When to Withdraw Resuscitation in the ED

When can and should we withdraw from continuing resuscitation in the Emergency Department? We are here to save lives. I would argue the Emergency Medicine is a very pure expression of a Doctor's role: we meet a patient, we... read more

Extreme Measures: Finding a Better Path to the End of Life

Extreme Measures: Finding a Better Path to the End of Life

In our current medical culture, the old and the ill are put on what she terms the End-of-Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused,... read more

Should doctors be required to inform patients of their palliative care rights?

Should doctors be required to inform patients of their palliative care rights?

I overheard a colleague admit an 84-year-old woman to the hospital from the emergency department for a sizable mass in her uterus — no doubt, cancerous. I pictured a frail woman who’d been suffering for a while and was... read more

Dying at Home – Our Grandfather’s Great Escape

Dying at Home – Our Grandfather’s Great Escape

Our 94-year-old grandfather's last journey was not a glorious affair, an inelegant denouement to a life marked by global travel and migration. Still, to us, as we pushed his wheelchair out of the hospital lobby, it felt like... read more

A New Algorithm Identifies Candidates for Palliative Care by Predicting When Patients Will Die

A New Algorithm Identifies Candidates for Palliative Care by Predicting When Patients Will Die

End-of-life care can be stressful for patients and their loved ones, but a new algorithm could help provide better care to people during their final months. A paper published in arXiv by researchers from Stanford describes... read more

Is this critically ill patient elderly or too old?

Is this critically ill patient elderly or too old?

Life expectancy is increasing in industrialized countries. It is forecast that in the European Union 24.4 million people will be older than 85 years in 2040, more than doubling from the 10.4 million seen in 2010. In parallel,... read more

Delirium in Hospitalized Older Adults

Delirium in Hospitalized Older Adults

Delirium, an acute confusional state, is common among hospitalized elders and is associated with poor outcomes. All patients with delirium should be evaluated for reversible causes. Behavioral disturbances should be managed... read more

Humanizing the Treatment of Hyperactive Delirium in the Last Days of Life

Humanizing the Treatment of Hyperactive Delirium in the Last Days of Life

When patients with advanced cancer near the end of their life, it is important for physicians, nurses, and other health care personnel to respect and dignify the dying process of the patient. This requires a shift in focus... read more

Moral Distress in PICU and Neonatal ICU Practitioners

Moral Distress in PICU and Neonatal ICU Practitioners

In this single-center, cross-sectional study, we found that moral distress is present in PICU and neonatal ICU health practitioners and is correlated with burnout, uncertainty, and feeling unsupported. The main outcome was... read more

Under-reporting of End-of-life Decisions in Critical Care Trials: A Call to Modify CONSORT Statement

Under-reporting of End-of-life Decisions in Critical Care Trials: A Call to Modify CONSORT Statement

Under-reporting of End-of-life Decisions in Critical Care Trials: A Call to Modify CONSORT Statement... read more

Burn Till You’re Out

Burn Till You’re Out

When using the technical definition of burnout: "The reduction of a fuel to nothing", it clearly describes the state of being of the few people that I have met who are having a burnout. The problem is huge and almost... read more

Critical care at the end of life: a population-level cohort study of cost and outcomes

Critical care at the end of life: a population-level cohort study of cost and outcomes

Despite the high cost associated with ICU use at the end of life, very little is known at a population level about the characteristics of users and their end of life experience. In this study, our goal was to characterize... read more

Persistent Gaps in Use of Advance Directives Among Nursing Home Residents Receiving Maintenance Dialysis

Persistent Gaps in Use of Advance Directives Among Nursing Home Residents Receiving Maintenance Dialysis

Patients with end-stage renal disease receiving dialysis have a symptom burden and prognosis comparable to patients with incurable cancer. They frequently and increasingly receive intensive procedures near the end of life.... read more

How to Ensure Your Medical Wishes Are Followed if You’re Critically Ill and Incapacitated

How to Ensure Your Medical Wishes Are Followed if You’re Critically Ill and Incapacitated

It happens every day in the intensive care units of hospitals throughout the country: Physicians ask the loved ones of someone kept alive by a ventilator and other medical devices whether the patient would want to live hooked... read more