scholarly journals Do not attempt cardiopulmonary resuscitation (DNACPR) decisions for older medical inpatients: a cohort study

2021 ◽  
pp. bmjspcare-2021-003084
Author(s):  
Jane Walker ◽  
Katy Burke ◽  
Marta Wanat ◽  
Harriet Hobbs ◽  
Isabelle Rocroi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Medical Records ◽  
Older Patients ◽  
Medical Inpatients ◽  
John Radcliffe Hospital ◽  
Using Data ◽  
Medical Wards ◽  
Made In

ObjectivesA decision not to attempt cardiopulmonary resuscitation in the event of cardiorespiratory arrest requires a discussion between the doctor and the patient and/or their relatives. We aimed to determine how many older patients admitted to acute medical wards had a pre-existing 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision, how many had one recorded on the ward and how many of those who died had a DNACPR decision in place.MethodsA prospective cohort study, using data from medical records, of 481 consecutive patients aged ≥65 years admitted to the six acute medical wards of the John Radcliffe Hospital, Oxford.Results105/481 (22%) had a DNACPR decision at ward admission, 30 of which had been made in the emergency unit. A further 45 decisions were recorded on the ward, mostly after discussion with relatives. Of the 37 patients who died, 36 had a DNACPR decision. For the 20 deceased patients whose DNACPR decision was recorded during their admission, the median time from documentation to death was 4 days with 7/20 (35%) recorded the day before death.ConclusionsOlder patients with multimorbidity need the opportunity to discuss the role of CPR earlier in their care and preferably before acute hospital admission.

Mending Broken Hearts

2012 ◽  
Vol 53 (1) ◽  
pp. 33-49 ◽  
Author(s):  
Ellen L. Idler ◽  
David A. Boulifard ◽  
Richard J. Contrada
Keyword(s):  
Medical Records ◽  
Lower Risk ◽  
Adult Mortality ◽  
Men And Women ◽  
Never Married ◽  
The Social ◽  
Using Data ◽  
Long Term Mortality

Marriage has long been linked to lower risk for adult mortality in population and clinical studies. In a regional sample of patients ( n = 569) undergoing cardiac surgery, we compared 5-year hazards of mortality for married persons with those of widowed, separated or divorced, and never married persons using data from medical records and psychosocial interviews. After adjusting for demographics and pre- and postsurgical health, unmarried persons had 1.90 times the hazard of mortality of married persons; the disaggregated widowed, never married, and divorced or separated groups had similar hazards, as did men and women. The adjusted hazard for immediate postsurgical mortality was 3.33; the adjusted hazard for long-term mortality was 1.71, and this was mediated by married persons’ lower smoking rates. The findings underscore the role of spouses (both male and female) in caregiving during health crises and the social control of health behaviors.

scholarly journals End-Of-Life Discussions Reduce The Utilization of Life-Sustaining Treatments During The Last Three Months of Life in Cancer Patients : A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Shang-Yih Chan ◽  
Yun-Ju Lai ◽  
Yu-Yen Hsin Chen ◽  
Shuo-Ju Chiang ◽  
Yi-Fan Tsai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Cancer Patients ◽  
Medical Records ◽  
Population Based ◽  
Lower Likelihood ◽  
The Mean ◽  
The Impact ◽  
To Receive

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

scholarly journals Adherence to Recommendations from Comprehensive Geriatric Assessment of Older Individuals with HIV

2019 ◽  
Vol 18 ◽  
pp. 232595821882165 ◽  
Author(s):  
Christiana Bitas ◽  
Sian Jones ◽  
Harjot Kaur Singh ◽  
Mildred Ramirez ◽  
Eugenia Siegler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Social Workers ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Older Individuals ◽  
The Impact

This retrospective cohort study sought to assess the effectiveness of comprehensive geriatric assessment (CGA) for older patients at an HIV clinic in a large US city. We systematically reviewed medical records of all patients who underwent CGA from June 2013 to July 2017. In addition, physicians and social workers completed an anonymous survey about the impact of CGA on their patients. For the 76 patients (median age 67.2; Q1, Q3 = 60.9, 72.6) seen by geriatricians at the clinic, there were 184 recommendations, 54 instances of counseling, and 11 direct actions. Overall adherence to recommendations was 32.8%, 34.9% for patient-directed, and 31.7% for provider-directed recommendations. No demographic or CGA variables were associated with adherence. Despite this lack of adherence, surveyed providers reported that they usually or always followed recommendations; the most frequently cited barrier to implementation was lack of feasibility. Further research will be needed to determine how CGA can improve outcomes for this population.

scholarly journals Informal and formal social support during pregnancy and joint maternal and paternal postnatal depression: Data from the French representative ELFE cohort study

2020 ◽  
Vol 66 (5) ◽  
pp. 431-441 ◽  
Author(s):  
Aurélie Nakamura ◽  
Anne-Laure Sutter-Dallay ◽  
Fabienne El-Khoury Lesueur ◽  
Xavier Thierry ◽  
Florence Gressier ◽  
...  
Keyword(s):  
Social Support ◽  
Cohort Study ◽  
Multinomial Regression ◽  
Formal Support ◽  
Psychological Difficulties ◽  
Nationally Representative ◽  
Using Data ◽  
The Impact ◽  
Psychosocial Risk Assessment

Background: Insufficient social support has been intensively studied as a risk factor of postpartum depression (PPD) among mothers. However, to date, no study has examined the role of informal and formal dimensions of social support during pregnancy with regard to joint maternal and paternal depression after birth. Aim: Study associations between insufficient informal and formal support during pregnancy and joint parental PPD. Methods: Using data from the nationally representative French ELFE ( Etude Longitudinale Française depuis l’Enfance) cohort study ( N = 12,350), we estimated associations between insufficient informal and formal support received by the mother during pregnancy and joint parental PPD in multi-imputed multivariate multinomial regression models. Results: In 166 couples (1.3%), both parents were depressed. The likelihood of joint parental PPD was increased in case of insufficient informal support (insufficient partner support: odds ratio (OR) = 1.68 (95% confidence interval (CI): 1.57–1.80); frequent quarrels: OR = 1.38 (95% CI: 1.19–1.60)). We also observed associations between formal support during pregnancy and joint parental PPD (early prenatal psychosocial risk assessment: OR = 1.13 (95% CI: 1.05–1.22); antenatal education: OR = 1.13 (95% CI: 1.05–1.23)), which disappeared when analyses were restricted to women with no psychological difficulties during pregnancy. Conclusion: Insufficient informal social support during pregnancy appears to predict risk of joint PPD in mothers and fathers and should be identified early on to limit complications and the impact on children.

scholarly journals ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR)—difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors

2021 ◽  
pp. bmjspcare-2021-003151
Author(s):  
Jane Walker ◽  
Katy Burke ◽  
Nicholas Magill ◽  
Maike van Niekerk ◽  
Marta Wanat ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Teaching Hospital ◽  
Training Needs ◽  
Specific Training ◽  
Time And Space ◽  
Professional Characteristics ◽  
Medical Inpatients ◽  
Older Inpatients ◽  
Hospital Doctors ◽  
Medical Wards

ObjectivesTo determine, for doctors looking after older medical inpatients: (1) how difficult they find discussions about ‘do not attempt cardiopulmonary resuscitation’ (DNACPR); (2) whether difficulty is associated with doctors’ personal and professional characteristics; (3) how frequently DNACPR discussions are made more difficult by practical issues and by doctors’ uncertainties.MethodsSurvey of hospital doctors working on the acute medical wards of a UK NHS teaching hospital.Results171/200 (86%) of eligible doctors participated. 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in our analysis. ‘Difficulty’ (defined as finding discussions ‘fairly difficult’ or ‘difficult’) was experienced by 52/165 (32%) for discussions with patients and 60/165 (36%) for discussions with families. Doctors with specific training in DNACPR discussions were less likely to have difficulty in discussions with patients. Older, more experienced doctors were less likely to have difficulty in discussions with families. Lack of time and place, and uncertainty about prognosis were the most frequently reported causes of difficulty.ConclusionsMany doctors have difficulty in DNACPR discussions. Training needs to include managing discussions with families, as well as with patients, and doctors need time and space to deliver this important part of their job.

Movement Societies and Digital Protest: Fan Activism and Other Nonpolitical Protest Online

2009 ◽  
Vol 27 (3) ◽  
pp. 220-243 ◽  
Author(s):  
Jennifer Earl ◽  
Katrina Kimport
Keyword(s):  
Social Movements ◽  
New Media ◽  
Social Movement ◽  
The Internet ◽  
Internet Studies ◽  
Random Samples ◽  
Use Of The Internet ◽  
Using Data ◽  
Made In

Sociologists of culture studying “fan activism” have noted an apparent increase in its volume, which they attribute to the growing use of the Internet to register fan claims. However, scholars have yet to measure the extent of contemporary fan activism, account for why fan discontent has been expressed through protest, or precisely specify the role of the Internet in this expansion. We argue that these questions can be addressed by drawing on a growing body of work by social movement scholars on “movement societies,” and more particularly on a nascent thread of this approach we develop that theorizes the appropriation of protest practices for causes outside the purview of traditional social movements. Theorizing that the Internet, as a new media, is positioned to accelerate the diffusion of protest practices, we develop and test hypotheses about the use of movement practices for fan activism and other nonpolitical claims online using data on claims made in quasi-random samples of online petitions, boycotts, and e-mailing or letter-writing campaigns. Results are supportive of our hypotheses, showing that diverse claims are being pursued online, including culturally-oriented and consumer-based claims that look very different from traditional social movement claims. Findings have implications for students of social movements, sociologists of culture, and Internet studies.

Relevance of immobility as a risk factor for symptomatic proximal and isolated distal deep vein thrombosis in acutely ill medical inpatients

2021 ◽  
pp. 1358863X2199682
Author(s):  
Michelangelo Sartori ◽  
Elisabetta Favaretto ◽  
Benilde Cosmi
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Bed Rest ◽  
Surgical Patients ◽  
Vein Thrombosis ◽  
Medical Inpatients ◽  
Medical Wards ◽  
Deep Vein

Immobility is a well-recognized risk factor for deep vein thrombosis (DVT) in surgical patients, whereas the level of DVT risk conferred by immobility is less defined in patients on medical wards. The aim of this study was to establish whether immobility and its duration are associated with the risk of DVT in acutely ill medical inpatients. We conducted a cohort study in acutely ill medical inpatients. Patients underwent whole leg ultrasound for suspected lower extremity DVT and were divided into two groups according to presence or absence of immobility, defined as total bed rest or sedentary without bathroom privileges. The endpoint was the detection of proximal DVT or isolated distal DVT (IDDVT). Among the 252 acutely ill medical inpatients with immobility (age 82.6 ± 10.3 years, female 63.9%), ultrasound showed 36 (14.3%) proximal DVTs and 39 (15.5%) IDDVTs, while there were 11 (4.4%) proximal DVTs and 26 (10.5%) IDDVTs among the 248 inpatients without immobility (age 73.6 ± 14.2 years, female 54.8%). The risk of proximal DVT was higher in immobile than in mobile patients (OR 3.59, 95% CI: 1.78–7.23, p = 0.0001), whereas the risk of IDDVT was similar between the two groups (OR 1.56, 95% CI: 0.92–2.66, p = 0.111). During the first 3 days of hospitalization, the frequency of all DVTs was similar in patients with and without immobility, but it was 0.26 ± 0.03 vs 0.18 ± 0.03, respectively, after 4 days. In conclusion, immobility for more than 3 days is a risk factor for proximal DVT in acutely ill medical inpatients.

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