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Objectives: This study was conducted to characterize the need for palliative care and its effect on patients with end-stage disease in the emergency department (ED). Design: This was a prospective cohort study. A questionnaire survey was administered to patients with end-stage disease who were admitted to the resuscitation room of the ED and expected to live less than 6 months. Results: A total of 82 of 2095 patients admitted to the resuscitation room were included. Only 1 (1.22%) patient had ever received palliative care before admission. Nine patients received palliative care consultation after admission, and they were more likely to select medical places of death accompanied by their families and do not resuscitate orders at the end of life after consultation (P < 0.05). Whether the disease had previously been actively treated and the number of children impacted the choice of treatment at the end of life (P < 0.05). Conclusions: Among patients with end-stage disease admitted to the ED, knowledge of palliative care was lacking. Palliative care could help them avoid the damage caused by pointless resuscitation. [ABSTRACT FROM AUTHOR]

The article discusses the impact of the executive order signed by former U.S. President Donald Trump that protects newborn and infant children on making resuscitation decisions. Topics mentioned include the failure of acknowledging the rights of parents to make medical decisions, the factors that need to include in how parents should process knowledgeable counseling, and some modifications to executive order to gain support from the neonatal and physician communities.

At the beginning of the COVID-19 pandemic, whether performing CPR on patients with COVID-19 would be effective or increase COVID-19 transmission to health care workers was unclear. Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to health care workers improved? This cross-sectional study assessed DNR orders for all adult patients admitted to ICUs at two academic medical centers in Chicago, IL, between April 2020 and April 2021. DNR orders by COVID-19 status were assessed using risk-adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness. The study population of 3,070 critically ill patients were 46% Black, 53% male, with median age (interquartile range [IQR]) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs 29% vs 23%; P =.006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in patients with COVID-19 in the nonpropensity score-matched (n = 3,070; aOR, 2.01; 95% CI, 1.64-2.38) and propensity score-matched (n = 1,118; aOR, 1.91; 95% CI, 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for patients with COVID-19 than patients without COVID-19 during all months of the study period (difference in prevalence over time, P =.751). In this multihospital study, DNR orders remained persistently higher for patients with COVID-19 vs patients without COVID-19 with similar severity of illness during the first year of the pandemic. The specific reasons why DNR orders remained persistently elevated for patients with COVID-19 should be assessed in future studies, because these changes may continue to affect COVID-19 patient care and outcomes. [ABSTRACT FROM AUTHOR]

This is the largest study to examine do-not-resuscitate (DNR) orders in pneumonia and the first to assess the relationship between DNR orders, receipt of intensive care, inpatient mortality, and costs. In particular, the study adjusted for predicted mortality, which other studies have not done. The authors found that DNR orders are strongly associated with higher mortality and lower cost, that they were only weakly associated with intensive care admission, and that these associations vary depending on patients' predicted mortality at admission. This has important implications for quality of care at the end of life. Although more patients need to have advance directives before admission, addressing goals of care for high-risk patients appears to be particularly important. Objectives: Do-not-resuscitate (DNR) orders are used to express patient preferences for cardiopulmonary resuscitation. This study examined whether early DNR orders are associated with differences in treatments and outcomes among patients hospitalized with pneumonia. Methods: This is a retrospective cohort study of 768,015 adult patients hospitalized with pneumonia from 2010 to 2015 in 646 US hospitals. The exposure was DNR orders present on admission. Secondary analyses stratified patients by predicted in-hospital mortality. Main outcomes included in-hospital mortality, length of stay, cost, intensive care admission, invasive mechanical ventilation, noninvasive ventilation, vasopressors, and dialysis initiation. Results: Of 768,015 patients, 94,155 (12.3%) had an early DNR order. Compared with those without, patients with DNR orders were older (mean age 80.1 ± 10.6 years vs 67.8 ± 16.4 years), with higher comorbidity burden, intensive care use (31.6% vs 30.6%), and in-hospital mortality (28.2% vs 8.5%). After adjustment via propensity score weighting, these patients had higher mortality (odds ratio [OR] 2.39, 95% confidence interval [CI] 2.33–2.45) and lower use of intensive therapies such as vasopressors (OR 0.83, 95% CI 0.81–0.85) and invasive mechanical ventilation (OR 0.68, 95% CI 0.66–0.70). Although there was little relationship between predicted mortality and DNR orders, among those with highest predicted mortality, DNR orders were associated with lower intensive care use compared with those without (66.7% vs 80.8%). Conclusions: Patients with early DNR orders have higher in-hospital mortality rates than those without, but often receive intensive care. These orders have the most impact on the care of patients with the highest mortality risk. [ABSTRACT FROM AUTHOR]

The article focuses attention on the fact that a structural element of everyone's subjective legal right to medical care is the right to access to a medicinal product. It is emphasized that the Covid-19 pandemic, the increase in the spectrum of incurable diseases and the number of patients suffering from them, Russia's aggression against Ukraine, the consequences of which are an increase in the number of military personnel and civilians who need the use of medicinal products created using the latest technologies, but which (medicines) are still not allowed in the state, the integration of Ukraine with the EU became the factors that actualized the discussion of scientists and practitioners on the issue of the conditions that must be observed by the EU member state in order to apply the provisions of Article 1. 5 of Directive 2001/83/EC of the European Parliament and of the Council on the Community Code regarding medicinal products intended for human use, the exception is to provide an EU member state with access to a patient to a medicinal product not authorized by the competent authorities of such a member state and thereby fulfill its obligation to provide everyone's constitutional right to medical care. The conditions that must be observed by the EU member state in order to apply the provisions of Article 1. 5 of the Exclusion Directives - for an EU member state to provide a patient with access to a medicinal product that is not authorized by the competent authorities of such a member state: 1) the presence of a norm of national law that allows the supply of a medicinal product for which a permit was not granted; 2) the goal is to meet the special needs of a specific seriously ill patient (private interest) and ensure the protection of public health (public interest); 3) be due to the absence on the national market of any authorized medicinal product - the equivalent of an unauthorized medicinal product; 4) delivery is made in response to a bona fide order on one's own initiative; 5) supply is carried out according to the prescription in accordance with the specifications of the authorized medical worker; 6) an unauthorized medicinal product is prescribed for use by a specific patient under his direct personal responsibility. The signs of the patient's special needs are highlighted: 1) the specific situation of the patient's state of health and the course of his illness; 2) medical reasoning, which is justified; 3) the patient's need for a certain medicinal product. The grounds for an unregistered medicinal product to be prescribed by a doctor are: the doctor's therapeutic considerations; results of research, analyzes of the patient. In a situation where there are authorized medicinal products on the market of an EU member state - analogues of prohibited medicinal products - the import of unauthorized medicinal products can be qualified as an act of non-fulfillment by the EU member state of its obligations, provided for in Article 1. 6 Directives. [ABSTRACT FROM AUTHOR]

The Joint Commission has identified falls as an issue within hospitals nationwide. In-hospital falls are a significant clinical, legal, and regulatory problem and are noted to be one of the leading causes of preventable injuries that occur within the hospital setting. Injuries can occur at any age; however, the severity of the injury increases with age, with patients over age 65 at higher risk for severe injury or death. Reducing in-hospital falls is imperative to deliver appropriate, safe care to patients. Developing and implementing evidence-based fall prevention programs within the hospital setting is essential in reducing falls. Hospitals must identify patients who are at risk of falling. Proper and consistent assessment, communication with colleagues on a patient's fall history, current status, and medications, and a team approach are essential for a patient-focused program. Several tools can be used to prevent falls or limit injury if a fall occurs. Proper use of tools, such as bed alarms, chair alarms, fall mats, and fall risk alerts on the chart, door, and in patient's rooms, is critical. [ABSTRACT FROM AUTHOR]

The perspective of plausible new paradigm of inflated unequal economic growth during the era of globalization produced a mounting paradoxical order of persistent inequality in a new form. The paradigm of massive historical process spurred by the Neo-liberal doctrine deteriorated the developing regions with sheer experience of the concentration of poverty and social insecurity. The most tragic aspect is that it eroded the hope of success of the poor regions by creating their dependency institutionalized with the institutionalization of ever-growing gap between countries and within countries. However, the usual consequence of the crises of neoliberal financial market capitalism led to a new political dimension of 'Post-neoliberalism'. Focusing briefly on these key-issues, the present article attempts to explore the consequential effect of the unleashed capital over the developing and underprivileged global regions. Finally, the article concludes with the need for the accomplishment of the solidarity of common development towards the space of social security and a real democratic global environment. Hence, the approach towards social solidarity would invariably be an alternative paradigm of today's global society. [ABSTRACT FROM AUTHOR]

Background: Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams. Objective: To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure. Methods: A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs). Results: "Do not resuscitate" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home. Conclusions: Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families. [ABSTRACT FROM AUTHOR]

Background: In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. Methods: We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. Results: A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality. Conclusions: Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Objective: We investigated the role of rapid response systems (RRSs) in limitations of medical treatment (LOMT) planning among children, their families, and health care providers. Methods: This multicenter retrospective cohort study examined children with clinical deterioration using the Japanese RRS registry between 2012 and 2021. Results: Children (n = 348) at 28 hospitals in Japan who required RRS calls were analyzed. Eleven (3%) of the 348 patients had LOMT before RRS calls and 11 (3%) had newly implemented LOMT after RRS calls. Patients with LOMT were significantly less likely to be admitted to an intensive care unit compared with those without (36% vs. 61%, p < 0.001) and were more likely to die within 30 days (45% vs. 11%, p < 0.001). Conclusions: LOMT issues existed in 6% of children who received RRS calls. RRS calls for clinically deteriorating children with LOMT were associated with less intensive care and higher mortality. [ABSTRACT FROM AUTHOR]

Background: Reports of poor outcomes among older adults with COVID-19 may have changed patient perceptions of Do-Not-Resuscitate (DNR) orders or caused providers to pressure older adults into accepting DNR orders to conserve resources. Objective: We determined early-DNR utilization during COVID-19 surges compared with nonsurge periods among nonsurgical adults ≥75 and its connection to hospital mortality. Methods: We conducted a retrospective cohort study among adults ≥75 years using the California Patient Discharge Database 2020. The primary outcome was early-DNR utilization. Control cohorts included nonsurgical adults <75 years in 2020 and nonsurgical adults ≥75 in 2019. Multiple causal inference methods were used to address measured and unmeasured confounding. Results: A total of 487,955 adults ≥75 years were identified, with 233,678 admitted during COVID-19 surges. Older adults admitted during surges had higher rates of early-DNR orders (30.1% vs. 29.4%, absolute risk differences = 0.7, 95% confidence interval [CI]: 0.5–1.0) even after adjusting for patient case-mix (adjusted odds ratio [aOR] = 1.02, 95% CI: 1.01–1.04). Patients with early-DNR orders experienced higher hospital mortality (15.5% vs. 4.8%, aOR = 3.96, 95% CI: 3.85–4.06). Difference-in-difference analyses demonstrated that adults <75 years in 2020 and adults ≥75 years in 2019 did not experience variation in early-DNR utilization. Conclusions: Older adults had slightly higher rates of early-DNR orders during COVID-19 surges compared with nonsurge periods. While the difference in early-DNR utilization was small, it was linked to higher odds of death. The increase in early-DNR use only during COVID-19 surges and only among older adults may reflect changes in patient preferences or increased pressure on older adults stemming from provider fears of rationing during COVID-19 surges. [ABSTRACT FROM AUTHOR]

Summary: Current guidance recommends that, in most circumstances, cardiopulmonary resuscitation should be attempted when cardiac arrest occurs during anaesthesia, and when a patient has a pre‐existing 'do not attempt cardiopulmonary resuscitation' recommendation, this should be suspended. How this guidance is translated into everyday clinical practice in the UK is currently unknown. Here, as part of the 7th National Audit Project of the Royal College of Anaesthetists, we have: assessed the rates of pre‐operative 'do not attempt cardiopulmonary resuscitation' recommendations via an activity survey of all cases undertaken by anaesthetists over four days in each participating site; and analysed our one‐year case registry of peri‐operative cardiac arrests to understand the rates of cardiac arrest in patients who had 'do not attempt cardiopulmonary resuscitation' decisions pre‐operatively. In the activity survey, among 20,717 adults (aged > 18 y) undergoing surgery, 595 (3%) had a 'do not attempt cardiopulmonary resuscitation' recommendation pre‐operatively, of which less than a third (175, 29%) were suspended. Of the 881 peri‐operative cardiac arrest reports, 54 (6%) patients had a 'do not attempt cardiopulmonary resuscitation' recommendation made pre‐operatively and of these 38 (70%) had a clinical frailty scale score ≥ 5. Just under half (25, 46%) of these 'do not attempt cardiopulmonary resuscitation' recommendations were formally suspended at the time of anaesthesia and surgery. One in five of these patients with a 'do not attempt cardiopulmonary resuscitation' recommendation who had a cardiac arrest survived to leave hospital and of the seven patients with documented modified Rankin Scale scores before and after cardiac arrest, four remained the same and three had worse scores. Very few patients who had a pre‐existing 'do not attempt cardiopulmonary resuscitation' recommendation had a peri‐operative cardiac arrest, and when cardiac arrest did occur, return of spontaneous circulation was achieved in 57%, although > 50% of these patients subsequently died before discharge from hospital. [ABSTRACT FROM AUTHOR]

The article focuses on the need to have a do not resuscitate (DNR) Portable Orders for Life-Sustaining Treatment (POLST) form in place to ensure that patients' stated wishes are followed at future visits.

Key Points: Question: Does ordering palliative care by default (allowing opt-out) increase consultation and improve clinical outcomes? Findings: In this pragmatic trial conducted from March 2016 to November 2018 among 24 065 inpatients 65 years or older with advanced chronic obstructive pulmonary disease, dementia, or kidney disease, default orders for palliative care did not significantly reduce length of stay. Default orders significantly increased consultation rate compared with usual care (43.9% vs 16.6%), decreased time to consultation by 1.2 days, and increased odds of hospice discharge and do-not-resuscitate orders at discharge. Meaning: Default palliative care consult orders did not reduce length of stay for older inpatients with advanced chronic illnesses, but improved the rate and timing of consultation and some end-of-life care processes. Importance: Increasing inpatient palliative care delivery is prioritized, but large-scale, experimental evidence of its effectiveness is lacking. Objective: To determine whether ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increased consultations and improved outcomes. Design, Setting, and Participants: A pragmatic, stepped-wedge, cluster randomized trial was conducted among patients 65 years or older with advanced chronic obstructive pulmonary disease, dementia, or kidney failure admitted from March 21, 2016, through November 14, 2018, to 11 US hospitals. Outcome data collection ended on January 31, 2019. Intervention: Ordering palliative care consultation by default for eligible patients, while allowing clinicians to opt-out, was compared with usual care, in which clinicians could choose to order palliative care. Main Outcomes and Measures: The primary outcome was hospital length of stay, with deaths coded as the longest length of stay, and secondary end points included palliative care consult rate, discharge to hospice, do-not-resuscitate orders, and in-hospital mortality. Results: Of 34 239 patients enrolled, 24 065 had lengths of stay of at least 72 hours and were included in the primary analytic sample (10 313 in the default order group and 13 752 in the usual care group; 13 338 [55.4%] women; mean age, 77.9 years). A higher percentage of patients in the default order group received palliative care consultation than in the standard care group (43.9% vs 16.6%; adjusted odds ratio [aOR], 5.17 [95% CI, 4.59-5.81]) and received consultation earlier (mean [SD] of 3.4 [2.6] days after admission vs 4.6 [4.8] days; P <.001). Length of stay did not differ between the default order and usual care groups (percent difference in median length of stay, −0.53% [95% CI, −3.51% to 2.53%]). Patients in the default order group had higher rates of do-not-resuscitate orders at discharge (aOR, 1.40 [95% CI, 1.21-1.63]) and discharge to hospice (aOR, 1.30 [95% CI, 1.07-1.57]) than the usual care group, and similar in-hospital mortality (4.7% vs 4.2%; aOR, 0.86 [95% CI, 0.68-1.08]). Conclusions and Relevance: Default palliative care consult orders did not reduce length of stay for older, hospitalized patients with advanced chronic illnesses, but did improve the rate and timing of consultation and some end-of-life care processes. Trial Registration: ClinicalTrials.gov Identifier: NCT02505035 This cluster randomized trial examines whether the effect of ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increased consultations and improved outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Do Not Resuscitate (DNR) order is a type of Advance Medical Directive (AMD) that documents a patient's wishes or desire to refrain from Cardiopulmonary Resuscitation (CPR), especially in the terminally ill patient. It is a sensitive issue in patient care and less is known on medical students awareness on the area. Aim: This study assessed the opinion, knowledge, awareness and familiarity toward Do Not Resuscitate (DNR) order among undergraduate medical students from year 1 to 5 in Universiti Sains Malaysia. Methods: A cross-sectional study was conducted with 250 undergraduate medical students using an online questionnaire on awareness towards DNR orders. Descriptive statistics, independent t-test and one-way ANOVA were applied to examine the distribution and association of DNR awareness among medical students with year of study, gender, race and religion. Results: The study indicated that most participants (84.4%) were familiar with DNR orders. There was no significant association between all 4 variables (year of study, gender, race and religion) with level of awareness among undergraduate medical students in HUSM. Conclusion: Undergraduate medical students have a good awareness on DNR orders. Despite having a multiracial and multi religion community, the medical students have similar patterns in their knowledge about DNR. [ABSTRACT FROM AUTHOR]

Objective: The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods: Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results: The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion: After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation. [ABSTRACT FROM AUTHOR]

The article focuses on neurosurgeons' observations of poor outcomes among patients with pre-existing do-not-resuscitate (DNR) orders undergoing cranial neurosurgery. Analyzing data from over 30,000 patients, the study reveals higher mortality rates and reduced use of life-sustaining interventions among those with DNR orders, emphasizing the ethical considerations in managing such cases.

This article explores the difficulties that residents and interns in the healthcare field encounter, including low wages and extended working hours. Dr. Phillip Sossenheimer, a former resident at Stanford Healthcare, shares his personal experiences and draws attention to issues like the absence of rest areas and the unequal treatment of residents during the COVID-19 pandemic. Dr. Sossenheimer emphasizes the significance of collective action and union representation in addressing these challenges and advocating for improved working conditions, such as strategies to combat fatigue and enhanced leave policies. The article also delves into the obstacles faced by physicians in the American healthcare system, such as the high cost of education, the pressure to work long hours, and the growing influence of private equity. The author stresses the importance of physicians organizing and advocating for better working conditions and patient care. Additionally, the article highlights the ethical dilemmas that doctors confront, such as discharging homeless patients onto the streets due to limited resources. Dr. Sossenheimer encourages library patrons to support physician unions and engage in local politics to bring about change in the healthcare system. [Extracted from the article]

Rationale. Contribute to the understanding of DNR decision-making and conducting end-of-life conversations, about which there is a paucity of data available in the current literature. Aims and Objectives. Assess how the decision-making process to determine a DNR code is implemented in the day-to-day clinical practice in a tertiary teaching hospital. Familiarity with the use of different scores as a possible objective support for DNR decisions and the influence of various elements on a DNR decision was explored. Method. A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic. Results. 127 doctors participated in this study. The familiarity with the different scores used in the triage during the COVID-10 pandemic was 51% for the Clinical Frailty Scale (CFS) and 20% for the Charlson Comorbidity Index (CCI). Participants indicated that their DNR decision is based on various aspects such as clinical assessment, comorbidities, patient's wishes, age, prognosis, and functional state. Conclusion. The familiarity with the different scores used during triage assessments is low. The total clinical picture of the patient is needed to make a considered decision, and this total picture of the patient seems to be well encompassed by frailty measurement (CFS). Although many participants indicated that the different scores do not offer much added value compared to their clinical assessment, it can help guide DNR decisions, especially for doctors in training. [ABSTRACT FROM AUTHOR]

This study aims to determine Turkish Muslim physicians' and nurses' views about the Do Not Resuscitate order and the factors influencing these views. This was a cross-sectional, descriptive study. The sample consisted of 327 health workers including 77 physicians and 250 nurses employed in internal and surgical clinics, intensive care units and emergency services of two different university hospitals located in the northeast of Turkey. 90.9% of Muslim Turkish physicians and 74.4% of nurses request the Do Not Resuscitate order to be legally implemented. The factors predicting 40.0% of Muslim Turkish physicians and nurses requesting the legal implementation of the Do Not Resuscitate order were determined as working at institution 1; requesting implemented before emergencies occur, in emergencies and in both cases; considering informing the patient and their surrogates about as a patient's right; and requesting to be a surrogate for one relatives. [ABSTRACT FROM AUTHOR]

Background: Physician Orders for Life Sustaining Treatment (POLST) document instructions for intensity of care based upon patient care preferences. POLST forms generally reflect patients' wishes and dictate subsequent medical care, but it is not known how POLST use and content among nursing home residents is associated with inpatient utilization across a large population. Objective: Evaluate the relationship between POLST use and content with hospital utilization among nursing home residents in California. Design: Retrospective cohort study using the Minimum Data Set linked to California Section S (POLST documentation), the Medicare Beneficiary Summary File, and Medicare line item claims. Patients: California nursing home residents with Medicare fee-for-service insurance, 2011–2016. Main Measures: Hospitalization, days in the hospital, and days in the intensive care unit (ICU) after adjustment for resident and nursing home characteristics. Key Results: The 1,112,834 residents had a completed and signed (valid) POLST containing orders for CPR with Full treatment 29.6% of resident-time (in person-years) and a DNR order with Selective treatment or Comfort care 27.1% of resident-time. Unsigned POLSTs accounted for 11.3% of resident-time. Residents experienced 14 hospitalizations and a mean of 120 hospital days and 37 ICU days per 100 person-years. Residents with a POLST indicating CPR Full treatment had utilization nearly identical to residents without a POLST. A gradient of decreased utilization was related to lower intensity of care orders. Compared to residents without a POLST, residents with a POLST indicating DNR Comfort care spent 56 fewer days in the hospital and 22 fewer days in the ICU per 100 person-years. Unsigned POLST had a weaker and less consistent relationship with hospital utilization. Conclusions: Among California NH residents, there is a direct relationship between intensity of care preferences in POLST and hospital utilization. These findings emphasize the importance of a valid POLST capturing informed preferences for nursing home residents. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical concerns surrounding unilateral do-not-resuscitate (DNR) orders, as clinicians express worries about their disproportionate use, particularly among certain populations, prompting a study that found a higher rate of unilateral DNR orders.

The article focuses on the ethical and legal complexities surrounding do-not-resuscitate (DNR) orders, exploring scenarios where patient wishes may be unclear, emphasizing the need for physicians to navigate these situations while considering both legal protections and ethical considerations. The topics include the interpretation of advance directives, challenges in maintaining consistent DNR orders, and the ethical implications of unilateral DNR orders in certain circumstances.

Upon admission to an acute care hospital, patients and families are faced with determining their cardiopulmonary resuscitation status during conversation with providers. Medical providers are tasked with providing education and options in the context of the patient's acute and chronic conditions. Misconceptions are common in the general public, and providers may struggle with providing guidance in high-stress situations. Literature review revealed a lack of national consensus on code status definitions. Electronic health records may include multiple options for code status orders, which may lead to confusion for patients and medical staff, resulting in provision of potentially ineffective or undesired medical care. The following discussion will examine multiple cases in a large health care system and a novel way of standardizing resuscitation options using Havelock's change theory. This quality improvement project was approved by the institutional review board. [ABSTRACT FROM AUTHOR]

This study extends the understanding of if and how consumer impulse buying tendency toward unhealthy food can be explained by the conflicting and interactive mechanisms of individual differences in self-construal and future time perspectives. Based on a survey sample of 439 Vietnamese consumers, this study adopts a structural equation modelling approach for second-order constructs and moderating effects to test hypotheses. The study confirms that interdependent and independent self-construal are structured as second-order individual constructs, and that interdependent self-construal has a negative impact, while an independent self-construal positively affects impulse buying tendency toward unhealthy food. In particular, besides having a direct negative effect on this tendency, future time perspectives have opposite moderating effects on these relationships. [ABSTRACT FROM AUTHOR]

Numerous times, TV medical dramas show a patient in cardiac arrest getting cardiopulmonary resuscitation (CPR), coming back to life, and being back to their old self in no time. In fact, being resuscitated is not so simple and can be dangerous in its own right. Given that, in many cases, the risks of pain and harm from CPR outweigh the benefits, it comes as no surprise that a growing number of people issue a do-not-resuscitate (DNR) order as part of their advance care plan to prevent CPR attempts on them should their heart or breathing stop. This legal document illustrates their aversion to euthanasia. For many, the idea of being kept alive via artificial means, such as life support, is more appalling than death itself. This study focuses on the concept of dying and the legal repercussions of a medical doctor (MD)'s refusal to perform CPR without the patient's consent, thus, allowing, the patient’s natural death to occur. What ought the MDs do and ask in a situation like this so as to avoid criminal responsibility? The result of this study is that deciding about DNR orders is a difficult process that can be affected by various factors. However, few legislations have codified the criminal responsibility of the doctor, as the UAE legislator did in Federal Decree-Law No. (4) of 2016 regarding Medical Liability. [ABSTRACT FROM AUTHOR]

This case study describes the antenatal care, birth, and subsequent management of a baby boy born via elective lower segment Caesarean section. The pregnancy, initially uneventful, revealed multiple congenital anomalies during the second trimester. Despite extensive efforts, including respiratory support and antibiotic treatment for late-onset sepsis, the neonate's condition deteriorated rapidly, leading to a cardiac arrest on day 25 of life. Palliative care was provided, consistent with the parents' wishes for a do-notresuscitate (DNR) approach due to the severity of the congenital anomalies. This case underscores the complexities of managing neonates with profound congenital anomalies, and the importance of respectful and supportive care for families facing such challenges. [ABSTRACT FROM AUTHOR]

This research explores the key drivers of purchase intention for luxury goods in the new tourism era after the pandemic via constructs associated with the behavior of tourist consumers of luxury goods and the business strategy regarding them. The mixed methodology allowed for a twofold objective with the investigation of purchase intention to clearly establish what the most important determinants that affect purchase intention are, and, secondly, to determine to some extent the order, importance, and combination of these determinants. The PLS-SEM demonstrated price, vanity, communication, and social influence as increasing purchase intention. The QCA analysis evidences value and vanity as the necessary conditions for intention. [ABSTRACT FROM AUTHOR]

Objectives: This review examined studies regarding the implementation and translation of patients' advance directives (AD) in intensive care units (ICUs), focusing on practical difficulties and obstacles. Methods: The digital PubMed and Medline databases were screened using predefined keywords to identify relevant prospective and retrospective studies published until 2022. Results: Seventeen studies from the United States, Europe, and South Africa (including 149,413 patients and 1210 healthcare professionals) were identified. The highest prevalence of ADs was described in a prospective study in North America (49%), followed by Central Europe (13%), Asia (4%), Australia and New Zealand (4%), Latin America (3%), and Northern and Southern Europe (2.6%). While four retrospective studies reported limited effects of ADs, four retrospective studies, one survey and one systematic review indicated significant effects on provision of intensive care, higher rates of do-not-resuscitate orders, and care withholding in patients with ADs. Four of these studies showed shorter ICU stays, and lower treatment costs in patients with ADs. One prospective and two retrospective studies reported issues with loss, delayed or no transmission of ADs. One survey revealed that 91% of healthcare workers did not regularly check for ADs. Two retrospective studies and two survey revealed that the implementation of directives is further challenged by issues with their applicability, phrasing, and compliance by the critical care team and family members. Conclusions: Although ADs may improve intensive- and end-of-life care, insufficient knowledge, lack of awareness, poor communication between healthcare providers and patients or surrogates, lack of standardization of directives, as well as ethical and legal concerns challenge their implementation. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on what constitutes "early" pediatric palliative care (PPC) referral within pediatric oncology. Few studies report outcomes based on PPC timing. Objectives: Investigate associations between early (<12 weeks) or late (≥12 weeks from diagnosis) outpatient PPC consultation with demographics, advance care planning (ACP), and end-of-life (EOL) outcomes. Design: Retrospective chart and database review of demographic, disease, visit data, and PPC/EOL outcomes. Setting/Subjects: Deceased pediatric patients with cancer 0–27 years of age seen at an embedded consultative PPC clinic. Measurements: Patient demographics, disease characteristics, PPC/EOL outcomes: timing/receipt of ACP, hospice enrollment, do-not-resuscitate (DNR) documentation, hospital days in last 90 days of life, concordance between actual and preferred location of death, receipt of cardiopulmonary resuscitation (CPR) at EOL, and death in the intensive care unit. Results: Thirty-two patients received early and 118 received late PPC. Early outpatient PPC was associated with cancer type (p < 0.01). Early PPC (p = 0.04) and ACP documentation (p = 0.04) were associated with documentation of preferred location of death. Early PPC was associated with a preference for home death (p = 0.02). Timing of outpatient PPC was not associated with ACP documentation or other EOL outcomes. In the entire cohort, 73% of PPC patients received hospice, 74% had a DNR order, 87% did not receive CPR at EOL, and 90% died in their preferred location. Conclusions: When using a cutoff of 12 weeks from diagnosis, outpatient PPC timing was only associated with location of death metrics, likely due to high-quality PPC and EOL care among all patients. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]

Background: Even though nurses take various measures to decrease acute pain after surgery in older adults with dementia, it is unclear why most of them suffer from severe pain. This study aimed to evaluate the factors affecting acute pain management in older adults with dementia after hip fracture surgery. Materials and Methods: This cross-sectional study used single-stage cluster and convenience sampling to select 330 nurses working in hospitals located in Western Mazandaran, Iran, in 2020. The demographic characteristic questionnaire and the Obstacles to Postoperative Pain Management in Dementia Scale (OPOPMDS) were used to collect data. Results: The study results confirmed the modified model. The second-order Confirmatory Factor Analysis (CFA) indicated that the Critical Ratio (CR) for all three factors was more than 1.96, and the significance level was considered 0.05. Based on the values of standard coefficients, older people-related (β = 0.86, p < 0.001), system-related (β = 0.70, p < 0.001), and healthcare provider-related (β = 0.61, p < 0.001) factors had the highest impacts on the OPOPMD. Conclusions: The study results suggested that older adult-related factors had the most significant impact on the OPOPMD. [ABSTRACT FROM AUTHOR]

Background: Infusion rate is one of the essential elements that should be included in all intravenous orders. Patients may experience adverse consequences or risks associated with inappropriate infusion. Meanwhile, there is growing pressure on the chemotherapy unit to deliver treatment quickly, efficiently, and safely, and thus it is very necessary to improve the chemotherapy process and service to cancer patients. Clinicians should consider how to further standardize infusion therapy, and innovate new infusion strategies to increase efficacy, reduce toxicity, improve patient satisfaction and save health resource costs. Sporadic studies have evaluated the effects of infusion rates of anticancer agents on clinical outcomes, economic benefits, and administration efficiency. However, an update review has not been available.Methods: Relevant literature was identified by search of PubMed until September 2023.Results: Infusion rates may have significant effect on the efficacy of anticancer agents (e.g., methotrexate, fluorouracil, and arsenic trioxide). Slow infusion is safer for platinum compounds, doxorubicin and carmustine, whereas fast infusion is safer than slow infusion of gemcitabine. Optimal flow rates of paclitaxel and fluorouracil are based on the balance between multiple risks of toxicity. Optimal infusion rate may bring economic benefits. If efficacy and safety are not compromised, shortened infusion may result in higher patient satisfaction, improved institutional efficiency and more nursing time available for other activities (e.g., biosimilar products, endostar). Other concerns about infusion rate include clinical indications (eg, paclitaxel and rituximab, methotrexate), severity and type of hypersensitivity reactions (e.g., platinum compounds), formulation features (e.g., paclitaxel, doxorubicin), and genetic polymorphism (e.g., gemcitabine, methotrexate).Conclusion: The latest knowledge of infusion rate concerns will enhance the appropriateness and accuracy in intravenous administration. Interdisciplinary teams should collaborate and implement relevant risk management and healthcare policy. It is worthwhile to conduct comparative studies of intravenous therapy with different infusion speeds. [ABSTRACT FROM AUTHOR]

Burn injuries often require complex interdisciplinary care. Despite potential benefits, consultation with specialist palliative care typically occurs in 2% of burn admissions, due largely to lack of availability and misconceptions concerning palliative care. Criteria to guide consultation with specialist palliative care have been developed at this institution. The purpose of this study was to quantify the sensitivity and specificity of these criteria, and then optimize them. Retrospective examination of 388 admissions over 15 months at this adult and pediatric Burn Center were conducted. Chi-square or Fisher's exact test for categorical variables and Wilcoxon Rank Sum test for continuous variables were used to test for between-group differences in demographic and clinical characteristics. Logistic regression model was built to determine modified Baux cut-off score using Youden index (J) value. Criteria were sensitive (0.96) and specific (0.90), though with a low positive predictive value (0.43). Persons with lengths of stay greater than one week, advanced directives, Allow Natural Death orders, and/or deterioration events were significantly more likely to have had palliative care consulted. There were significant between-group differences (with/without palliative care consultation) based on burn surface area, modified Baux score, and mortality risk. Potential criteria revisions are proposed. Prospective adherence to revised criteria could provide useful guidance to providers and benefit to patients and families. [ABSTRACT FROM AUTHOR]

This article centers on the nonprofit landscape in Vancouver, Canada, a city that occupies the territories of the xʷməθkʷəy̓əm (Musqueam), sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) nations, which have never been ceded to the colonial occupation of Canada. Vancouver has a competitive nonprofit field, with an estimated 1600+ nonprofits operating within city limits. This descriptive review starts by defining what a nonprofit industrial complex (NPIC) is, then outlines an abbreviated history of the nonprofit sector on the aforementioned lands. The article then explores issues related to colonialism, anti-poor legislation, neoliberal governance, the fusing of the public and private sectors, and the bureaucratization of social movements and care work as mechanisms to uphold the status quo social order and organization of power. Focusing on under-examined issues related to the business imperatives of nonprofit organizations in the sectors of housing, health and social services, community policing, and research, this work challenges the positive default framing of nonprofits and charities. Instead, we contend that Vancouver's NPIC allows the government and the wealthy to shirk responsibility for deepening health and social inequities, while shaping nonprofits' revenue-generating objectives and weakening their accountability to the community. [ABSTRACT FROM AUTHOR]

Purpose: To investigate patterns of ancillary imaging testing among vitreoretinal specialists for patients with vitreoretinal disease in the United States (US).Methods: Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA), ordered by vitreoretinal specialists and documented within the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) between 01 January 2018 and 31 December 2020, were retrospectively assessed. Trends in imaging modality choice were analyzed by payer type, geographic region, and practice type. Sub-analyses were conducted according to categorization of vitreoretinal specialists into those treating a high versus low volume of patients with neovascular age-related macular degeneration (nAMD).Results: OCT was the most common imaging modality used, followed by CFP and FA. Following normalization, the highest volume of OCT procedures performed were identified among Medicare Advantage and Medicare Fee-for-Service beneficiaries, within the South of the US, and at medium and large practices. Minimal differences were observed for CFP and FA volume across payer types and regions. Across practice types, the largest volume of CFP and FA procedures were identified in small and private equity owned practices, respectively. Vitreoretinal specialists with a high nAMD volume more frequently performed OCT than those with a low nAMD volume.Conclusion: Vitreoretinal specialists demonstrated a strong preference for OCT, with real-world associations according to payer type, geographic location, and practice type. Volume of nAMD patients seen impacted the likelihood of specialists ordering OCTs.Plain Language Summary: Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA) are key imaging modalities used by vitreoretinal specialists in routine eye care. This study aimed to uncover patterns of OCT, CFP, and FA usage in the United States from 2018 to 2020, and investigated the impact of volume of patients with neovascular age-related macular degeneration on these trends. Higher rates of OCT use, compared with CFP and FA, were identified in the US. [ABSTRACT FROM AUTHOR]

Excessive opioid use after sustaining trauma has contributed to the opioid epidemic. Standardizing the quantity of opioids prescribed at discharge can improve prescribing behavior. We hypothesized that adopting new electronic medical record order sets would be associated with decreased morphine milligram equivalents (MME) prescribed at discharge for trauma patients. This was a quasi-experimental study examining opioid prescribing practices at a Level 1 Trauma Center. All patients ages 18-89 admitted to the Trauma Service from January 2017 through March 2021 and hospitalized for at least 2 d were included. In November 2020, new trauma admission and discharge order sets were implemented with recommended discharge opioid quantity based on inpatient opioid usage the day prior to discharge multiplied by five. Postintervention prescribing practices were compared to historical controls. The primary outcome was MME at discharge. Baseline characteristics between preintervention and postintervention cohorts were comparable. There was a significant reduction in median MME prescribed at discharge postintervention (112.5 versus 75.0, P < 0.0001). Median inpatient MME usage also significantly reduced postintervention (184.1 versus 160.5; P < 0.0001). There were trends toward increased ideal prescribing per order set recommendation and a reduction in overprescribing. Patients receiving the recommended opioid quantity at discharge had the lowest opioid refill prescription rate (under: 29.6%, ideal: 7.3%, over: 19.7%, P < 0.0001). For trauma patients requiring inpatient opioid therapy, a pragmatic and individualized intervention was associated with a reduced quantity of discharge opioids without negative outcomes. Reduction in inpatient opioid use was also associated with standardizing prescribing practices of surgeons with electronic medical record order sets. • Best opioid prescribing practices after discharge in trauma patients are unknown. • 24-hour prior to discharge opioids multiplied by 5 calculator is effective. • Inpatient opioid usage can guide optimal discharge opioid prescription. • Streamlining multimodal pain regimen during trauma admission is associated with decreased opioid usage overall. [ABSTRACT FROM AUTHOR]

Background: Previous studies of do-not-resuscitate (DNR) or do-not-intubate (DNI) orders in stroke patients have primarily been conducted in North America or Europe. However, characteristics associated with DNR/DNI orders in stroke patients in Asia have not been reported. Methods: Based on the Taiwan Stroke Registry, this nationwide cross-sectional study enrolled hospitalized stroke patients from 64 hospitals between 2006 and 2020. We identified characteristics associated with DNR/DNI orders using a two-level random effects model. Results: Among the 114,825 patients, 5531 (4.82%) had DNR/DNI orders. Patients with acute ischemic stroke (AIS) had the highest likelihood of having DNR/DNI orders (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.61–1.93), followed by patients with intracerebral hemorrhage (ICH), and patients with subarachnoid hemorrhage (SAH) had the lowest likelihood (aOR 0.53, 95% CI 0.43–0.66). From 2006 to 2020, DNR/DNI orders increased in all three types of stroke. In patients with AIS, women were significantly more likely to have DNR/DNI orders (aOR 1.23, 95% CI 1.15–1.32), while patients who received intravenous alteplase had a lower likelihood (aOR 0.74, 95% CI 0.65–0.84). Patients with AIS who were cared for by religious hospitals (aOR 0.55, 95% CI 0.35–0.87) and patients with SAH who were cared for by medical centers (aOR 0.40, 95% CI 0.17–0.96) were significantly less likely to have DNR/DNI orders. Conclusions: In Taiwan, DNR/DNI orders increased in stroke patients between 2006 and 2020. Hospital characteristics were found to play a significant role in the use of DNR/DNI orders. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effect of real-time audio ventilation feedback on the survival of patients with an out-of-hospital cardiac arrest (OHCA) during advanced cardiac life support (ACLS) performed by paramedics. This research was a prospective randomized controlled study performed in Busan, South Korea, from July 2022 to December 2022. This study included 121 patients, ages 19 and up, who were transferred to the study site, excluding 91 patients who did not receive CPR under a doctor's direction as well as those who had a '(DNR)' order among 212 adult CA patients. OHCA patients' clinical prognosis was compared by being randomly assigned to either a general manual defibrillator (NVF) group (N = 58) or a manual defibrillator with an audio ventilation feedback (AVF) group (N = 63). To verify the primary outcome, the cerebral performance category (CPC), return of spontaneous consciousness (ROSC), 30h survival, and survival discharge were compared. Multivariate logistic regression was conducted to analyze the association between the audio-feedback manual defibrillator (AVF) and the ROSC of OHCA patients. This study analyzed 121 patients among 212 OHCA patients. The ROSC (AVF group: 32 {26.4%} vs. NVF group: 21 {17.3%}), 24 h survival (AVF group: 24 {19.8%} vs. NVF group: 11 {9.0%}), and survival discharge (AVF group: 12 {9.9%} vs. NVF group: 6 {4.9%}) were higher in the AVF group than the NVF group. However, upon analyzing CPC scores in the surviving patients between the two groups, there was no significant difference (AVF group: 4.1 ± 1.23 vs. NVF group:4.7 ± 1.23, p = 1.232). Multivariate logistic regression analysis showed that the use of AVF was associated with a higher ROSC (odds ratio {OR}, 0.46; 95% confidence interval {CI}, 0.23–0.73; p < 0.01) and higher survival at 30 h (OR, 0.63; 95% CI, 0.41–0.98; p = 0.01). [ABSTRACT FROM AUTHOR]

This study surveys the differences of relatively healthy proponents of end-of-life choices and people with irremediable health conditions having already made the decision to hasten their deaths on what each group considers important in influencing a desire to hasten death. Psychosocial factors were more important than physical ones for both groups; but those contemplating what might influence them to hasten their deaths in the future thought pain and feeling ill would be much bigger factors than they turned out to be for those deciding to do so. Those having decided to hasten their deaths cited the lack of any further viable medical treatments and having to live in a nursing home as bigger factors. Identifying these psychosocial factors influencing a desire for a hastened death suggests that caregivers and medical providers may want to review what compassionate understanding and support looks like for people wanting to hasten their death. [ABSTRACT FROM AUTHOR]

Background: Physician Orders for Life‐Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. Methods: California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content—orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. Results: POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two‐thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. Conclusions: Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative. [ABSTRACT FROM AUTHOR]