Abstract P399: Do Not Resuscitate Orders in Subarachnoid Hemorrhage Patients. Impact on Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
The Self ◽  
Racial Groups ◽  
Do Not Resuscitate ◽  
Code Status ◽  
International Classification Of Disease ◽  
Discharge Outcomes ◽  
Racial Ethnic ◽  
Dnr Orders

Introduction/background: Do not resuscitate (DNR) orders have been associated with higher mortality in hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all subarachnoid hemorrhage (ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups. Results: Of the 325923 patients with SAH, 20127 (6.17%%) had DNR order. SAH patients with DNR order had higher proportion of females (61.7% versus 59.4%, P=0.0048) and were older (70.9 years versus 58.4 years, P <.0001) compared to SAH patients without DNR. The in-hospital mortality was also higher (66.4% versus 22.4%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 5.05 (4.58 -5.56), p<.0001) after adjusting for potential confounders. Whites have a higher rate (7.59% versus 5.84%, P <.0001) of DNR order as compared to other racial/ethnic groups Conclusions: While there may be other explanations at play, the higher mortality and shorter LOS suggest that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.

Abstract P454: Do Not Resuscitate Orders in Intracerebral Hemorrhage Patients. Impact on Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf A Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
The Self ◽  
Racial Groups ◽  
Do Not Resuscitate ◽  
Code Status ◽  
International Classification Of Disease ◽  
Discharge Outcomes ◽  
Racial Ethnic ◽  
Dnr Orders

Introduction/background: Do not resuscitate (DNR) orders have been associated with higher mortality in hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups. Results: Of the 884379 patients with ICH, 81968 (9.26%%) had DNR order. ICH patients with DNR order had higher proportion of females (55.1% versus 49.1%, P <.0001) and were older (74.2 years versus 66 years, P <.0001) compared to ICH patients without DNR. The in-hospital mortality was also higher (53.4% versus 23.3%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 3.24 (3.07 -3.41), p<.0001) after adjusting for potential confounders. Whites have a higher rate (11.5% versus 8.08%) of DNR order as compared to other racial/ethnic groups Conclusions: While there may be other explanations at play, the higher mortality and shorter LOS suggest that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.

Clinician Perspectives on Challenges to Patient Centered Care at the End of Life

2016 ◽  
Vol 36 (4) ◽  
pp. 401-415 ◽  
Author(s):  
Shoshana H. Bardach ◽  
Edward J. Dunn ◽  
J. Christopher Stein
Keyword(s):  
End Of Life ◽  
Medical Center ◽  
Local Policy ◽  
Do Not Resuscitate ◽  
Patient Centered ◽  
Code Status ◽  
Respiratory Therapists ◽  
Centered Care ◽  
Preventive Ethics ◽  
Dnr Orders

Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients’ end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients’ preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients’ end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

“Allow natural death” versus “Do not resuscitate”: What do patients with advanced cancer choose?

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 89-89
Author(s):  
Milos Miljkovic ◽  
Dennis Omoding Emuron ◽  
Lori Rhodes ◽  
Joseph Abraham ◽  
Kenneth David Miller
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Cancer Education ◽  
Living Will ◽  
Tube Placement ◽  
Similar Proportion ◽  
Do Not Resuscitate ◽  
Natural Death ◽  
Code Status ◽  
Dnr Orders

89 Background: Many patients with advanced cancer at our hospital request full resuscitative efforts at the end of life. In the first in a series of quality improvement projects to improve end-of-life (EOL) care, we assessed the knowledge and attitudes of patients towards it to determine if “Allow Natural Death” (AND) orders were more acceptable than “Do Not Resuscitate” (DNR) orders. Methods: Adult patients with advanced cancer being treated at a single community hospital were invited to participate. The first 100 consenting patients were surveyed regarding their diagnosis, prognosis, and attitudes about critical care and resuscitation. They were then presented with hypothetical scenarios in which a decision on their code status had to be made if they had 1 year, 6 months or 1 month left to live. Fifty patients were given a choice between being “full code“ and “DNR”, and 50 could choose between ”full code" and “AND”. Results: Participants were equally likely to choose either of the “no code” options in all hypothetical scenarios (p > 0.54). The choice was not affected by age, sex, race, type of cancer, education, or income level. Patients who said they would want life-prolonging measures such as CPR, tracheostomies, and feeding tube placement in case of a permanent vegetative state were significantly less likely to choose “AND” than “full code” (p=0.001–0.002). A similar proportion of patients who had a living will chose “AND” and “DNR” orders instead of “full code” in all the scenarios (47–74% and 63–71%). In contrast, among patients who did not have a living will 52% chose “DNR”, while 19% opted for “AND”. More than a third (39 of 93) patients were not aware their illness was terminal. Conclusions: We hypothesized that “AND” orders may be more acceptable to patients with advanced cancer, but the wording of the “no code” order does not seem to be related to the patients’ code status decisions. The “Do not resuscitate” phrasing may be more acceptable to patients who view life-prolonging measures favorably.

scholarly journals Assessing the Utility and Accuracy of ICD10-CM Nontraumatic Subarachnoid Hemorrhage Codes for Intracranial Aneurysm Research

2020 ◽  
Author(s):  
Christopher Roark ◽  
Melissa P. Wilson ◽  
Sheila Kubes ◽  
David Mayer ◽  
Laura K. Wiley
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
International Classification ◽  
Intracranial Artery ◽  
Patient History ◽  
Unruptured Intracranial Aneurysm ◽  
International Classification Of Disease ◽  
History Of

ABSTRACTBackgroundThe 10th revision of International Classification of Disease, Clinical Modification (ICD10-CM) increased the number of codes to identify nontraumatic subarachnoid hemorrhage from one to twenty-two. ICD10-CM codes are able to specify the location of aneurysms causing subarachnoid hemorrhage (aSAH), however it is not clear how frequently or accurately these codes are being used in practice.ObjectiveTo systematically evaluate the usage and accuracy of location-specific ICD10-CM codes for aSAH.MethodsWe extracted all uses of ICD10-CM codes for nontraumatic subarachnoid hemorrhage (I60.x) during the first three years following the implementation of ICD10-CM from the billing module of the EHR for UCHealth. For those codes that specified aSAH location (I60.0-I60.6), EHR documentation was reviewed to determine whether there was an active aSAH, any patient history of aSAH, or unruptured intracranial aneurysm/s and the locations of those outcomes.ResultsBetween October 1, 2015 – September 30, 2018, there were 3,119 instances of nontraumatic subarachnoid hemorrhage ICD10-CM codes (I60.00-I60.9), of which 297 (9.5%) code instances identified aSAH location (I60.0-I60.6). These codes accurately identified current aSAH (64%), any patient history of aSAH (84%), and any patient history of intracranial aneurysm (87%). The accuracy of identified outcome location was 53% in current aSAH, 72% for any history of aSAH, and 76% for any history of an intracranial artery.ConclusionsResearchers should use ICD10-CM codes with caution when attempting to detect active aSAH and/or aneurysm location.

Differential Trends in Racial Preferences for Cosmetic Surgery Procedures

2011 ◽  
Vol 77 (8) ◽  
pp. 1081-1085 ◽  
Author(s):  
Tahira I. Prendergast ◽  
Sharon K. Ong'Uti ◽  
Gezzer Ortega ◽  
Amal L. Khoury ◽  
Ekene Onwuka ◽  
...  
Keyword(s):  
Native American ◽  
Cosmetic Surgery ◽  
Cosmetic Procedure ◽  
International Classification Of Disease ◽  
Racial Preferences ◽  
Modification Procedure ◽  
Procedure Codes ◽  
Racial Ethnic ◽  
Zip Code

There appears to be an increasing acceptance of cosmetic surgery procedures among minority populations in America. Our objective was to determine trends in elective cosmetic procedure utilization as they apply to racial/ethnic differences. A retrospective analysis was performed using the Nationwide Inpatient Sample. Adult patients undergoing elective cosmetic procedures defined by the appropriate International Classification of Disease 9 Clinical Modification procedure codes were included. Demographic characteristics and hospital course particulars were evaluated. There were 71,775 patients meeting the inclusion criteria. Median age was 48 years. The majority were female (90%), and white (65%). The median household income for the patient's zip code was most commonly in the highest economic quartile (4th quartile, 40%). The most common cosmetic procedure was liposuction (67%). The overall mean percentage change in the frequency of these procedures showed a 1.8 per cent decline among white patients, whereas Black, Hispanic, Asian, and Native American patients had an increase of 7.5 per cent, 4.7 per cent, 14.5 per cent, and 105.5 per cent, respectively. We conclude that there is an identified increasing trend in the proportion of racial/ethnic minorities represented among the recipients of cosmetic surgery procedures.

Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Hospital Charges ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Discharge Outcomes ◽  
Baseline Characteristics

Introduction/background: Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI Conclusions: While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.

Estimates of Ten Multiple Intelligences

2002 ◽  
Vol 7 (4) ◽  
pp. 245-255 ◽  
Author(s):  
Adrian Furnham ◽  
Thomas Li-Ping Tang ◽  
David Lester ◽  
Rory O'Connor ◽  
Robert Montgomery
Keyword(s):  
Multiple Intelligences ◽  
Male Partner ◽  
Bill Clinton ◽  
The Self ◽  
Tony Blair ◽  
Female Partners ◽  
American Students ◽  
Bill Gates ◽  
Nationality Differences

A total of 253 British and 318 American students were asked to make various estimates of overall intelligence as well as Gardner's (1999a) new list of 10 multiple intelligences. They made these estimations (11 in all) for themselves, their partner, and for various well-known figures such as Prince Charles, Tony Blair, Bill Gates, and Bill Clinton. Following previous research there were various sex and nationality differences in self-estimated IQ: Males rated themselves higher on verbal, logical, spatial, and spiritual IQ compared to females. Females rated their male partner as having lower verbal and spiritual, but higher spatial IQ than was the case when males rated their female partners. Participants considered Bill Clinton (2 points) and Prince Charles (5 points) less intelligent than themselves, but Tony Blair (5 points) and Bill Gates (15 points) more intelligent than themselves. Multiple regressions indicated that the best predictors of one's overall IQ estimates were logical, verbal, existential, and spatial IQ. Factor analysis of the 10 and then 8 self-estimated scores did not confirm Gardner's classification of multiple intelligences. Results are discussed in terms of the growing literature in the self-estimates of intelligence, as well as limitations of that approach.

Future Directions

2020 ◽  
pp. 476-479
Author(s):  
Marc N. Potenza ◽  
Kyle A. Faust ◽  
David Faust
Keyword(s):  
Technology Development ◽  
Digital Technologies ◽  
World Health ◽  
International Classification Of Disease ◽  
Levels Of Use ◽  
Pornography Use ◽  
Negative Impacts ◽  
Mental Health Treatments ◽  
The Many

As digital technology development continues to expand, both its positive and negative applications have also grown. As such, it is essential to continue gathering data on the many types of digital technologies, their overall effects, and their impact on public health. The World Health Organization’s inclusion of Gaming Disorder in the eleventh edition of the International Classification of Disease (ICD-11) indicates that some of the problematic effects of gaming are similar to those of substance-use disorders and gambling. Certain behaviors easily engaged in via the internet may also lead to compulsive levels of use in certain users, such as shopping or pornography use. In contrast, digital technologies can also lead to improvements in and wider accessibility to mental health treatments. Furthermore, various types of digital technologies can also lead to benefits such as increased productivity or social functioning. By more effectively understanding the impacts of all types of digital technologies, we can aim to maximize their benefits while minimizing or preventing their negative impacts.

Orders Not to Resuscitate: The Sharon Siebert Case

1981 ◽  
Vol 2 (5) ◽  
pp. 3-7
Author(s):  
George J. Annas
Keyword(s):  
Do Not Resuscitate ◽  
Lower Court ◽  
Legal Standard ◽  
Dnr Orders

In a previous column I discussed the testimony of a number of nurses in the case of Ms. Sharon Siebert. That case was decided by a lower court on February 13, 1981, and this column discusses Judge Lindsay G. Arthur's opinion. Jane Hoyt, a friend, not a relative, of Ms. Siebert, brought suit to enjoin an order not to resuscitate that had been written on Ms. Siebert. The case raised a number of important issues, including whether the court would allow a suit brought by someone in Ms. Hoyt's position vis-à-vis the patient, and if it did, what legal standard the court might require in the writing of Do Not Resuscitate (DNR) orders.

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