Chemotherapy near the end of life: a retrospective single-centre analysis of patients' charts

BACKGROUND: Chemotherapy near the end of life is an issue frequently discussed nowadays. The concern is that chemotherapy could cause more harm than good in a palliative situation; this is even truer as the patient nears death. The objective of our study is to evaluate the aggressiveness of patient care near the end of life by determining how many cancer patients receive chemotherapy during their final weeks. METHODS: In a retrospective analysis of patient charts, we investigated whether cancer patients had been treated with chemotherapy during the last four or two weeks of life. If they had, we looked at whether treatment was ongoing or newly initiated. RESULTS: Out of the 119 cancer patients who died in our hospital over two years, 14 (11.7%) received chemotherapy during the last four weeks of life, nine of whom (7.6%) in the last two weeks of life. Treatment had been ongoing in six (5%) and newly initiated for eight (6.7%) within four weeks of death. Corresponding figures for the last two weeks of life were seven patients (5.9%) who continued previously prescribed treatment and two (1.7%) who were started on chemotherapy. Patients given chemotherapy during the last four weeks of life were significantly younger than those who were not (p = 0.003). CONCLUSIONS: Cancer patient care in our hospital is not considered overly aggressive as only 7.6% of these patients receive chemotherapy within the last two weeks of life. To determine how aggressive care near the end of life really is, however, we suggest evaluating newly started chemotherapy alongside ongoing treatment. As the line between the effects (beneficience) and side effects (nonmaleficience) of chemotherapy is often very narrow, doctors and patients have to work together to find the best way of treading this fine line

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19). Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival. Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used. Setting: 67 hospitals in the United States. Participants: Adults with COVID-19 admitted to a participating ICU. Measurements: Time to death, censored at hospital discharge, or date of last follow-up. Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]). Limitation: Observational design. Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation

Peran Mahasiswa KKN dalam Bidang Pendidikan di Desa Bahjoga Utara Utara

KKN (Real Work Lectures) activities are activities that must be followed by every student in lectures at least Strata One (S.1) at Higher Education Institutions, such as at the State Islamic University of North Sumatra, every 6th semester student and above must take part in KKN (Real Work Lectures) activities. ). Several students of the State Islamic University of North Sumatra carried out KKN (Real Work Lectures) in Bahjoga Utara village, Simalungun in July 2022. Students who carried out KKN (Real Work Lectures) in Bahjoga Utara village were 20 students and 6 students of which, all students/ I come from Simalungun. The students came from 4 faculties and 7 study programs. The method of carrying out the activities is carried out by surveying locations by KKN participants in several visits with the aim of seeing the condition of the village that will be inhabited for one month. Then the KKN participants socialized with the surrounding community to introduce themselves and provide information about the whereabouts of the participants with the aim of helping the surrounding community and helping find solutions to existing problems. Several educational institutions in Bahjoga Utara Village are the targets of the KKN student work program which is carried out routinely every day. All KKN students play a role in assisting the implementation of education in the village. Not only at school, KKN students also hold free lessons and teach the Koran for children in the village in order to maximize educational activities in the village. We hope that the Community Service Program that we carry out in the village can be a factor that helps the implementation of better education