Articles: function.
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The use of mechanical circulatory support (MCS) devices has increased sixfold since 2006. Although there is an established legal and ethical consensus that patients have the right to withdraw and withhold life-sustaining interventions when burdens exceed benefits, this consensus arose prior to the widespread use of MCS technology and is not uniformly accepted in these cases. ⋯ Our center recently encountered the challenge of an awake and functionally improving patient with a total artificial heart (TAH) who requested its deactivation. We present a narrative description of this case with discussion of the following questions: (1) Is it ethically permissible to deactivate this particular device, the TAH? (2) Are there any particular factors in this case that are ethical contraindications to proceeding with deactivation? (3) What are the specific processes necessary to ensure a compassionate and respectful deactivation? (4) What proactive practices could have been implemented to lessen the intensity of this case's challenges? We close with a list of recommendations for managing similar cases.
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COPD QVA149 PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: The current GOLD strategy recommends combining two long-acting bronchodilators for the maintenance treatment of patients with moderate-to-severe COPD. The SHINE study evaluated the effect of QVA149, a dual bronchodilator combining the LABA indacaterol and the LAMA glycopyrronium (NVA237), compared with glycopyrronium, indacaterol, tiotropium monotherapies and placebo. ⋯ Kenneth Chapman: Consultant fee, speaker bureau, advisory committee, etc.: "KRC holds the GSK-CIHR Research Chair in Respiratory Healthcare Delivery at the University Health Network, has served as a consultant to CSL Behring, GlaxoSmithKline, Novartis, Nycomed (Takeda), and Talecris (Grifols), and has received payment for lectures or service on speakers bureaus from Boehringer-Ingelheim, GlaxoSmithKline, Grifols, Nycomed (Takeda), Family Physicians Airways Group of Canada, Canadian Network for Respiratory Care, and Talecris. " Eric Bateman: Consultant fee, speaker bureau, advisory committee, etc.: Prof Eric Bateman has served on advisory boards for Boehringer Ingelheim, AstraZeneca, Elevation Pharma, Napp Pharma, Novartis, Almirall, Forest, and Merck and Takeda; has served as a consultant to Navigant Consulting, IMS consulting group, ALK-Abello, Almirall, Hoffman la Roche, and ICON; has been paid lecture fees by AstraZeneca, ALK-Abello, Chiesi, Boehringer Ingelheim, GlaxoSmithKline, Nycomed/Takeda, Novartis, Pfizer, and Indegene Lifesciences Ltd. Nicola Gallagher: Employee: Novartis employee Huilin Hu: Employee: Novartis employee Donald Banerji: Employee: Novartis employeeClinical trial results of QVA149, combination of two approved products indacaterol and glycopyrronium, will be presented, QVA149 is in the late stage phase 3 trials prior to approval.
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Infectious Disease Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: The Milwaukee Protocol was used for a 24 year-old male U.S. soldier who was diagnosed with rabies after being bit by a feral dog in Afghanistan. He did not receive effective post exposure prophylaxis (PEP) for rabies however [1]. ⋯ Our case highlights the first time ECMO was used in rabies. Also, it exemplifies another failed case of the Milwaukee Protocol. Given the lack of efficacy, the protocol should not be used for rabies. A better understanding of rabies pathogenesis is needed in order to develop novel therapies.Reference #1: Jackson AC. Current and future approaches to the therapy of human rabies. Antiviral Res. 2013 Jul;99(1):61-7.Reference #2: Willoughby,R et. Al Survival after Treatment of Rabies with Induction of Coma, N Engl J Med2005; 352:2508-2514DISCLOSURE: The following authors have nothing to disclose: Amritpal Nat, Amitpal Nat, Amit Sharma, Aravind Pothineni, Ioana AmzutaNo Product/Research Disclosure Information.
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COPD QVA149 PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Current COPD treatment guidelines recommend long-acting β2-agonist/inhaled corticosteroids (LABA/ICS) for severe COPD patients with a history of exacerbations. The 26-week ILLUMINATE study in moderate-to-severe COPD patients showed superiority of QVA149 versus the LABA/ICS salmeterol/fluticasone combination (SFC) in lung function. A novel study design to evaluate the effect of QVA149 versus SFC on COPD exacerbations in more severe patients with a history of exacerbations is presented. ⋯ Jadwiga Wedzicha: Consultant fee, speaker bureau, advisory committee, etc.: JW has received speaking fee and/or for advisory boards from GlaxoSmithKline, AstraZeneca, Novartis, Bayer, Boehringer Ingelheim, Nycomed. Chiesi and Respifor as well as travel reimbursements from Boehringer Ingelheim. JW has received research grants from GlaxoSmithKline, AstraZeneca, Chiesi and Novartis. Nicola Gallagher: Employee: Novartis employee Donald Banerji: Employee: Novartis employee The following authors have nothing to disclose: Jørgen VestboClinical trial results of QVA149, combination of two approved products indacaterol and glycopyrronium, will be presented, QVA is in the late stage phase 3 trials prior to approval.
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Slide PresentationsPRESENTED ON: Saturday, March 22, 2014 at 12:15 PM - 01:15 PMPURPOSE: Although plasma BNP level is considered to be a useful biomarker for identifying cardiac involvement in patients with Sarcoidosis (Sarc) few data exist for its predictive role in mortality. Our aim was to investigate the predictive role of BNP on all-cause mortality. ⋯ The following authors have nothing to disclose: Elias Gialafos, Vasileios Kouranos, Aggeliki Rapti, Efrosyni Manali, Theodore Papaioannou, Nikolaos Koulouris, Spuridon Papiris, Athol Wells, George TzelepisNo Product/Research Disclosure Information.