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40
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.4065/80.2.166" target="_blank" rel="noreferrer">http://doi.org/10.4065/80.2.166</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Resource utilization and outcome in gravely ill intensive care unit patients with predicted in-hospital mortality rates of 95% or higher by APACHE III scores: the relationship with physician and family expectations
Publisher
An entity responsible for making the resource available
Mayo Clinic Proceedings
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Female; Humans; Male; Cohort Studies; Adult; Hospital Mortality; Aged; Middle Aged; Professional-Family Relations; Minnesota; Outcome Assessment (Health Care); Intensive Care; Medical Records; adolescent; 80 and over; Family/psychology; APACHE; Physicians/psychology; Health Resources/utilization; Critical Illness/mortality/therapy
Creator
An entity primarily responsible for making the resource
Berge KH; Maiers DR; Schreiner DP; Jewell SM; Bechtle PS; Schroeder DR; Stevens SR; Lanier WL
Description
An account of the resource
OBJECTIVE: To assess resource utilization and outcome in gravely ill patients admitted to an intensive care unit (ICU) and the potential association with health care workers' and family members' expectations. PATIENTS AND METHODS: We retrospectively evaluated ICU patients with a predicted in-hospital mortality rate of 95% or higher (PM95) using the Acute Physiology and Chronic Health Evaluation III (APACHE III) on 2 consecutive days. All patients were admitted to a single institution between September 30, 1994, and August 9, 2001. RESULTS: The APACHE III database contained data from 38,165 ICU patients during the study interval. Of these, 248 (0.65% of ICU admissions) achieved PM95 status and were included in the study. Between PM95 and hospital discharge, resource utilization (eg, blood transfusion, hemodialysis, surgery, and computed tomography or magnetic resonance imaging) was extensive. A total of 23% of patients survived to hospital discharge, yet all but 1 were moderately or severely disabled. One year after achieving PM95, 10% (95% confidence interval, 7%-15%) of patients were alive. For 229 patients, the medical records contained physician documentation that indicated a likely fatal outcome. Thirty-six of these medical records documented unrealistic family expectations of a good outcome. The latter finding correlated with increased resource utilization without significant improvement in 1-year survival. In contrast, absence of physician documentation of a likely fatal outcome In 19 patients correlated with an improved likelihood of hospital (74%) and 1-year (47%) survival. CONCLUSION: Despite better-than-predicted survival outcomes, patient functionality and 1-year survival were poor. Unrealistic family expectations were associated with increased resource utilization without significant survival benefit, whereas absence of physician documentation of likely impending death (which correlated with improved survival) may denote the prognostication skills of experienced clinicians.
2005
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.4065/80.2.166" target="_blank" rel="noreferrer">10.4065/80.2.166</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2005
80 And Over
Adolescent
Adult
Aged
APACHE
Backlog
Bechtle PS
Berge KH
Cohort Studies
Critical Illness/mortality/therapy
Family/psychology
Female
Health Resources/utilization
Hospital Mortality
Humans
Intensive Care
Jewell SM
Journal Article
Lanier WL
Maiers DR
Male
Mayo Clinic Proceedings
Medical Records
Middle Aged
Minnesota
Outcome Assessment (health Care)
Physicians/psychology
Professional-family Relations
Schreiner DP
Schroeder DR
Stevens SR
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1007/s00134-003-1989-3" target="_blank" rel="noreferrer">http://doi.org/10.1007/s00134-003-1989-3</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death
Publisher
An entity responsible for making the resource available
Intensive Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2003
Subject
The topic of the resource
Female; Humans; Male; Hospital Mortality; Prospective Studies; Aged; Middle Aged; Comorbidity; Resuscitation Orders; Severity of Illness Index; Survival Analysis; Risk Factors; Hospitals; Analysis of Variance; Predictive Value of Tests; Proportional Hazards Models; Teaching; 80 and over; Empirical Approach; Death and Euthanasia; decision making; ICU Decision Making; Intensive Care Units/statistics & numerical data; APACHE; Critical Care/statistics & numerical data; Life Support Care/statistics & numerical data; Paris/epidemiology; Withholding Treatment/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Azoulay E; Pochard F; Garrouste-Orgeas M; Moreau D; Montesino L; Adrie C; deLassence A; Cohen Y; Timsit JF; Outcomerea Study Group
Description
An account of the resource
OBJECTIVE: More than one-half the deaths of patients admitted to intensive care units (ICUs) occur after a decision to forgo life-sustaining therapy (DFLST). Although DFLSTs typically occur in patients with severe comorbidities and intractable acute medical disorders, other factors may influence the likelihood of DFLSTs. The objectives of this study were to describe the factors and mortality associated with DFLSTs and to evaluate the potential independent impact of DFLSTs on hospital mortality. DESIGN AND SETTING: Prospective multicenter 2-year study in six ICUs in France. PATIENTS: The 1,698 patients admitted to the participating ICUs during the study period, including 295 (17.4%) with DFLSTs. MEASUREMENTS AND RESULTS: The impact of DFLSTs on hospital mortality was evaluated using a model that incorporates changes in daily logistic organ dysfunction scores during the first ICU week. Univariate predictors of death included demographic factors (age, gender), comorbidities, reasons for ICU admission, severity scores at ICU admission, and DFLSTs. In a stepwise Cox model five variables independently predicted mortality: good chronic health status (hazard ratio, 0.479), SAPS II score higher than 39 (2.05), chronic liver disease (1.463), daily logistic organ dysfunction score (1.357 per point), and DFLSTs (1.887). CONCLUSIONS: DFLSTs remain independently associated with death after adjusting on comorbidities and severity at ICU admission and within the first ICU week. This highlights the need for further clarifying the many determinants of DFLSTs and for routinely collecting DFLSTs in studies with survival as the outcome variable of interest.
2003
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1007/s00134-003-1989-3" target="_blank" rel="noreferrer">10.1007/s00134-003-1989-3</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2003
80 And Over
Adrie C
Aged
Analysis of Variance
APACHE
Azoulay E
Backlog
Cohen Y
Comorbidity
Critical Care/statistics & numerical data
Death and Euthanasia
Decision Making
deLassence A
Empirical Approach
Female
Garrouste-Orgeas M
Hospital Mortality
Hospitals
Humans
ICU Decision Making
Intensive Care Medicine
Intensive Care Units/statistics & numerical data
Journal Article
Life Support Care/statistics & numerical data
Male
Middle Aged
Montesino L
Moreau D
Outcomerea Study Group
Paris/epidemiology
Pochard F
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Resuscitation Orders
Risk Factors
Severity Of Illness Index
Survival Analysis
Teaching
Timsit JF
Withholding Treatment/statistics & Numerical Data
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1097/01.ccm.0000126402.51524.52" target="_blank" rel="noreferrer">http://doi.org/10.1097/01.ccm.0000126402.51524.52</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Clinician predictions of intensive care unit mortality
Publisher
An entity responsible for making the resource available
Critical Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2004
Subject
The topic of the resource
Female; Humans; Male; Medical Staff; Hospital Mortality; Prognosis; Prospective Studies; Middle Aged; Respiration; Severity of Illness Index; Survival Analysis; Risk Factors; Predictive Value of Tests; Chi-Square Distribution; Proportional Hazards Models; Nursing Staff; Artificial; Intensive Care Units/statistics & numerical data; APACHE; Nursing Assessment/standards; Likelihood Functions; Clinical Competence/standards; Critical Illness/mortality/therapy; Hospital/standards; Multiple Organ Failure/classification/mortality
Creator
An entity primarily responsible for making the resource
Rocker G; Cook D; Sjokvist P; Weaver B; Finfer S; McDonald E; Marshall J; Kirby A; Levy M; Dodek P; Heyland D; Guyatt G; Level of Care Study Investigators; Canadian Critical Care Trials Group
Description
An account of the resource
OBJECTIVE: Predicting outcomes for critically ill patients is an important aspect of discussions with families in the intensive care unit. Our objective was to evaluate clinical intensive care unit survival predictions and their consequences for mechanically ventilated patients. DESIGN: Prospective cohort study. SETTING: Fifteen tertiary care centers. PATIENTS: Consecutive mechanically ventilated patients > or = 18 yrs of age with expected intensive care unit stay > or = 72 hrs. INTERVENTIONS: We recorded baseline characteristics at intensive care unit admission. Daily we measured multiple organ dysfunction score (MODS), use of advanced life support, patient preferences for life support, and intensivist and bedside intensive care unit nurse estimated probability of intensive care unit survival. MEASUREMENTS AND MAIN RESULTS: The 851 patients were aged 61.2 (+/- 17.6, mean + SD) yrs with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 21.7 (+/- 8.6). Three hundred and four patients (35.7%) died in the intensive care unit, and 341 (40.1%) were assessed by a physician at least once to have a < 10% intensive care unit survival probability. Independent predictors of intensive care unit mortality were baseline APACHE II score (hazard ratio, 1.16; 95% confidence interval, 1.08-1.24, for a 5-point increase) and daily factors such as MODS (hazard ratio, 2.50; 95% confidence interval, 2.06-3.04, for a 5-point increase), use of inotropes or vasopressors (hazard ratio, 2.14; 95% confidence interval, 1.66-2.77), dialysis (hazard ratio, 0.51; 95% confidence interval, 0.35-0.75), patient preference to limit life support (hazard ratio, 10.22; 95% confidence interval, 7.38-14.16), and physician but not nurse prediction of < 10% survival. The impact of physician estimates of < 10% intensive care unit survival was greater for patients without vs. those with preferences to limit life support (p < .001) and for patients with less vs. more severe organ dysfunction (p < .001). Mechanical ventilation, inotropes or vasopressors, and dialysis were withdrawn more often when physicians predicted < 10% probability of intensive care unit survival (all ps < .001). CONCLUSIONS: Physician estimates of intensive care unit survival < 10% are associated with subsequent life support limitation and more powerfully predict intensive care unit mortality than illness severity, evolving or resolving organ dysfunction, and use of inotropes or vasopressors.
2004
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1097/01.ccm.0000126402.51524.52" target="_blank" rel="noreferrer">10.1097/01.ccm.0000126402.51524.52</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2004
APACHE
Artificial
Backlog
Canadian Critical Care Trials Group
Chi-Square Distribution
Clinical Competence/standards
Cook D
Critical Care Medicine
Critical Illness/mortality/therapy
Dodek P
Female
Finfer S
Guyatt G
Heyland D
Hospital Mortality
Hospital/standards
Humans
Intensive Care Units/statistics & numerical data
Journal Article
Kirby A
Level of Care Study Investigators
Levy M
Likelihood Functions
Male
Marshall J
McDonald E
Medical Staff
Middle Aged
Multiple Organ Failure/classification/mortality
Nursing Assessment/standards
Nursing Staff
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Respiration
Risk Factors
Rocker G
Severity Of Illness Index
Sjokvist P
Survival Analysis
Weaver B
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1017/s1478951511000423" target="_blank" rel="noreferrer">http://doi.org/10.1017/s1478951511000423</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients.
Publisher
An entity responsible for making the resource available
Palliative & Supportive Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Subject
The topic of the resource
Female; Humans; Male; Medical Futility; Aged; referral and consultation; Costs and Cost Analysis; retrospective studies; DNAR; Resuscitation Orders; Palliative Care; DNAR Outcomes; APACHE; Hospital Mortality/td [Trends]; Intensive Care Units/statistics & numerical data; Length of Stay/sn [Statistics & Numerical Data]; Acute physiology and chronic health evaluation; Do not resuscitate; Length of Stay/td [Trends]; Medical intensive care; Palliative medicine consultation
Creator
An entity primarily responsible for making the resource
Lustbader DR; Pekmezaris R; Frankenthaler M; Walia R; Smith F; Hussain E; Napolitano B; Lesser M
Description
An account of the resource
OBJECTIVE: The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization., METHOD: A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study., RESULTS: Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, chi2 test, p < 0.0001)., SIGNIFICANCE OF RESULTS: Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1017/s1478951511000423" target="_blank" rel="noreferrer">10.1017/s1478951511000423</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2011
Acute physiology and chronic health evaluation
Aged
APACHE
Backlog
Costs And Cost Analysis
DNAR
DNAR Outcomes
Do Not Resuscitate
Female
Frankenthaler M
Hospital Mortality/td [Trends]
Humans
Hussain E
Intensive Care Units/statistics & numerical data
Journal Article
Length of Stay/sn [Statistics & Numerical Data]
Length of Stay/td [Trends]
Lesser M
Lustbader DR
Male
Medical Futility
Medical intensive care
Napolitano B
Palliative & Supportive Care
Palliative Care
Palliative medicine consultation
Pekmezaris R
Referral And Consultation
Resuscitation Orders
Retrospective Studies
Smith F
Walia R