What do people value most? – is longevity the main goal? by A.Professor Charlie Corke
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The document discusses the results of a survey of 1424 people's attitudes towards medical treatment and end-of-life care. The survey asked questions about fighting for life in the face of suffering, living as long as possible versus medical treatment having limits, and preferences around nursing home care or euthanasia. The results showed that most people agreed that medical treatment has its limits and is not appropriate when the odds of a good outcome are small, and many agreed with statements about preferring euthanasia over being in a nursing home or getting into a bad state. The conclusion is that longevity is not the only priority for most people, and other factors should be considered in end-of-life care decisions.
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Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
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So why do we do cEEGs for patients with suspected SE?
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To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
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Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Brain injury outcomes and predictors
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
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Study Resources:
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The Electrocardiogram - Physiologic Principles
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
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14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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What do people value most? – is longevity the main goal? by A.Professor Charlie Corke
- 1. Whatever it takes? A/Prof Charlie Corke
- 4. Each statement shown 4 times Always most agree = +1 Always least agree = -1
- 7. NUMBER 121 27 234 1 2 3 7%
- 11. Goal that patient would like their doctor to make number one priority
- 16. QUESTION 5 It is important to me to keep fighting for life and to battle on in the face of suffering STG DISAGREE 28% DISAGREE 36% UNSURE 17% AGREE 14% STG AGREE 4%
- 17. QUESTION 17 It is important to live as long as possible and to fight every step of the way STG DISAGREE 35% DISAGREE 40% UNSURE 11% AGREE 11% STG AGREE 3%
- 18. QUESTION 28 Medical treatment has its limits. Keeping going too long is not appropriate when the odds of a good outcome are small STG DISAGREE 1% DISAGREE 2% UNSURE 5% AGREE 43% STG AGREE 48%
- 19. QUESTION 9 I’d rather be dead than to have to go into a nursing home (long term) STG DISAGREE 3% DISAGREE 18% UNSURE 20% AGREE 30% STG AGREE 29%
- 20. QUESTION 31 ‘Just push me off a cliff’ and ‘take me to the back paddock and shoot me’ are a good summary of how I feel should I get into a bad state STG DISAGREE 7% DISAGREE 25% UNSURE 13% AGREE 34% STG AGREE 22%
- 23. •1424 MyValues users •Half are female.
- 24. 60 questions
- 25. Attitudes to intervention istribution of the total pro-interventional answers. Possible values range from 0 to 41.
- 28. X Nulla sed consequat tortor. Phasellus tempor dolor quis bibendum tincidunt. In nec eros sed lorem faucibus posuere. Proin aliquet tempor lectus, id rhoncus ligula laoreet Pellentesque dignissim egestas purus id hendrerit. Donec molestie CONCLUSION The desire for longevity is not a priority (certainly not the only priority) Other things are important and should be considered Tools can help
Editor's Notes
- Concepts are presented in a number of ways. This one explores if people feel they might not get a ‘fair go’
- Concepts are presented in a number of ways. This one explores if people feel they might not get a ‘fair go’