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https://www.readbyqxmd.com/read/29675055/shifting-paradigm-from-no-code-and-do-not-resuscitate-to-goals-of-care-policies
#1
Yaseen M Arabi, Abdulla A Al-Sayyari, Mohamed S Al Moamary
Policies addressing limitations of medical therapy in patients with advanced medical conditions are typically referred to as Code Status (No Code) policies or Do-Not-Resuscitate (DNR) status polices. Inconsistencies in implementation, understanding, decision-making, communication and management of No Code or DNR orders have led to delivery of poorer care to some patients. Several experts have called for a change in the current approach. The new approach, Goals of Care paradigm, aims to contextualize the decisions about resuscitation and advanced life support within the overall plan of care, focusing on choices of treatments to be given rather than specifically on treatments not to be given...
April 2018: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/29649400/impact-of-inpatient-palliative-care-on-quality-of-end-of-life-care-and-downstream-acute-and-postacute-care-utilization
#2
Peter S Khang, Susan E Wang, In-Lu Amy Liu, Heather L Watson, Sandra Y Koyama, Dan N Huynh, Janet S Lee, Huong Q Nguyen
BACKGROUND: Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM: Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN: Retrospective cohort design. SETTING/PARTICIPANTS: Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29548908/asthma-related-mortality-in-the-united-states-of-america-1999-2015-a-multiple-causes-of-death-analysis
#3
Vijay Kodadhala, Jennifer Obi, Priscilla Wessly, Alem Mehari, R F Gillum
BACKGROUND: Asthma mortality based on the underlying cause of death (UCOD) underestimates disease burden. OBJECTIVE: Therefore, in this study, asthma mortality in the US 1999-2015 was analyzed, as well as the pattern of reporting of asthma and its co-morbidities in death certificates, using multiple-cause of death (MCOD) records. METHODS: All 156,517 death certificates with any mention of asthma were analyzed for 1999-2015. Asthma was defined by ICD-10 code J45 based either on the UCOD or MCOD...
March 13, 2018: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/29502379/-the-option-of-critical-patients-with-cancer-for-icu
#4
R Xia, D H Wang
With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
https://www.readbyqxmd.com/read/29483008/the-utilization-of-mgmt-promoter-methylation-testing-in-united-states-hospitals-for-glioblastoma-and-its-impact-on-prognosis
#5
Anna Lee, Irini Youssef, Virginia W Osborn, Joseph Safdieh, Daniel J Becker, David Schreiber
Multiple studies have identified O6 -methylguanine-DNA methyltransferase (MGMT) promoter methylation status to be an important prognostic factor in glioblastoma (GBM). We used the National Cancer Data Base (NCDB) to analyze completeness of coding for MGMT as well as to compare outcomes of GBM patients treated with adjuvant chemoradiation based on MGMT promoter methylation status (positive, negative, unknown). Patients diagnosed with GBM from 2010 to 2012 who received adjuvant chemoradiation were identified...
May 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29480756/a-pilot-study-to-evaluate-compliance-with-guidelines-for-preprocedural-reconsideration-of-code-status-limitations
#6
Richard D Urman, Elizabeth J Lilley, Marguerite Changala, Charlotta Lindvall, David L Hepner, Angela M Bader
BACKGROUND: Periprocedural providers are encountering more patients with code status limitations (CSLs) regarding their preferences for resuscitation and life-sustaining treatment who choose to undergo palliative procedures. Surgical and anesthesia guidelines for preprocedural reconsideration of CSLs have been available for several years, but it is not known whether they are being followed in practice. OBJECTIVE: We assessed compliance with existing guidelines for patients undergoing venting gastrostomy tube (VGT) for malignant bowel obstruction (MBO), serving as an example of a palliative procedure received by patients near the end of life...
February 26, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29366336/end-of-life-decision-making-for-patients-with-geriatric-trauma-cared-for-in-a-trauma-intensive-care-unit
#7
Meghan Wooster, Alyssa Stassi, Joshua Hill, James Kurtz, Marco Bonta, M Chance Spalding
BACKGROUND: The geriatric trauma population is growing and fraught with poor physiological response to injury and high mortality rates. Our primary hypothesis analyzed how prehospital and in-hospital characteristics affect decision-making regarding continued life support (CLS) versus withdrawal of care (WOC). Our secondary hypothesis analyzed adherence to end-of-life decisions regarding code status, living wills, and advanced directives. MATERIALS AND METHODS: We performed a retrospective review of patients with geriatric trauma at a level I and level II trauma center from January 1, 2007, to December 31, 2014...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29280908/expanding-the-presence-of-primary-services-at-rapid-response-team-activations-a-quality-improvement-project
#8
Alice Gallo de Moraes, John C O╩╝Horo, Ronaldo A Sevilla-Berrios, Gina Iacovella, Andrea Lenhertz, Julie Schmidt, Jennifer Elmer, Richard Oeckler, Sean Caples, Jeffrey B Jensen
Rapid response teams (RRTs) were implemented to provide critical care services for deteriorating patients outside of intensive care units. To date, research on RRT has been conflicting, with some studies showing significant mortality benefit and reduction in cardiac arrest events and others showing no benefit. However, studies have consistently showed improved outcomes when RRTs work closely with primary services. Baseline data analysis at our institution found that primary services were present only on 50% of RRT activations...
January 2018: Quality Management in Health Care
https://www.readbyqxmd.com/read/29219759/does-the-obesity-paradox-predict-functional-outcome-in-intracerebral-hemorrhage
#9
Neha S Dangayach, Harpreet Singh Grewal, Gian Marco De Marchis, Roberta K Sefcik, Rachel Bruce, Aarti Chhatlani, E Sander Connolly, M Cristina Falo, Sachin Agarwal, Jan Claassen, J Michael Schmidt, Stephan A Mayer
OBJECTIVE Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29210596/mayo-registry-for-telemetry-efficacy-in-arrest-study-an-evaluation-of-the-feasibility-of-the-do-not-intubate-code-status
#10
David Snipelisky, Adrian Dumitrascu, Jordan Ray, Archana Roy, Gautam Matcha, Dana Harris, Tyler Vadeboncoeur, Fred Kusumoto, M Caroline Burton
INTRODUCTION: Guidelines recommend discussing code status with patients on hospital admission. No study has evaluated the feasibility of a full code with do not intubate (DNI) status. METHODS: A retrospective analysis of patients who experienced a cardiopulmonary arrest was performed between May 1, 2008 and June 20, 2014. A descriptive analysis was created based on whether patients required mechanical ventilatory support during the hospitalization and comparisons were made between both patient subsets...
December 6, 2017: Acute Cardiac Care
https://www.readbyqxmd.com/read/29159371/care-planning-for-inpatients-referred-for-palliative-care-consultation
#11
Kara Bischoff, David L O'Riordan, Angela K Marks, Rebecca Sudore, Steven Z Pantilat
Importance: Care planning is a critical function of palliative care teams, but the impact of advance care planning and goals of care discussions by palliative care teams has not been well characterized. Objective: To describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. Design, Setting, and Participants: This was a prospective cohort study conducted between January 1, 2013, and December 31, 2016...
January 1, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29156396/determining-code-status-on-inpatient-psychiatry
#12
EDITORIAL
David Y Harari, Robert C Macauley
No abstract text is available yet for this article.
March 2018: General Hospital Psychiatry
https://www.readbyqxmd.com/read/29123339/hospital-workers-confidence-for-end-of-life-decisions-in-their-family-a-multicenter-study
#13
Monica Leon, Luis Omar Chavez, Sharon Einav, Joseph Varon
Aims: To study whether health-care workers feel capable of making resuscitation decisions for their own families, the confidence in their family to represent their own preferences, and if some health-care workers feel greater confidence in their ability to undertake such decisions for their family than others. Methods: An anonymous survey conducted among health-care workers of nine institutions in North and Central America. The self-administered questionnaire included demographic and professional characteristics, attitudes, personal preferences, and value judgments on the topic of resuscitation...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29118858/characteristics-and-predictors-of-mortality-of-patients-with-hematologic-malignancies-requiring-invasive-mechanical-ventilation
#14
Hasan M Al-Dorzi, Haya Al Orainni, Faten Al Eid, Haytham Tlayjeh, Abedalrahman Itani, Ayman Al Hejazi, Yaseen M Arabi
RATIONALE: Acute respiratory failure (ARF) may complicate the course of hematologic malignancies (HMs). Our objective was to study the characteristics, outcomes and predictors of mortality of patients with HMs who required intubation for ARF. METHODS: This retrospective cohort study evaluated all patients with HMs who were admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City-Riyadh between 2008 and 2013 and required invasive mechanical ventilation...
October 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/29095938/challenges-to-code-status-discussions-for-pediatric-patients
#15
Katherine E Kruse, Jason Batten, Melissa L Constantine, Saraswati Kache, David Magnus
OBJECTIVES: In the context of serious or life-limiting illness, pediatric patients and their families are faced with difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary arrest. Code status orders are one way to inform end-of-life medical decision making. The objectives of this study are to evaluate the extent to which pediatric providers have knowledge of code status options and explore the association of provider role with (1) knowledge of code status options, (2) perception of timing of code status discussions, (3) perception of family receptivity to code status discussions, and (4) comfort carrying out code status discussions...
2017: PloS One
https://www.readbyqxmd.com/read/29049425/comparison-of-internal-medicine-and-general-surgery-residents-assessments-of-risk-of-postsurgical-complications-in-surgically-complex-patients
#16
(no author information available yet)
No abstract text is available yet for this article.
March 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/28985622/outcomes-and-changes-in-code-status-of-patients-with-acute-myeloid-leukemia-undergoing-induction-chemotherapy-who-were-transferred-to-the-intensive-care-unit
#17
Tamjeed Ahmed, Abby L Koch, Scott Isom, Heidi D Klepin, Jonathan M Bishop, Leslie R Ellis, Dmitriy Berenzon, Dianna Howard, Susan Lyerly, Bayard L Powell, Timothy S Pardee
Patients with Acute Myeloid Leukemia (AML) have compromised marrow function and chemotherapy causes further suppression. As a result complications are frequent, and patients may require admission to the intensive care unit (ICU). How codes status changes when these events occur and how those changes influence outcome are largely unknown. Outcomes for adult patients with AML, undergoing induction chemotherapy, and transferred to the ICU between January 2000 and December 2013 were analyzed. 94 patients were included...
November 2017: Leukemia Research
https://www.readbyqxmd.com/read/28950726/educational-intervention-to-improve-code-status-discussion-proficiency-among-obstetrics-and-gynecology-residents
#18
Benjamin Margolis, Craig Blinderman, Alexandre Buckley de Meritens, Sudeshna Chatterjee-Paer, Rini B Ratan, Holly G Prigerson, June Y Hou, William M Burke, Jason D Wright, Ana I Tergas
BACKGROUND: Obstetrics and gynecology (OB/GYN) residents receive little formal training in conducting code status discussions (CSDs). OBJECTIVE: We piloted an educational intervention to improve resident confidence and competence at conducting CSDs. DESIGN: The OB/GYN residents at a single institution participated in a 3-part educational program. First, participants reviewed a journal article and completed an online module. Second, they received a didactic lecture followed by a resident-to-resident mock CSD...
April 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#19
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
February 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28914272/a-randomized-controlled-trial-of-a-cpr-decision-support-video-for-patients-admitted-to-the-general-medicine-service
#20
Aimee M Merino, Ryan Greiner, Kristopher Hartwig
BACKGROUND: Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process. OBJECTIVE: We examined the effect of an informational video about CPR on hospitalized patients' code status choices. DESIGN: This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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