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"do not resuscitate"

Anuj B Mehta, Colin R Cooke, Ivor S Douglas, Peter K Lindenauer, Renda Soylemez Wiener, Allan J Walkey
RATIONALE: In the United States, approximately 20% of patients hospitalized with pneumonia are readmitted to a hospital within 30 days. Given the significant costs and healthcare system utilization due to unplanned readmissions, pneumonia readmission rates are a target of national quality measures. Patient do-not-resuscitate (DNR) status strongly influences hospital pneumonia mortality measures; however, associations between DNR status and 30-day readmissions following pneumonia are unclear...
October 18, 2016: Annals of the American Thoracic Society
Mary P Henman
BACKGROUND: A suicidal person with a do-not-resuscitate (DNR) order presents an ethical dilemma to the emergency physician. Many believe that suicide is an irrational action, and therefore, all suicide attempts must be treated. Others believe a DNR order should be respected even in the setting of a suicide attempt. CASE REPORT: An elderly woman with a known terminal illness presented to the emergency department after a suspected suicide attempt. She had a DNR order during her previous hospitalization...
October 14, 2016: Journal of Emergency Medicine
Raghavendra Charan P Makam, Nathaniel Erskine, David D McManus, Darleen Lessard, Joel M Gore, Jorge Yarzebski, Robert J Goldberg
Optimization of medical therapy during discharge planning is vital for improving patient outcomes after hospitalization for acute myocardial infarction (AMI). However, limited information is available about recent trends in the prescribing of evidence-based medical therapies in these patients, especially from a population-based perspective. We describe decade-long trends in the discharge prescribing of aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β blockers, and statins in hospital survivors of AMI...
September 13, 2016: American Journal of Cardiology
Kaisa Rajala, Juho T Lehto, M Saarinen, E Sutinen, T Saarto, M Myllärniemi
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. METHODS: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death...
October 12, 2016: BMC Palliative Care
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multi-center studies that examine the impact of systematic screening for palliative care and specialty consultation in the ICU. OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was utilized to estimate the conditional probability of receiving a PCC and to balance important covariates...
October 5, 2016: Journal of Pain and Symptom Management
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Yi-Hsin Liang, Chih-Hsin Wei, Wen-Hui Hsu, Yu-Yun Shao, Ya-Chin Lin, Pei-Chun Chou, Ann-Lii Cheng, Kun-Huei Yeh
PURPOSE: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS: This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups...
October 4, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Kaci Osenga, Andrea Postier, Jill Dreyfus, Laurie Foster, Wrenda Teeple, Stefan J Friedrichsdorf
CONTEXT: Specialized pediatric palliative care (PPC) services have become more common in urban pediatric hospital settings, though little is known about palliative care specialist involvement. OBJECTIVES: The objective of this study was to compare circumstances prior to death in children who spent their last days of life in an inpatient pediatric hospital setting, with or without PPC provider involvement during their inpatient stay. METHODS: Retrospective chart review of medical records of children for the last inpatient stay that resulted in death at a children's hospital setting between January 2012 through June 2013...
September 29, 2016: Journal of Pain and Symptom Management
Ian N Olver, Jaklin A Eliott
Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients' views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate...
2016: Cancers
Samuel J Stratton
No abstract text is available yet for this article.
October 2016: Prehospital and Disaster Medicine
Heather Worthington, Will Pickett, Laurie J Morrison, Damon C Scales, Chun Zhan, Steve Lin, Paul Dorian, Katie N Dainty, Niall D Ferguson, Steven C Brooks
OBJECTIVE: Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes. METHODS: This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h...
September 20, 2016: Resuscitation
Sandra Regina Gonzaga Mazutti, Andréia de Fátima Nascimento, Renata Rego Lins Fumis
OBJECTIVE: To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. METHODS: This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs...
September 2016: Revista Brasileira de Terapia Intensiva
Timothy F Platts-Mills, Natalie L Richmond, Eric M LeFebvre, Sowmya A Mangipudi, Allison G Hollowell, Debbie Travers, Kevin Biese, Laura C Hanson, Angelo E Volandes
INTRODUCTION: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. OBJECTIVE: We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR. METHODS: In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality...
September 13, 2016: Journal of Palliative Medicine
Juan Ruiz-Garcia, Pablo Diez-Villanueva, Ana Ayesta, Vanessa Bruña, Lourdes M Figueiras-Graillet, Laura Gallego-Parra, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol. METHODS & RESULTS: Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C)...
July 2016: Journal of Geriatric Cardiology: JGC
Sun Kyung Baek, Hye Jung Chang, Ja Min Byun, Jae Joon Han, Dae Seog Heo
Purpose: We explored the relationship between the use of each medical intervention and the length of time between DNR consent and death in Korea. Materials and Methods: A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions [e.g., cardiopulmonary resuscitation (CPR), intubation, and hemodialysis], less invasive interventions (e.g., transfusion, antibiotic use, inotropic use and laboratory tests), and the time interval between the DNR order and death were evaluated...
September 1, 2016: Cancer Research and Treatment: Official Journal of Korean Cancer Association
Jason Lambden, Baohui Zhang, Robert Friedlander, Holly G Prigerson
BACKGROUND: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. OBJECTIVE: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. DESIGN: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death...
August 30, 2016: Journal of Palliative Medicine
Kathleen G Davis
Children and adolescents with complex chronic conditions often receive pediatric palliative care (PPC) from health care professionals. However, children's needs exist both in a health care context and in the community where children interact with peers, including school, places of worship, sports, activities, and organizations. Partnerships between PPC professionals in health care settings and teachers, coaches, spiritual leaders, activity directors, and others, may lead to greater health and well-being. Children near the end of life or those with out-of-hospital do-not-resuscitate orders may also find palliation in their community...
October 2016: Pediatric Clinics of North America
Alec Samuels
No abstract text is available yet for this article.
August 12, 2016: Medico-legal Journal
Luca Cabrini, Giovanni Landoni, Speranza Bocchino, Rosalba Lembo, Giacomo Monti, Massimiliano Greco, Massimo Zambon, Sergio Colombo, Laura Pasin, Luigi Beretta, Alberto Zangrillo
OBJECTIVE: Noninvasive ventilation is a life-saving technique increasingly used to treat acute respiratory failure. Noninvasive ventilation has been applied mostly in ICUs, but several reasons brought to an increasing application of noninvasive ventilation in ordinary wards. Few articles evaluated the outcomes of patients receiving noninvasive ventilation including long-term follow-up. The aim of the present study was to assess 1-year survival rate of patients treated with noninvasive ventilation outside the ICU for acute respiratory failure of heterogeneous causes and to identify the predictors of long-term mortality...
August 4, 2016: Critical Care Medicine
Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam, Amber Mehmood, Bryan McNally, Kent Stevens, Rozina Nuruddin, Mohammad Ishaq, Junaid Abdul Razzak
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country. METHODS: We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013...
2016: BMC Emergency Medicine
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