Medicine and Health Sciences Commons^™

Hoping For A Miracle: Supporting Patients In Transplantation And Cardiac Assist Programs, Katrina Bramstedt

Katrina A. Bramstedt

Purpose of review: Palliative medicine is often viewed as a medical specialty reserved for end of life care. This review focuses on the role that palliative care can play in transplant and cardiac assist device programs, along the continuum of a patient's disease course. Recent findings: In general, transplant and cardiac assist programs do not incorporate palliative medicine during the treatment course, but rather reserve it for when the patient is approaching death and is no longer a candidate for transplant or device therapy. There is a new shift, however, to viewing the practice of aggressive medicine and palliative medicine …

Deactivating Implanted Cardiac Devices In Terminally Ill Patients: Practices And Attitudes, Paul Mueller, Sarah Jenkins, Katrina Bramstedt, David Hays

Katrina A. Bramstedt

Background: Clinicians may receive requests to deactivate pacemakers and implantable cardioverter-defibrillators (ICDs) in terminally ill patients. Methods: We describe practices and attitudes regarding deactivation of pacemakers and ICDs in terminally ill patients among physicians, nurses, and others who manage treatment of patients with implanted cardiac devices and among field representatives of device manufacturers. A Web-based survey was provided to Heart Rhythm Society members and to representatives of two manufacturers of implantable cardiac devices. Measurements were the answers of 787 respondents. Results: Of the respondents, 86.8% reported involvement in requests for ICD deactivation and 77.6% reported involvement in pacemaker deactivation (P …

Alcohol Abstinence Criteria For Living Donors And Their Organ Recipients, Katrina Bramstedt

Katrina A. Bramstedt

Purpose of review: Psychosocial criteria for live organ donors and their organ recipients are important for their safety and welfare. In liver transplantation, alcohol use by either party is problematic. This article reviews this topic and offers guidance for donor and recipient selection. Recent findings: The '6 month rule' for alcohol abstinence is the standard approach for many hospitals when evaluating patients for transplant candidacy. Recently, clinicians have explored the rationale for this quantitative rule and discovered additional factors that can help to predict the risk for post-transplant alcohol relapse. Guidance for live liver donors is a newer topic and …

Destination Nowhere: A Potential Dilemma With Ventricular Assist Devices, Katrina Bramstedt

Katrina A. Bramstedt

Increasingly, ventricular assist devices (VADs) are used as destination therapy for those who are not candidates for heart transplantation. Although these devices can benefit patients by improving their functional status and quality of life, they can, in some cases, facilitate an end-point known as destination nowhere. In such situations, patients and clinicians find themselves in medical limbo where the patient's net benefit is, in fact, a burden, or the continued use of the device has no utility in light of the goals of the technology. This article presents guidance for avoiding destination nowhere, as well as guidance for ethical care …

China: A Case Study Regarding Transplant Publishing Issues, Katrina A. Bramstedt, Jun Xu

Katrina A. Bramstedt