Search

A multidisciplinary research program on levels of care was conducted in 15 adult intensive care units in North America, Europe, and Australia. The program addressed advance directives for cardiopulmonary resuscitation, [...]

* BACKGROUND Levels of cardiac troponin, a sensitive and specific marker of myocardial injury, are often elevated in critically ill patients. * OBJECTIVES To document elevated levels of cardiac troponin [...]

Doctors are most likely to withdraw patients from a mechanical ventilator if the patient does not want life support or the doctor believes the patient will not survive much longer or will survive but have severely impaired mental function. This was the conclusion of a study of 851 patients who were on a ventilator in 15 hospital intensive care units. Twenty percent of the patients were taken off the ventilator for the reasons noted above.

Background: Loneliness is a public health concern and its influence on morbidity and mortality are well documented. The association between loneliness and emergency department visits is less clear. Further, while sex and gender-related factors are known to be associated with loneliness and health services use, little research looks at the relationship by gender. Our study aimed to estimate the association between loneliness and emergency department use in the previous 12 months. We aimed to determine if this association differed based on gender identity and gender-related characteristics.Methods: We used a retrospective cohort study design to analyze population-based survey data from the Canadian Longitudinal Study on Aging (CLSA). We analysed data from the baseline and follow-up 1 survey respondents (2015-2018) from both the tracking (telephone interviews) and comprehensive (in-home data collection) cohorts (n=44816). Loneliness was assessed using a dichotomous measure (lonely/not lonely) from a validated scale. Emergency department visits were dichotomous (yes/no) by self-reported emergency department use in the 12 months prior to the survey date. Multivariable logistic regression analyses using analytic weights examined the association between loneliness and emergency department visit, controlling for other demographic, social, and health related factors.Results: We identified 44,413 respondents to the baseline and follow-up 1 survey. The prevalence of loneliness in our sample was 23.1% (n=10263). Of those who had been to the emergency department in the previous year, 27.2% (n=2793) were lonely. Lonely respondents had higher odds of an emergency department visit (aOR: 1.13, 95% CI: 1.05-1.21), adjusted for various demographic and health factors. Loneliness was associated with emergency department visits more so in women (aOR: 1.15, 95% CI: 1.05-1.25) than in men (aOR: 1.10, 95% CI: 0.99-1.22).Conclusions: In our study, loneliness was associated with emergency department visits in the previous 12 months. When our analysis was disaggregated by gender, we found differences in the odds of emergency department visit for men, women, and gender-diverse respondents. The odds of ED visit were higher in women than men. These findings highlight the general importance of identifying loneliness in both primary care and hospital. Care providers in ED need resources to refer patients who present in this setting with health issues complicated by social conditions such as loneliness. [ABSTRACT FROM AUTHOR]

Background: As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute settings may be more beneficial and suitable for both patients and emergency departments. We aimed to evaluate whether emergency department interventions conducted on patients with nonemergent conditions who are transported by paramedics could be conducted in subacute health centres. Methods: We conducted a RAND/UCLA modified Delphi study in Ontario between Oct. 13 and Dec. 19, 2020. We used purposive sampling to recruit practising emergency and primary care physicians for an expert panel. We abstracted interventions given to adult patients with nonemergent conditions (18 yr of age or older) who were transported by paramedics to an emergency department from the National Ambulatory Care Reporting System (NACRS) database (Jan. 1, 2014, to Mar. 31, 2018). Participants in the expert panel rated the suitability of the 150 most frequently recorded emergency department interventions from the NACRS database, for completion in subacute health care centres. We set consensus at 70% agreement. Results: We invited 25 physician experts, 21 of whom consented to participate; 20 physicians completed round 1, and 18 physicians completed both rounds. After 2 rounds, consensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for subacute centres, 43 (28.7%) for only the emergency department and 4 (2.6%) did not receive consensus. For subacute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) interventions and clinics led by nurse practitioners for 47 (31.3%) interventions. Interpretation: Most interventions provided to patients with nonemergent conditions transported by paramedics to emergency departments were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or clinics led by nurse practitioners. This study has potential to inform a patient classification model for paramedic-initiated redirection of patients from emergency departments, although further contextualization is required for this to be implemented in clinical practice. Study registration: ID ISRCTN22901977. [ABSTRACT FROM AUTHOR]

Background: Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes.Methods: In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing ('LTCF readiness'), and death at 180 days from discharge.Results: A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission.Conclusion: Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults. [ABSTRACT FROM AUTHOR]

The anti-ulcer drug ranitidine appears to be more effective than sucralfate in preventing gastrointestinal bleeding from stress ulcers in hospital patients on a ventilator. Researchers randomly assigned 1200 to receive either sucralfate or ranitidine through an intravenous line or a nasogastric tube. Only 1.7% of the patients receiving ranitidine developed gastrointestinal bleeding compared to 3.8% of those receiving sucralfate. There were no significant differences in mortality rates or hospital stay between both groups.

Younger asthmatic children may provide more helpful information in some areas while their parents may provide more helpful information in others. Older children may provide more helpful information in all areas. Fifty-two asthmatic children ages 7 to 17 and their parents rated change in symptoms, evaluated quality of life, and recorded peak flow rates, symptoms and medication use over a one-month period. Ratings of symptom changes in children younger than 11 were better correlated with quality of life whereas parents' ratings were better correlated with asthma control and airway functioning. Older children's ratings were correlated more closely with both., Objective. To explore children&apos;s and parents&apos; assessment of children&apos;s asthma. Design. Prospective 2-month cohort study in which children and parents were reviewed at baseline and 1-month intervals. Setting. Mid-sized, English-speaking, industrial community serving an urban and regional rural population. Patients or Participants. Fifty-two children, 7 to 17 years old, with a wide range of asthma severity, and their parents. Interventions. We offered patients with inadequately controlled asthma additional inhaled steroid. Main Outcome Measures. Children and parents provided global ratings of change in childhood symptoms and children completed spirometry and the Paediatric Asthma Quality of Life Questionnaire at clinic visits. Patients recorded peak flow rates, symptoms, and medication use in a daily diary. The diary symptom report, medication use, and spirometry were combined to form an asthma control score. Results. In children younger than 11, children&apos;s global rating of change in symptoms correlated strongly with changes in quality of life (0.54 to .67) but not with measures of airway caliber or asthma control, while parents&apos; global ratings did not correlate with children&apos;s quality of life but showed moderate correlations with airway caliber (0.29 to .48) and asthma control (0.50). In children over the age of 11, correlations with all clinical variables were higher for their own than their parents&apos; global ratings. Conclusions. In children under 11, clinicians can gain complementary information from questioning children and parents. For children over 11, parents can provide little if any information beyond that obtained through questioning the child. Pediatrics 1997;99:165-168; asthma, health-related quality of life, pediatrics., ABBREVIATIONS. HRQL, health-related quality of life; PAQLQ, Paediatric Asthma Quality of Life Questionnaire; FE[V.sub.1], forced expiratory volume in 1 second. Clinicians treating children with asthma have a number of sources [...]