of physiological and
pharmacological factors. In retrospective studies,
between 43%8 and 48%1 of adults and up to 85% of
Division of Cardiology, Hospital Rijnstate, Arnhem, Netherlands children10 who had a life-threatening illness were
(P van Lommel MD); Tilburg, Netherlands (R van Wees PhD); estimated to have had an NDE. A random investigation
Nijmegen, Netherlands (V Meyers PhD); and Capelle a/d Ijssel, of more than 2000 Germans showed 4·3% to have had
Netherlands (I Elfferich PhD) an NDE at a mean age of 22 years.11 Differences in
Correspondence to: Dr Pim van Lommel, Division of Cardiology, estimates of frequency and uncertainty as to causes of
Hospital Rijnstate, PO Box 9555, 6800 TA Arnhem, Netherlands this experience result from varying definitions of the
(e-mail: pimvanlommel@wanadoo.nl) phenomenon, and from inadequate methods of
THE LANCET • Vol 358 • December 15, 2001 2039
For personal use. Only reproduce with permission from The Lancet Publishing Group.
2. ARTICLES
research.12 Patients’ transformational processes after an We did standardised and taped interviews with
NDE are very similar1,3,13–16 and encompass life-changing participants a mean of 2 years after CPR. Patients also
insight, heightened intuition, and disappearance of fear of completed a life-change inventory.16 The questionnaire
death. Assimilation and acceptance of these changes is addressed self-image, concern with others, materialism
thought to take at least several years.15 and social issues, religious beliefs and spirituality, and
We did a prospective study to calculate the frequency attitude towards death. Participants answered 34
of NDE in patients after cardiac arrest (an objective questions with a five-point scale indicating whether and
critical medical situation), and establish factors that to what degree they had changed. After 8 years,
affected the frequency, content, and depth of the surviving patients and their partners were interviewed
experience. We also did a longitudinal study to assess the again with the life-change inventory, and also completed
effect of time, memory, and suppression mechanisms on a medical and psychological questionnaire for cardiac
the process of transformation after NDE, and to reaffirm patients (from the Dutch Heart Foundation), the
the content and allow further study of the experience. We Utrecht coping list, the sense of coherence inquiry, and
also proposed to reassess theories on the cause and a scale for depression. These extra questionnaires were
content of NDE. deemed necessary for qualitative analysis because of the
reduced number of respondents who survived to 8 years
Methods follow-up. Our control group consisted of resuscitated
Patients patients who had not reported an NDE. We matched
We included consecutive patients who were successfully controls with patients who had had an NDE by age, sex,
resuscitated in coronary care units in ten Dutch hospitals and time interval between CPR and the second and
during a research period varying between hospitals from third interviews.
4 months to nearly 4 years (1988–92). The research
period varied because of the requirement that all Statistical analysis
consecutive patients who had undergone successful We assessed causal factors for NDE with the Pearson 2
cardiopulmonary resuscitation (CPR) were included. If test for categorical and t test for ratio-scaled factors.
this standard was not met we ended research in that Factors affecting depth of NDE were analysed with the
hospital. All patients had been clinically dead, which we Mann-Whitney test for categorical factors, and with
established mainly by electrocardiogram records. All Spearman’s coefficient of rank correlation for ratio-
patients gave written informed consent. We obtained scaled factors. Links between NDE and altered scores
ethics committee approval. for questions from the life-change inventory were
assessed with the Mann-Whitney test. The sums of the
Procedures individual scores were used to compare the responses to
We defined NDE as the reported memory of all the life-change inventory in the second and third
impressions during a special state of consciousness, interview. Because few causes or relations exist for
including specific elements such as out-of-body NDE, the null hypotheses are the absence of factors.
experience, pleasant feelings, and seeing a tunnel, a light, Hence, all tests were two-tailed with significance shown
deceased relatives, or a life review. We defined clinical by p values less than 0·05.
death as a period of unconsciousness caused by
insufficient blood supply to the brain because of Results
inadequate blood circulation, breathing, or both. If, in Patients
this situation, CPR is not started within 5–10 min, We included 344 patients who had undergone 509
irreparable damage is done to the brain and the patient successful resuscitations. Mean age at resuscitation was
will die. 62·2 years (SD 12·2), and ranged from 26 to 92 years.
We did a short standardised interview with sufficiently 251 patients were men (73%) and 93 were women
well patients within a few days of resuscitation. We (27%). Women were significantly older than men (66 vs
asked whether patients recollected the period of un- 61 years, p=0·005).The ratio of men to women was
consciousness, and what they recalled. Three researchers 57/43 for those older than 70 years, whereas at younger
coded the experiences according to the weighted core ages it was 80/20. 14 (4%) patients had had a previous
experience index.1 In this scoring system, depth of NDE NDE. We interviewed 248 (74%) patients within 5 days
is measured with weighted scores assigned to elements of after CPR. Some demographic questions from the first
the content of the experience. Scores between 1 and 5 interview had too many values missing for reliable
denote superficial NDE, but we included these events statistical analysis, so data from the second interview
because all patients underwent transformational changes were used. Of the 74 patients whom we interviewed at
as well. Scores of 6 or more denote core experiences, and 2-year follow-up, 42 (57%) had previously heard of
scores of 10 or greater are deep experiences. We also NDE, 53 (72%) were religious, 25 (34%) had left
recorded date of cardiac arrest, date of interview, sex, education aged 12 years, and 49 (66%) had been
age, religion, standard of education reached, whether the educated until aged at least 16 years.
patient had previously experienced NDE, previously 296 (86%) of all 344 patients had had a first
heard of NDE, whether CPR took place inside or outside myocardial infarction and 48 (14%) had undergone
hospital, previous myocardial infarction, and how many more than one infarction. Nearly all patients with acute
times the patient had been resuscitated during their stay myocardial infarction were treated with fentanyl, a
in hospital. We estimated duration of circulatory arrest synthetic opiod antagonist; thalamonal, a combined
and unconsciousness, and noted whether artificial preparation of fentanyl with dehydrobenzperidol that
respiration by intubation took place. We also recorded has an antipsychotic and sedative effect; or both. 45
type and dose of drugs before, during, and after the crisis, (13%) patients also received sedative drugs such as
and assessed possible memory problems at interview after diazepam or oxazepam, and 38 (11%) were given strong
lengthy or difficult resuscitation. We classed patients sedatives such as midazolam (for intubation), or
resuscitated during electrophysiological stimulation haloperidol for cerebral unrest during or after long-
separately. lasting unconsciousness.
2040 THE LANCET • Vol 358 • December 15, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
3. ARTICLES
WCEI score* n artificial respiration without intubation, while heart
A No memory 0 282 (82%)
massage and defibrillation are also applied. When we
B Some recollection 1–5 21 (6%) want to intubate the patient, he turns out to have
C Moderately deep NDE 6–9 18 (5%) dentures in his mouth. I remove these upper dentures
D Deep NDE 10–14 17 (5%) and put them onto the ‘crash car’. Meanwhile, we
E Very deep NDE 15–19 6 (2%) continue extensive CPR. After about an hour and a half
WCEI=weighted core experience index. NDE=near-death experience. *A=no the patient has sufficient heart rhythm and blood
NDE, B=superficial NDE, C/D/E=core NDE. pressure, but he is still ventilated and intubated, and he
Table 1: Distribution of the 344 patients in five WCEI classes* is still comatose. He is transferred to the intensive care
unit to continue the necessary artificial respiration. Only
234 (68%) patients were successfully resuscitated after more than a week do I meet again with the patient,
within hospital. 190 (81%) of these patients were who is by now back on the cardiac ward. I distribute his
resuscitated within 2 min of circulatory arrest, and medication. The moment he sees me he says: ‘Oh, that
unconsciousness lasted less than 5 min in 187 (80%). 30 nurse knows where my dentures are’. I am very
patients were resuscitated during electrophysiological surprised. Then he elucidates: ‘Yes, you were there
stimulation; these patients all underwent less than 1 min when I was brought into hospital and you took my
of circulatory arrest and less than 2 min of un- dentures out of my mouth and put them onto that car, it
consciousness. This group were only given 5 mg of had all these bottles on it and there was this sliding
diazepam about 1 h before electrophysiological stim- drawer underneath and there you put my teeth.’ I was
ulation. especially amazed because I remembered this happening
101 (29%) patients survived CPR outside hospital, while the man was in deep coma and in the process of
and nine (3%) were resuscitated both within and outside CPR. When I asked further, it appeared the man had
hospital. Of these 110 patients, 88 (80%) had more than seen himself lying in bed, that he had perceived from
2 min of circulatory arrest, and 62 (56%) were above how nurses and doctors had been busy with CPR.
unconscious for more than 10 min. All people with brief He was also able to describe correctly and in detail the
cardiac arrest and who were resuscitated outside small room in which he had been resuscitated as well as
hospital were resuscitated in an ambulance. Only 12 the appearance of those present like myself. At the time
(9%) patients survived a circulatory arrest that lasted that he observed the situation he had been very much
longer than 10 min. 36% (123) of all patients were afraid that we would stop CPR and that he would die.
unconsciousness for longer than 60 min, 37 of these And it is true that we had been very negative about the
patients needed artificial respiration through intubation. patient’s prognosis due to his very poor medical
Intubated patients received high doses of strong condition when admitted. The patient tells me that he
sedatives and were interviewed later than other patients; desperately and unsuccessfully tried to make it clear to
most were still in a weakened physical condition at the us that he was still alive and that we should continue
time of first interview and 24 showed memory defects. CPR. He is deeply impressed by his experience and says
Significantly more younger than older patients survived he is no longer afraid of death. 4 weeks later he left
long-lasting unconsciousness following difficult CPR hospital as a healthy man.”
(p=0·005). Table 3 shows relations between demographic,
medical, pharmacological, and psychological factors and
Prospective findings the frequency and depth of NDE. No medical,
62 (18%) patients reported some recollection of the pharmacological, or psychological factor affected the
time of clinical death (table 1). Of these patients, 21 frequency of the experience. People younger than
(6% of total) had a superficial NDE and 41 (12%) had a 60 years had NDE more often than older people
core experience. 23 of the core group (7% of total) (p=0·012), and women, who were significantly older
reported a deep or very deep NDE. Therefore, of 509 than men, had more frequent deep experiences than
resuscitations, 12% resulted in NDE and 8% in core men (p=0·011) (table 3). Increased frequency of
experiences. Table 2 shows the frequencies of ten experiences in patients who survived cardiac arrest in
elements of NDE.1 No patients reported distressing or first myocardial infarction, and deeper experiences in
frightening NDE. patients who survived CPR outside hospital could have
During the pilot phase in one of the hospitals, a resulted from differences in age. Both these groups of
coronary-care-unit nurse reported a veridical out-of- patients were younger than other patients, though the
body experience of a resuscitated patient: age differences were not significant (p=0·05 and 0·07,
“During a night shift an ambulance brings in a 44- respectively).
year-old cyanotic, comatose man into the coronary care Lengthy CPR can sometimes induce loss of memory
unit. He had been found about an hour before in a and patients thus affected reported significantly fewer
meadow by passers-by. After admission, he receives NDEs than others (table 3). No relation was found
between frequency of NDE and the time between CPR
Elements of NDE1 Frequency (n=62) and the first interview (range 1–70 days). Mortality
1 Awareness of being dead 31 (50%) during or shortly after stay in hospital in patients who
2 Positive emotions 35 (56%) had an NDE was significantly higher than in patients
3 Out of body experience 15 (24%) who did not report an NDE (13/62 patients [21%] vs
4 Moving through a tunnel 19 (31%)
24/282 [9%], p=0·008), and this difference was even
5 Communication with light 14 (23%)
6 Observation of colours 14 (23%) more marked in patients who reported a deep
7 Observation of a celestial landscape 18 (29%) experience (10/23 [43%] vs 24/282 [9%], p<0·0001).
8 Meeting with deceased persons 20 (32%)
9 Life review 8 (13%) Longitudinal findings
10 Presence of border 5 (8%) At 2-year follow-up, 19 of the 62 patients with NDE had
NDE=near-death experience. died and six refused to be interviewed. Thus, we were
Table 2: Frequency of ten elements of NDE able to interview 37 patients for the second time. All
THE LANCET • Vol 358 • December 15, 2001 2041
For personal use. Only reproduce with permission from The Lancet Publishing Group.
4. ARTICLES
Frequency of NDE Depth LIfe-change inventory questionnaire p
of NDE
NDE No NDE p (n=62) Social attitude
(n=62) (n=282) Showing own feelings 0·034
Categorical factors Acceptance of others* 0·012
Demographic More loving, empathic* 0·002
Women 13 (21%) 80 (28%) NS 0·011 Understanding others* 0·003
Age* <60 years 32 (52%) 96 (34%) 0·012 NS Involvement in family* 0·008
Religion† (yes) 26 (70%) 27 (73% ) NS NS Religious attitude
Education†‡ Elementary 10 (27%) 15 (43%) NS NS Understand purpose of life* 0·020
Medical Sense inner meaning of life* 0·028
Intubation 6 (10%) 31 (11%) NS NS Interest in spirituality* 0·035
Electrophysiological 8 (13%) 22 (8%) NS NS
stimulation Attitude to death
First myocardial 60 (97%) 236 (84%) 0·013 NS Fear of death* 0·009
infarction Belief in life after death* 0·007
CPR outside hospital§ 13 (21%) 88 (32%) NS 0·027 Others
Memory defect after 1 (2%) 40 (14%) 0·011 NS Interest in meaning of life 0·020
lengthy CPR Understanding oneself 0·019
Death within 30 days 13 (21%) 24 (9%) 0·008 0·017 Appreciation of ordinary things 0·0001
Pharmacological
NDE=near-death experience. 35 patients had NDE, 39 had not had NDE.
Extra medication 17 (27%) 70 (25%) NS NS 1 value missing for patients wih NDE in all categories; *2 values missing for
Psychological patients with NDE (ie, n=33).
Fear before CPR†§ 4 (13%) 2 (6%) NS 0·045
Previous NDE 6 (10%) 8 (3%) 0·035 NS Table 4: Significant differences in life-change inventory-scores16
Foreknowledge of NDE† 22 (60%) 20 (54%) NS NS of patients with and without NDE at 2-year follow-up
Ratio-scaled factors
Demographic NDE was linked to high scores in spiritual items such as
Age (mean [SD], years)* 58·8 (13·4) 63·5 (11·8) 0·006 NS interest in the meaning of one’s own life, and social
Medical items such as showing love and accepting others. The 13
Duration of cardiac 4·0 (5·2) 3·7 (3·9) NS NS patients who had superficial NDE underwent the same
arrest (mean [SD], min)
specific transformational changes as those who had a
Duration of 66·1 (269·5) 118·3 (355·5) NS NS
unconsciousness core experience.
(mean [SD], min) 8-year follow-up included 23 patients with an NDE
Number of CPRs (SD) 2·1 (2·5) 1·4 (1·2) 0·029 NS that had been affirmed at 2-year follow-up. 11 patients
Data are number (%) unless otherwise indicated. CPR=cardiopulmonary had died and one could not be interviewed. Patients
resuscitation. NS=not significant (p>0·05). *3 missing values. †n=74 (data could still recall their NDE almost exactly. Of the
from 2nd interview, 35 NDE, 39 no NDE). ‡2 missing values. §10 missing
values.
patients without an NDE at 2-year follow-up, 20 had
died and four patients could not be interviewed (for
Table 3: Factors affecting frequency and depth of near-death
reasons such as dementia and long stay in hospital),
experience (NDE)
which left 15 patients without an NDE to take part in
the third interview.
patients were able to retell their experience almost All patients, including those who did not have NDE,
exactly. Of the 17 patients who had low scores in the had gone through a positive change and were more self-
first interview (superficial NDE), seven had unchanged assured, socially aware, and religious than before. Also,
low scores, and four probably had, in retrospect, an
NDE that consisted only of positive emotions (score 1). Life-change inventory 2-year follow-up 8-year follow-up
Six patients had not in fact had an NDE after all, which questionnaire
NDE no NDE NDE no NDE
was probably because of our wide definition of NDE at (n=23) (n=15) (n=23) (n=15)
the first interview. Social attitude
We selected a control group, matched for age, sex, Showing own feelings 42 16 78 58
and time since cardiac arrest, from the 282 patients who Acceptance of others 42 16 78 41
had not had NDE. We contacted 75 of these patients to More loving, empathic 52 25 68 50
obtain 37 survivors who agreed to be interviewed. Two Understanding others 36 8 73 75
Involvement in family 47 33 78 58
controls reported an NDE consisting only of positive
emotions, and two a core experience. The first interview Religious attitude
after CPR might have been too soon for these four Understand purpose of life 52 33 57 66
Sense inner meaning of life 52 25 57 25
patients (1% of total) to remember their NDE, or to be Interest in spirituality 15 –8 42 –41
willing or able to describe the experience. We were
therefore able to interview 35 patients who had had an Attitude to death
Fear of death –47 –16 –63 –41
affirmed NDE, and 39 patients who had not. Belief in life after death 36 16 42 16
Only six of the 74 patients that we interviewed at
Others
2 years said they were afraid before CPR (table 3). Four
Interest in meaning of life 52 33 89 66
of these six had deep NDE (p=0·045, table 3). Most Understanding oneself 58 8 63 58
patients were not afraid before CPR, as the arrest Appreciation of ordinary things 78 41 84 50
happened too suddenly and unexpectedly to allow time NDE=near-death experience. The sums of all individual scores per item are
for fear. reported in the same 38 patients who had both follow-up interviews.
Significant differences in answers to 13 of the 34 Participants responded in a five-point scale indicating whether and to what
degree they had changed: strongly increased (+2), somewhat increased (+1),
items in the life-change inventory between people with no change (0), somewhat decreased (–1), and strongly decreased (–2). Only in
and without an NDE are shown in table 4. For instance, the reported 13 (of 34) items in this table were significant differences found in
people who had NDE had a significant increase in belief life-change scores in the interview after 2 years (table 4).
in an afterlife and decrease in fear of death compared Table 5: Total sum of individual life-change inventory scores16
with people who had not had this experience. Depth of of patients at 2-year and 8-year follow-up
2042 THE LANCET • Vol 358 • December 15, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
5. ARTICLES
people who did not have NDE had become more In a study of mortality in patients after resuscitation
emotionally affected, and in some, fear of death had outside hospital,18 chances of survival increased in
decreased more than at 2-year follow-up. Their interest people younger than 60 years and in those undergoing
in spirituality had strongly decreased. Most patients who first myocardial infarction, which corresponds with our
did not have NDE did not believe in a life after death at findings. Older people have a smaller chance of cerebral
2-year or 8-year follow-up (table 5). People with NDE recovery after difficult and complicated resuscitation
had a much more complex coping process: they had after cardiac arrest. Younger patients have a better
become more emotionally vulnerable and empathic, and chance of surviving a cardiac arrest, and thus, to
often there was evidence of increased intuitive feelings. describe their experience. In a study of 11 patients after
Most of this group did not show any fear of death and CPR, the person that had an NDE was significantly
strongly believed in an afterlife. Positive changes were younger than other patients who did not have such an
more apparent at 8 years than at 2 years of follow-up. experience.19 Greyson7 also noted a higher frequency of
NDE and significantly deeper experiences at younger
Discussion ages, as did Ring.1
Our results show that medical factors cannot account Good short-term memory seems to be essential for
for occurrence of NDE; although all patients had been remembering NDE. Patients with memory defects after
clinically dead, most did not have NDE. Furthermore, prolonged resuscitation reported fewer experiences than
seriousness of the crisis was not related to occurrence or other patients in our study. Forgetting or repressing
depth of the experience. If purely physiological factors such experiences in the first days after CPR was unlikely
resulting from cerebral anoxia caused NDE, most of our to have occurred in the remaining patients, because no
patients should have had this experience. Patients’ relation was found between frequency of NDE and date
medication was also unrelated to frequency of NDE. of first interview. However, at 2-year follow-up, two
Psychological factors are unlikely to be important as fear patients remembered a core NDE and two an NDE that
was not associated with NDE. consisted of only positive emotions that they had not
The 18% frequency of NDE that we noted is lower reported shortly after CPR, presumably because of
than reported in retrospective studies,1,8 which could be memory defects at that time. It is remarkable that people
because our prospective study design prevented self- could recall their NDE almost exactly after 2 and
selection of patients. Our frequency of NDE is low 8 years.
despite our wide definition of the experience. Only 12% Unlike our results, an inverse correlation between
of patients had a core NDE, and this figure might be an foreknowledge and frequency of NDE has been
overestimate. When we analysed our results, we noted shown.1,8 Our finding that women have deeper
that one hospital that participated in the study for nearly experiences than men has been confirmed in two other
4 years, and from which 137 patients were included, studies,1,7 although in one,7 only in those cases in which
reported a significantly (p=0·01) lower percentage of women had an NDE resulting from disease.
NDE (8%), and significantly (p=0·05) fewer deep The elements of NDE that we noted (table 2)
experiences. Therefore, possibly some selection of correspond with those in other studies based on Ring’s1
patients occurred in the other hospitals, which classification. Greyson20 constructed the NDE scale
sometimes only took part for a few months. In a differently to Ring,1 but both scoring systems are
prospective study17 with the same design as ours, 6% of strongly correlated (r=0·90). Yet, reliable comparisons
63 survivors of cardiac arrest reported a core are nearly impossible between retrospective studies that
experience, and another 5% had memories with features included selection of patients, unreliable medical
of an NDE (low score in our study); thus, with our wide records, and used different criteria for NDE,12 and our
definition of the experience, 11% of these patients prospective study.
reported an NDE. Therefore, true frequency of the Our longitudinal follow-up research into trans-
experience is likely to be about 10%, or 5% if based on formational processes after NDE confirms the
number of resuscitations rather than number of transformation described by many others.1–3,8,10,13–16,21
resuscitated patients. Patients who survive several CPRs Several of these investigations included a control group
in hospital have a significantly higher chance of NDE to enable study of differences in transformation,14 but in
(table 3). our research, patients were interviewed three times
We noted that the frequency of NDE was higher in during 8 years, with a matched control group. Our
people younger than 60 years than in older people. In findings show that this process of change after NDE
other studies, mean age at NDE is lower than our tends to take several years to consolidate. Presumably,
estimate (62·2 years) and the frequency of the besides possible internal psychological processes, one
experience is higher. Morse10 saw 85% NDE in children, reason for this has to do with society’s negative response
Ring1 noted 48% NDE in people with a mean age of to NDE, which leads individuals to deny or suppress
37 years, and Sabom8 saw 43% NDE in people with a their experience for fear of rejection or ridicule. Thus,
mean age of 49 years; thus, age and the frequency of the social conditioning causes NDE to be traumatic,
experience seem to be associated. Other retrospective although in itself it is not a psychotraumatic experience.
studies have noted a younger mean age for NDE: As a result, the effects of the experience can be delayed
32 years,9 29 years,6 and 22 years.11 Cardiac arrest was for years, and only gradually and with difficulty is an
the cause of the experience in most patients in Sabom’s8 NDE accepted and integrated. Furthermore, the
study, whereas this was the case in only a low percentage longlasting transformational effects of an experience that
of patients in other work. We saw that people surviving lasts for only a few minutes of cardiac arrest is a
CPR outside hospital (who underwent deeper NDE surprising and unexpected finding.
than other patients) tended to be younger, as were those One limitation of our study is that our study group
who survived cardiac arrest in a first myocardial were all Dutch cardiac patients, who were generally
infarction (more frequent NDE), which indicates that older than groups in other studies. Therefore, our
age was probably decisive in the significant relation frequency of NDE might not be representative of all
noted with those factors. cases—eg, a higher frequency could be expected with
THE LANCET • Vol 358 • December 15, 2001 2043
For personal use. Only reproduce with permission from The Lancet Publishing Group.
6. ARTICLES
younger samples, or rates might vary in other elements of NDE, such as out-of-body experiences
populations. Also, the rates for NDE could differ in and other verifiable aspects. Finally, the theory
people who survive near-death episodes that come about and background of transcendence should be included as
by different causes, such as near drowning, near fatal car a part of an explanatory framework for these
crashes with cerebral trauma, and electrocution. experiences.
However, rigorous prospective studies would be almost
impossible in many such cases.
Several theories have been proposed to explain NDE. Contributors
Pim van Lommel coordinated the first interviews and was responsible
We did not show that psychological, neurophysiological, for collecting all demographic, medical, and pharmacological data.
or physiological factors caused these experiences after Pim van Lommel, Ruud van Wees, and Vincent Meyers rated the
cardiac arrest. Sabom22 mentions a young American first interview. Ruud van Wees and Vincent Meyers coordinated the
woman who had complications during brain surgery for second interviews. Ruud van Wees did statistical analysis of the first
and second interviews. Ingrid Elfferich did the third interviews and
a cerebral aneurysm. The EEG of her cortex and analysed these results.
brainstem had become totally flat. After the operation,
which was eventually successful, this patient proved to Acknowledgments
have had a very deep NDE, including an out-of-body We thank nursing and medical staff of the hospitals involved in the
experience, with subsequently verified observations research; volunteers of the International Association of Near Death
during the period of the flat EEG. Studies; IANDS-Netherlands; Merkawah Foundation for arranging
interviews, and typing the second and third interviews; Martin Meyers
And yet, neurophysiological processes must play some for help with translation; and Kenneth Ring and Bruce Greyson for
part in NDE. Similar experiences can be induced review of the article.
through electrical stimulation of the temporal lobe (and
hence of the hippocampus) during neurosurgery for
epilepsy,23 with high carbon dioxide levels References
(hypercarbia),24 and in decreased cerebral perfusion 1 Ring K. Life at death. A scientific investigation of the near-
resulting in local cerebral hypoxia as in rapid death experience. New York: Coward McCann and Geoghenan,
1980.
acceleration during training of fighter pilots,25 or as in 2 Blackmore S. Dying to live: science and the near-death experience.
hyperventilation followed by valsalva manoeuvre.4 London: Grafton—an imprint of Harper Collins Publishers,
Ketamine-induced experiences resulting from blockage 1993.
of the NMDA receptor,26 and the role of endorphin, 3 Morse M. Transformed by the light. New York: Villard Books,
serotonin, and enkephalin have also been mentioned,27 1990.
4 Lempert T, Bauer M, Schmidt D. Syncope and near-death
as have near-death-like experiences after the use of experience. Lancet 1994; 344: 829–30.
LSD,28 psilocarpine, and mescaline.21 These induced 5 Appelby L. Near-death experience: analogous to other stress
experiences can consist of unconsciousness, out-of-body induced physiological phenomena. BMJ 1989; 298: 976–77.
experiences, and perception of light or flashes of 6 Owens JE, Cook EW, Stevenson I. Features of “near-death
recollection from the past. These recollections, however, experience” in relation to whether or not patients were near death.
Lancet 1990; 336: 1175–77.
consist of fragmented and random memories unlike the
7 Greyson B. Dissociation in people who have near-death experiences:
panoramic life-review that can occur in NDE. Further, out of their bodies or out of their minds? Lancet 2000; 355:
transformational processes with changing life-insight 460–63.
and disappearance of fear of death are rarely reported 8 Sabom MB. Recollections of death: a medical investigation. New
after induced experiences. York: Harper and Row, 1982.
Thus, induced experiences are not identical to NDE, 9 Greyson B. Varieties of near-death experience. Psychiatry 1993;
56: 390–99.
and so, besides age, an unknown mechanism causes 10 Morse M. Parting visions: a new scientific paradigm. In: Bailey LW,
NDE by stimulation of neurophysiological and Yates J, eds. The near-death experience: a reader. New York and
neurohumoral processes at a subcellular level in the London: Routledge, 1996: 299–318.
brain in only a few cases during a critical situation such 11 Schmied I, Knoblaub H, Schnettler B. Todesnäheerfahrungen in
as clinical death. These processes might also determine Ost- und Westdeutschland—eine empirische Untersuchung. In:
Knoblaub H, Soeffner HG, eds. Todesnähe: interdisziplinäre
whether the experience reaches consciousness and can Zugänge zu einem außergewöhnlichen Phänomen. Konstanz:
be recollected. Universitätsverlag Konstanz, 1999: 217–50.
With lack of evidence for any other theories for NDE, 12 Greyson B. The incidence of near-death experiences. Med Psychiatry
the thus far assumed, but never proven, concept that 1998; 1: 92–99.
consciousness and memories are localised in the brain 13 Roberts G, Owen J. The near-death experience. Br J Psychiatry
1988; 153: 607–17.
should be discussed. How could a clear consciousness 14 Groth-Marnat G, Summers R. Altered beliefs, attitudes and
outside one’s body be experienced at the moment that behaviors following near-death experiences. J Hum Psychol 1998;
the brain no longer functions during a period of clinical 38: 110–25.
death with flat EEG?22 Also, in cardiac arrest the EEG 15 Atwater PMH. Coming back to life: the after-effects of the
usually becomes flat in most cases within about 10 s near-death experience. New York: Dodd, Mead and Company,
1988.
from onset of syncope.29,30 Furthermore, blind people 16 Ring K. Heading towards omega: in search of the meaning of
have described veridical perception during out-of-body the near-death experience. New York: Quill William Morrow,
experiences at the time of this experience.31 NDE pushes 1984.
at the limits of medical ideas about the range of human 17 Parnia S, Waller DG, Yeates R, Fenwick P. A qualitative and
consciousness and the mind-brain relation. quantitative study of the incidence, features and aetiology of near
death experiences in cardiac arrest survivors. Resuscitation 2001;
Another theory holds that NDE might be a changing 48: 149–56.
state of consciousness (transcendence), in which 18 Dickey W, Adgey AAJ. Mortality within hospital after resuscitation
identity, cognition, and emotion function independently from ventricular fibrillation outside hospital. Br Heart J 1992; 67:
from the unconscious body, but retain the possibility of 334–38.
non-sensory perception.7,8,22,28,31 19 Schoenbeck SB, Hocutt GD. Near-death experiences in patients
undergoing cardio-pulmonary resuscitation. J Near-Death Studies
Research should be concentrated on the effort to 1991; 9: 211–18.
explain scientifically the occurrence and content of 20 Greyson B. The near-death experience scale: construction, reliability
NDE. Research should be focused on certain specific and validity. J Nervous Mental Dis 1982; 171: 369–75.
2044 THE LANCET • Vol 358 • December 15, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
7. ARTICLES
21 Schröter-Kunhardt M. Nah—Todeserfahrungen aus psychiatrisch- the role of glutamate and the NMDA-receptor. In: Bailey LW,
neurologischer Sicht. In: Knoblaub H, Soeffner HG, eds. Yates J, eds. The near-death experience: a reader. New York and
Todesnähe: interdisziplinäre Zugänge zu einem außergewöhnlichen London: Routledge, 1996: 265–82.
Phänomen. Konstanz: Universitätsverlag Konstanz, 1999: 65–99. 27 Greyson B. Biological aspects of near-death experiences. Perspect
22 Sabom MB. Light and death: one doctors fascinating account of Biol Med 1998; 42: 14–32.
near-death experiences. Michigan: Zondervan Publishing House, 28 Grof S, Halifax J. The human encounter with death. New York:
1998: 37–52. Dutton, 1977.
23 Penfield W. The excitable cortex in conscious man. Liverpool: 29 Clute HL, Levy WJ. Electroencephalographic changes during brief
Liverpool University Press, 1958. cardiac arrest in humans. Anesthesiology 1990; 73: 821–25.
24 Meduna LT. Carbon dioxide therapy: a neuropsychological 30 Aminoff MJ, Scheinman MM, Griffing JC, Herre JM. Electrocerebral
treatment of nervous disorders. Springfield: Charles C Thomas, accompaniments of syncope associated with malignant ventricular
1950. arrhythmias. Ann Intern Med 1988; 108: 791–96.
25 Whinnery JE, Whinnery AM. Acceleration-induced loss of 31 Ring K, Cooper S. Mindsight: near-death and out-of-body
consciousness. Arch Neurol 1990; 47: 764–76. experiences in the blind. Palo Alto: William James Center for
26 Jansen K. Neuroscience, ketamine and the near-death experience: Consciousness Studies, 1999.
Clinical picture: Amiodarone-induced
pulmonary mass and cutaneous vasculitis
Christoph Scharf, Erwin N Oechslin, Franco Salomon, Wolfgang Kiowski
A 67-year-old man presented with haemoptysis and macular erythema on both legs.
He had longstanding congestive heart failure and was treated with quinapril,
digitalis, furosemide and phenprocoumon. He had been taking amiodarone for
4 years to treat unsustained bouts of ventricular tachycardia. An isolated pulmonary
mass of 5 cm in diameter with central necrosis was found in the right upper lobe
with extrinsic compression of the corresponding bronchus (figure, upper).
Transbronchial biopsies showed no abnormalities, the skin biopsy showed
lymphocytic vasculitis of the small capillaries. Antibody screening and urinalysis
were normal. On follow-up the mass decreased, new infiltrates appeared and the
TSH level increased to 37 mU/L (normal 0·1–4). The diagnosis of amiodarone-
induced pulmonary mass and cutaneous vasculitis was confirmed by complete
resolution of the infiltrates within 4 months after cessation of amiodarone therapy.
Department of Medicine, University Hospital, CH-8091 Zürich, Switzerland (Christoph Scharf MD;
Erwin N Oechslin MD; Franco Salomon MD, Wolfgang Kiowski MD)
THE LANCET • Vol 358 • December 15, 2001 2045
For personal use. Only reproduce with permission from The Lancet Publishing Group.