Predicting individual outcomes in hepatocellular carcinoma.
نویسندگان
چکیده
www.thelancet.com Vol 364 November 20, 2004 1837 want to be resuscitated? We are shifting full resuscitation from the hospital, where do-not-resuscitate orders are considered, into the community. Do people need to be encouraged to wear an advance directive (perhaps on a medical bracelet or necklace) and should the volunteer resuscitator look for this before attempting resuscitation or defibrillation? To maximise benefit, it seems reasonable to combine initial defibrillation initiatives with previous and promising neuroprotective measures, especially hypothermia, in the field and in the hospital. Further work and thought are needed before widespread adoption of out-of-hospital defibrillation. We require better studies of outcomes and strategies that optimise results by integrating early recognition and out-of-hospital defibrillation; efficient transfer to a facility; and full supportive measures, including hypothermia. Although such studies are difficult to do, they are needed to justify the monumental change in infrastructure necessary to make these resources widely available. However, the studies have the potential to easily demonstrate benefit, since, at best, only 5% of current cardiac-arrest victims survive to hospital discharge and neurological morbidity is prevalent in survivors. We must address societal, ethical, and practical considerations before there is a major policy change. Input from society, government, and health-care professionals is needed. At present we are just past proof of concept but well short of proof of benefit.
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ورودعنوان ژورنال:
- Lancet
دوره 364 9448 شماره
صفحات -
تاریخ انتشار 2004