1
40
27
-
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.
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URL Address
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216313484379</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
Impact of a palliative care initiative on end-of-life care in the general wards: A before-and-after study._
Publisher
An entity responsible for making the resource available
Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Subject
The topic of the resource
Female; Humans; Male; retrospective studies; Palliative Care; Logistic Models; Aged; Comorbidity; cardiopulmonary resuscitation; Program Evaluation; Social Class; retrospective studies; DNAR; cardiopulmonary resuscitation; Resuscitation Orders; Chronic Disease/therapy; Palliative Care; DNAR Outcomes; Life Support Care/statistics & numerical data; Withholding Treatment/statistics & numerical data; Chronic Disease/epidemiology; Patient Admission/statistics & numerical data; Palliative Care; Hospital Mortality/trends; Advance Care Planning/st [Standards]; Forms and Records Control; Life Support Care/mt [Methods]; Advance Care Planning/standards; Asian; Chronic Disease/ep [Epidemiology]; Chronic Disease/th [Therapy]; Clinical Audit; Do-not-resuscitate orders; Forms and Records Control; general wards; Hospital Mortality/td [Trends]; Life Support Care/methods; Life Support Care/sn [Statistics & Numerical Data]; Patient Admission/statistics & numerical data; Patient Admission/td [Trends]; Patient Admission/trends; Resuscitation Orders; Singapore/ep [Epidemiology]; Singapore/epidemiology; Withholding Treatment/sn [Statistics & Numerical Data]
Creator
An entity primarily responsible for making the resource
Tan A; Seah A; Chua G; Lim Tow K; Phua J
Description
An account of the resource
BACKGROUND: Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions., AIM: A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010., DESIGN: Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families., SETTINGS/PARTICIPANTS: This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714)., RESULTS: There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation., CONCLUSIONS: A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
2014
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">10.1177/0269216313484379</a>
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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
2014
Advance Care Planning/st [Standards]
Advance Care Planning/standards
Aged
Asian
Backlog
Cardiopulmonary Resuscitation
Chronic Disease/ep [Epidemiology]
Chronic Disease/epidemiology
Chronic Disease/th [Therapy]
Chronic Disease/therapy
Chua G
Clinical Audit
Comorbidity
DNAR
DNAR Outcomes
Do-not-resuscitate Orders
Female
Forms and Records Control
general wards
Hospital Mortality/td [Trends]
Hospital Mortality/trends
Humans
Journal Article
Life Support Care/methods
Life Support Care/mt [Methods]
Life Support Care/sn [Statistics & Numerical Data]
Life Support Care/statistics & numerical data
Lim Tow K
Logistic Models
Male
Palliative Care
Palliative Medicine
Patient Admission/statistics & numerical data
Patient Admission/td [Trends]
Patient Admission/trends
Phua J
Program Evaluation
Resuscitation Orders
Retrospective Studies
Seah A
Singapore/ep [Epidemiology]
Singapore/epidemiology
Social Class
Tan A
Withholding Treatment/sn [statistics & Numerical Data]
Withholding Treatment/statistics & Numerical Data
-
Text
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URL Address
<a href="http://doi.org/10.1177/0269216314552091" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216314552091</a>
<a href="http://pmj.sagepub.com/content/early/2014/11/08/0269216314552091.full" target="_blank" rel="noreferrer">http://pmj.sagepub.com/content/early/2014/11/08/0269216314552091.full</a>
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Title
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Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study
Publisher
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Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Lotz JD; Jox RJ; Borasio GD; Führer M
Identifier
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<a href="http://doi.org/10.1177/0269216314552091" target="_blank" rel="noreferrer">10.1177/0269216314552091</a>
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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
Description
An account of the resource
2014-11
2014
Backlog
Borasio GD
DNAR Outcomes
Führer M
Journal Article
Jox RJ
Lotz JD
Palliative Medicine
-
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.
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URL Address
<a href="http://doi.org/10.1001/jamasurg.2013.677" target="_blank" rel="noreferrer">http://doi.org/10.1001/jamasurg.2013.677</a>
<a href="http://dx.doi.org/10.1001/jamasurg.2013.677" target="_blank" rel="noreferrer">http://dx.doi.org/10.1001/jamasurg.2013.677</a>
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Title
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EXpectations and outcomes in geriatric patients with do-not-resuscitate orders undergoing emergency surgical management of bowel obstruction
Publisher
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Jama Surgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Speicher PJ; Lagoo-Deenadayalan SA; Galanos AN; Pappas TN; Scarborough JE
Description
An account of the resource
Objective To describe the outcomes and the expected postoperative course for patients with do-not-resuscitate (DNR) orders (DNR patients) who undergo emergency surgical management of bowel obstruction.Design We retrospectively identified all patients who underwent emergency surgical management of intestinal obstruction and who were classified previously as DNR using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Participant Use Data File for 2005 through 2009. We constructed a forward stepwise multivariate logistic regression model to determine predictors of postoperative mortality. We used propensity score analysis to determine the effect of DNR status on postoperative outcomes.Setting Institutions participating in the NSQIP.Patients All patients entered in the NSQIP database.Main Outcome Measures Thirty-day postoperative mortality and complication rates.Results We identified 242 patients who met the study criteria. Mean age was 80.9 years. Thirty-day mortality was 29.8%, with 47.1% of patients experiencing a postoperative complication. The presence of a postoperative complication was an independent predictor of postoperative mortality. Comparison of matched cohorts revealed a significantly higher postoperative mortality in DNR patients even after adjusting for comorbidities and overall complication rate.Conclusions Outcomes are poor after emergency surgical intervention for bowel obstruction in elderly DNR patients, with high postoperative complication and mortality rates. The presence of a DNR order is an independent risk factor for postoperative mortality. Patients, their families, and their physicians must be counseled on surgical expectations preoperatively and made aware of the significantly higher risks involved when a DNR order exists in the setting of emergency surgical management of bowel obstruction.
2013-01
Identifier
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<a href="http://doi.org/10.1001/jamasurg.2013.677" target="_blank" rel="noreferrer">10.1001/jamasurg.2013.677</a>
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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
2013
Backlog
DNAR Outcomes
Galanos AN
Jama Surgery
Journal Article
Lagoo-Deenadayalan SA
Pappas TN
Scarborough JE
Speicher PJ
-
Text
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Citation List Month
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URL Address
<a href="http://doi.org/10.1017/S1478951512000259" target="_blank" rel="noreferrer">http://doi.org/10.1017/S1478951512000259</a>
<a href="http://journals.cambridge.org/article_S1478951512000259" target="_blank" rel="noreferrer">http://journals.cambridge.org/article_S1478951512000259</a>
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Title
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Relationships among advance directives, principal diagnoses, and discharge outcomes in critically ill older adults
Publisher
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Palliative & Supportive Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Yoo Ji W; Nakagawa S; Kim S
Description
An account of the resource
Objective: The purpose of this study was to determine the relationships among advance directive status, principal diagnoses, and the discharge outcomes in community-dwelling, critically ill older adults. Method: Using administrative and clinical data (n = 1673), multinomial logit regressions were used to examine the relationships among advance directive status, principal diagnoses, and discharge outcomes (in-hospital deaths, hospice discharges, and transition to institutions). Results: In the overall sample, the adjusted probability of in-hospital deaths with advance directives (12%) was lower than that without advance directives (17%; odds ratio [OR] = 0.56; p = 0.007) and the adjusted probability of hospice discharges with advance directives (11%) was higher than that without advance directives (7%; OR = 1.96; p = 0.03). Subgroup analysis showed that the magnitude of the abovementioned changes was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of the abovementioned findings was diminished with other principal diagnoses. On the other hand, the presence of advance directives did not make a contribution to transition from communities to institutions. Significance of results: Significantly fewer in-hospital deaths in addition to higher hospice discharges were observed with any advance directives in community-dwelling, critically ill older adults. The magnitude of these findings was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of these findings was diminished with other principal diagnoses.
2013-08
Identifier
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<a href="http://doi.org/10.1017/S1478951512000259" target="_blank" rel="noreferrer">10.1017/S1478951512000259</a>
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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
2013
Backlog
DNAR Outcomes
Journal Article
Kim S
Nakagawa S
Palliative & Supportive Care
Yoo Ji W
-
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
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URL Address
<a href="http://doi.org/10.1016/j.resuscitation.2012.08.327" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.resuscitation.2012.08.327</a>
<a href="http://www.sciencedirect.com/science/article/pii/S0300957212007502" target="_blank" rel="noreferrer">http://www.sciencedirect.com/science/article/pii/S0300957212007502</a>
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Title
A name given to the resource
The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest
Publisher
An entity responsible for making the resource available
Resuscitation
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Subject
The topic of the resource
end of life; Ethics; DNAR Outcomes; Do not resuscitate; Cardiac arrest
Creator
An entity primarily responsible for making the resource
Richardson DK; Zive D; Daya M; Newgard CD
Description
An account of the resource
Objectives Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24 h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. Methods We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95% confidence intervals. Results Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5%) had a DNR order placed in the first 24 h after admission. These patients had decreased frequency of cardiac catheterization (1.1% vs. 4.3%), blood transfusion (7.6% vs. 11.2%), ICD placement (0.1% vs. 1.1%), and survival to discharge (5.2% vs. 21.6%, all p-values < 0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95% CI 0.48–0.95; Black, OR 0.49, 95% CI 0.35–0.69). Conclusions Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24 h may be premature given the lack of early prognostic indicators after OHCA.
2013-04
Identifier
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<a href="http://doi.org/10.1016/j.resuscitation.2012.08.327" target="_blank" rel="noreferrer">10.1016/j.resuscitation.2012.08.327</a>
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Type
The nature or genre of the resource
Journal Article
2013
Backlog
Cardiac Arrest
Daya M
DNAR Outcomes
Do Not Resuscitate
End Of Life
Ethics
Journal Article
Newgard CD
Resuscitation
Richardson DK
Zive D
-
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
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URL Address
<a href="http://doi.org/10.1177/0269216315571020" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216315571020</a>
<a href="http://pmj.sagepub.com/cgi/doi/10.1177/0269216315571020" target="_blank" rel="noreferrer">http://pmj.sagepub.com/cgi/doi/10.1177/0269216315571020</a>
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Title
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Novel legislation for pediatric advance directives: Surveys and focus groups capture parent and clinician perspectives
Publisher
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Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2015
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Boss RD; Hutton N; Griffin PL; Wieczorek BH; Donohue PK
Identifier
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<a href="http://doi.org/10.1177/0269216315571020" target="_blank" rel="noreferrer">10.1177/0269216315571020</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
Description
An account of the resource
2015-04
2015
Backlog
Boss RD
DNAR Outcomes
Donohue PK
Griffin PL
Hutton N
Journal Article
Palliative Medicine
Wieczorek BH
-
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/10.1089/jpm.2007.0055" target="_blank" rel="noreferrer">http://doi.org/10.1089/jpm.2007.0055</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
Impact of an inpatient palliative care team: a randomized control trial.
Publisher
An entity responsible for making the resource available
Journal Of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
Subject
The topic of the resource
Humans; Survival Rate; Prospective Studies; Aged; Cooperative Behavior; Patient Satisfaction; DNAR; DNAR Outcomes; Quality of Life/psychology; Critical Illness/psychology; patient care team; Hospice Care/utilization; Hospitalization; Palliative Care/mt [Methods]; patient care team; Advance Directives/sn [Statistics & Numerical Data]; Advance Directives/statistics & numerical data; Critical Illness/ep [Epidemiology]; Critical Illness/epidemiology; Critical Illness/px [Psychology]; Critical Illness/rehabilitation; Critical Illness/rh [Rehabilitation]; Hospice Care/ut [Utilization]; Hospitalization/statistics & numerical data; Hospitalization/statistics & numerical data; Palliative Care/methods; Quality of Life/px [Psychology]
Creator
An entity primarily responsible for making the resource
Gade G; Venohr I; Conner D; McGrady K; Beane J; Richardson RH; Williams MP; Liberson M; Blum M; Della PR
Description
An account of the resource
BACKGROUND: Palliative care improves care and reduces costs for hospitalized patients with life-limiting illnesses. There have been no multicenter randomized trials examining impact on patient satisfaction, clinical outcomes, and subsequent health care costs., OBJECTIVE: Measure the impact of an interdisciplinary palliative care service (IPCS) on patient satisfaction, clinical outcomes, and cost of care for 6 months posthospital discharge., METHODS: Multicenter, randomized, controlled trial. IPCS provided consultative, interdisciplinary, palliative care to intervention patients. Controls received usual hospital care (UC)., SETTING AND SAMPLE: Five hundred seventeen patients with life-limiting illnesses from a hospital in Denver, Portland, and San Francisco enrolled June 2002 to December 2003., MEASURES: Modified City of Hope Patient Questionnaire, total health care costs, hospice utilization, and survival., RESULTS: IPCS reported higher scores for the Care Experience scale (IPCS: 6.9 versus UC: 6.6, p = 0.04) and for the Doctors, Nurses/Other Care Providers Communication scale (IPCS: 8.3 versus UC: 7.5, p = 0.0004). IPCS patients had fewer intensive care admissions (ICU) on hospital readmission (12 versus 21, p = 0.04), and lower 6-month net cost savings of $4,855 per patient (p = 0.001). IPCS had longer median hospice stays (24 days versus 12 days, p = 0.04). There were no differences in survival or symptom control., CONCLUSIONS: IPCS patients reported greater satisfaction with their care experience and providers' communication, had fewer ICU admissions on readmission, and lower total health care costs following hospital discharge.
2008
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1089/jpm.2007.0055" target="_blank" rel="noreferrer">10.1089/jpm.2007.0055</a>
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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
2008
Advance Directives/sn [Statistics & Numerical Data]
Advance Directives/statistics & Numerical Data
Aged
Backlog
Beane J
Blum M
Conner D
Cooperative Behavior
Critical Illness/ep [Epidemiology]
Critical Illness/epidemiology
Critical Illness/psychology
Critical Illness/px [psychology]
Critical Illness/rehabilitation
Critical Illness/rh [Rehabilitation]
Della PR
DNAR
DNAR Outcomes
Gade G
Hospice Care/ut [Utilization]
Hospice Care/utilization
Hospitalization
Hospitalization/statistics & numerical data
Humans
Journal Article
Journal of Palliative Medicine
Liberson M
McGrady K
Palliative Care/methods
Palliative Care/mt [methods]
Patient Care Team
Patient Satisfaction
Prospective Studies
Quality Of Life/psychology
Quality Of Life/px [psychology]
Richardson RH
Survival Rate
Venohr I
Williams MP
-
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/10.1177/0269216308094336" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216308094336</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
Role of advance directives in palliative care units: a prospective study.
Publisher
An entity responsible for making the resource available
Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
Subject
The topic of the resource
Female; Humans; Male; Prospective Studies; Physician's Role; Patient Satisfaction; advance care planning; DNAR; Attitude to Death; Palliative Care; DNAR Outcomes; Neoplasms/th [Therapy]; decision making; Advance Directives; Terminally Ill/px [Psychology]
Creator
An entity primarily responsible for making the resource
Pautex S; Herrmann FR; Zulian GB
Description
An account of the resource
Advance directives (ADs) might be useful in achieving improved communication and satisfaction with decision making at the end-of-life. Our aims were to better characterise patients with advanced oncological disease who decided to complete ADs and to measure the effect of ADs completion on the satisfaction level with end-of-life care from both patients and their relatives. A prospective study was conducted in three palliative care units. Patients with advanced cancer were included if they met the following criteria: an estimated life expectancy of <6 months, fluency in French, Mini Mental State Examination >20 and not yet completed ADs. All the patients received information about ADs and decided whether to complete ADs or not. The level of satisfaction with involvement in the decision process concerning end-of-life care was assessed by means of a written questionnaire. In all, 53 of 228 patients were included, and 12 decided to complete ADs. Patients who completed ADs had statistically less depression one week after inclusion (P = 0.030), had a lower anxiety score on the second week and had a lower depression score on the third week. There was a trend towards a higher satisfaction level with the involvement of the patients in end-of-life care for those completing ADs (P = 0.878). In conclusion, each patient with an advanced progressive disease should be informed about ADs and be encouraged to complete the ADs with the aim to ease many fears as well as to improve communication.
2008
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1177/0269216308094336" target="_blank" rel="noreferrer">10.1177/0269216308094336</a>
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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
2008
Advance Care Planning
Advance Directives
Attitude To Death
Backlog
Decision Making
DNAR
DNAR Outcomes
Female
Herrmann FR
Humans
Journal Article
Male
Neoplasms/th [therapy]
Palliative Care
Palliative Medicine
Patient Satisfaction
Pautex S
Physician's Role
Prospective Studies
Terminally Ill/px [Psychology]
Zulian GB
-
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/10.1177/1049909110363806" target="_blank" rel="noreferrer">http://doi.org/10.1177/1049909110363806</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
The triad that matters: palliative medicine, code status, and health care costs.
Publisher
An entity responsible for making the resource available
The American Journal Of Hospice & Palliative Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Subject
The topic of the resource
Female; Humans; Male; Aged; Middle Aged; Equipment and Supplies; hospice; Patient Admission; Emergency Service; 80 and over; retrospective studies; DNAR; DNAR Outcomes; Surgical Procedures; Critical Illness/ep [Epidemiology]; Palliative Care/ut [Utilization]; Critical Illness/ec [Economics]; Emergency Service; Hospital Costs/sn [Statistics & Numerical Data]; Intensive Care/ec [Economics]; Length of Stay/ec [Economics]; Palliative Care/ec [Economics]; Code status; Direct Service Costs/sn [Statistics & Numerical Data]; health care cost; Hospital/ec [Economics]; Hospital/ut [Utilization]; Intensive Care/ut [Utilization]; Laboratories; Length of Stay/sn [Statistics & Numerical Data]; Operative/ec [Economics]; palliation; Radiology Department; Respiratory Care Units/ec [Economics]; United States/ep [Epidemiology]
Creator
An entity primarily responsible for making the resource
Celso BG; Meenrajan S
Description
An account of the resource
INTRODUCTION: Delayed discussion of a patient's code status can lead to shortsighted care plans that increase hospital length of stay (LOS) and costs., METHODS: Retrospective study compared intensive care unit (ICU) patients who accepted verses rejected palliation and examined the relationships between 5 predictor variables with the outcome variables ICU LOS and total hospital LOS, and total direct and variable hospital cost., RESULTS: A significant number of patients who accepted palliative care agreed to a hospice referral or expired in the hospital. The relationships between days until a family conference, do-not-resuscitate (DNR) order, and the number of invasive procedures were significant., CONCLUSIONS: The amount of time that expires until the issue of code status was settled to clearly related to utilization of hospital resources.
2010
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1177/1049909110363806" target="_blank" rel="noreferrer">10.1177/1049909110363806</a>
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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
2010
80 And Over
Aged
Backlog
Celso BG
Code status
Critical Illness/ec [Economics]
Critical Illness/ep [Epidemiology]
Direct Service Costs/sn [Statistics & Numerical Data]
DNAR
DNAR Outcomes
Emergency Service
Equipment and Supplies
Female
Health Care Cost
Hospice
Hospital Costs/sn [Statistics & Numerical Data]
Hospital/ec [Economics]
Hospital/ut [Utilization]
Humans
Intensive Care/ec [Economics]
Intensive Care/ut [Utilization]
Journal Article
Laboratories
Length of Stay/ec [Economics]
Length of Stay/sn [Statistics & Numerical Data]
Male
Meenrajan S
Middle Aged
Operative/ec [Economics]
palliation
Palliative Care/ec [economics]
Palliative Care/ut [Utilization]
Patient Admission
Radiology Department
Respiratory Care Units/ec [Economics]
Retrospective Studies
Surgical Procedures
The American Journal of Hospice & Palliative Care
United States/ep [Epidemiology]
-
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/10.1200/JCO.2007.11.1914" target="_blank" rel="noreferrer">http://doi.org/10.1200/JCO.2007.11.1914</a>
<a href="http://jco.ascopubs.org.ezproxy.library.ubc.ca/content/25/35/5643" target="_blank" rel="noreferrer">http://jco.ascopubs.org.ezproxy.library.ubc.ca/content/25/35/5643</a>
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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
Outcomes After Hematopoietic Stem-Cell Transplantation for Hematologic Malignancies in Patients With or Without Advance Care Planning
Publisher
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Journal Of Clinical Oncology
Date
A point or period of time associated with an event in the lifecycle of the resource
2007
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Ganti AK; Lee SJ; Vose JM; Devetten MP; Bociek RG; Armitage JO; Bierman PJ; Maness LJ; Reed EC; Loberiza FR
Description
An account of the resource
Purpose Engagement in advance care planning (ACP) is viewed as a way to prepare for possible death. In patients undergoing hematopoietic stem-cell transplantation (HSCT), an aggressive but possibly curative procedure for cancer, encouraging engagement in ACP is difficult. We conducted this analysis to determine if engagement in ACP among patients who undergo HSCT is associated with adverse outcomes. Patients and Methods Adult patients who were undergoing their first HSCT for hematologic malignancies between 2001 and 2003 were included. ACP was defined as having a living will, a power of attorney for health care, or life-support instructions. Outcomes assessed included the length of hospital stay, in-hospital mortality, and overall survival. Results Of the 343 patients, 172 did not have ACP, whereas 171 did have ACP, and 127 of those were reviewable. Of those with reviewable ACP, 28 patients (22%) completed ACP before cancer diagnosis, 87 (68%) completed ACP after the cancer diagnosis but before HSCT, and 12 (10%) engaged in ACP after HSCT. Patients without ACP before HSCT had a significantly greater risk of death compared with patients with ACP (hazard ratio, 2.11; 95% CI, 1.34 to 3.33; P = .001) while adjusting for statistically significant factors. Conclusion Our study demonstrated that lack of engagement in ACP is associated with adverse outcomes after HSCT. Thus, the patients least likely to have planned for poor outcomes are the ones most likely to face them. Additional studies should evaluate the nature of this association and should seek modifiable explanatory factors that could be the target of interventions.
2007-12
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1200/JCO.2007.11.1914" target="_blank" rel="noreferrer">10.1200/JCO.2007.11.1914</a>
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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
2007
Armitage JO
Backlog
Bierman PJ
Bociek RG
Devetten MP
DNAR Outcomes
Ganti AK
Journal Article
Journal Of Clinical Oncology
Lee SJ
Loberiza FR
Maness LJ
Reed EC
Vose JM
-
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/10.1136/bmj.c1345" target="_blank" rel="noreferrer">http://doi.org/10.1136/bmj.c1345</a>
<a href="http://www.bmj.com/content/340/bmj.c1345" target="_blank" rel="noreferrer">http://www.bmj.com/content/340/bmj.c1345</a>
Dublin Core
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Title
A name given to the resource
The impact of advance care planning on end of life care in elderly patients: randomised controlled trial
Publisher
An entity responsible for making the resource available
Bmj
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Detering KM; Hancock AD; Reade MC; Silvester W
Description
An account of the resource
Objective To investigate the impact of advance care planning on end of life care in elderly patients. Design Prospective randomised controlled trial. Setting Single centre study in a university hospital in Melbourne, Australia. Participants 309 legally competent medical inpatients aged 80 or more and followed for six months or until death. Interventions Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes. Main outcome measures The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died. Results 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group. Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives. Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.
2010-03
Identifier
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<a href="http://doi.org/10.1136/bmj.c1345" target="_blank" rel="noreferrer">10.1136/bmj.c1345</a>
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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
2010
Backlog
Bmj
Detering KM
DNAR Outcomes
Hancock AD
Journal Article
Reade MC
Silvester W
-
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/10.1056/NEJMsa0907901" target="_blank" rel="noreferrer">http://doi.org/10.1056/NEJMsa0907901</a>
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880881/" target="_blank" rel="noreferrer">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880881/</a>
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Title
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Advance Directives and Outcomes of Surrogate Decision Making before Death
Publisher
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The New England Journal Of Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Silveira MJ; Kim SYH; Langa KM
Description
An account of the resource
Background Recent discussions about health care reform have raised questions regarding the value of advance directives. Methods We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Results Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Conclusions Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.
2010-04
Identifier
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<a href="http://doi.org/10.1056/NEJMsa0907901" target="_blank" rel="noreferrer">10.1056/NEJMsa0907901</a>
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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
2010
Backlog
DNAR Outcomes
Journal Article
Kim SYH
Langa KM
Silveira MJ
The New England Journal Of Medicine
-
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/10.1016/j.resuscitation.2008.08.009" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.resuscitation.2008.08.009</a>
<a href="http://www.sciencedirect.com/science/article/pii/S0300957208006588" target="_blank" rel="noreferrer">http://www.sciencedirect.com/science/article/pii/S0300957208006588</a>
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Title
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‘Do Not Attempt Resuscitation’ – Do Standardised Order Forms make a clinical difference above hand-written note entries?
Publisher
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Resuscitation
Date
A point or period of time associated with an event in the lifecycle of the resource
2009
Subject
The topic of the resource
Advance Directives; cardiopulmonary resuscitation; DNAR; DNAR Outcomes; Patient Selection; Routine data
Creator
An entity primarily responsible for making the resource
Lewis KE; Edwards VM; Hall S; Temblett P; Hutchings H
Description
An account of the resource
SummaryAim To quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for ‘Do Not Attempt Resuscitation’ – on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts. Methods A prospective, observational study in two UK Hospitals, comparing numbers, demographics and survival rates from CPR attempts for 2 years prior to and 2 years after the introduction of SOFs (the only change in DNAR policy). Results There were 133 CPR attempts, representing 0.30% of the 44,792 admissions, pre SOFs and 147 CPR attempts representing 0.32% of the 45,340 admissions following the SOFs (p = 0.46). The median duration of a CPR attempt was 11 min prior to and 15 min following the SOFs (p = 0.02). Of the CPR attempts, there was no change in mean age (p = 0.34), proportions occurring outside working hours (p = 0.70) or proportions presenting with an initial shockable rhythm (p = 0.30). Survival to discharge following CPR was unchanged (p = 0.23). Conclusions The introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3–4 min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.
2009-01
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.resuscitation.2008.08.009" target="_blank" rel="noreferrer">10.1016/j.resuscitation.2008.08.009</a>
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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
2009
Advance Directives
Backlog
Cardiopulmonary Resuscitation
DNAR
DNAR Outcomes
Edwards VM
Hall S
Hutchings H
Journal Article
Lewis KE
Patient Selection
Resuscitation
Routine data
Temblett P
-
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/10.1089/jpm.2005.8.766" target="_blank" rel="noreferrer">http://doi.org/10.1089/jpm.2005.8.766</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
Pediatric advance care planning.
Publisher
An entity responsible for making the resource available
Journal Of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Child; Female; Humans; infant; Male; Interviews as Topic; Wisconsin; Preschool; PedPal Lit; infant; Newborn; DNAR; Parents/psychology; DNAR Outcomes; Pediatrics; Advance Care Planning/og [Organization & Administration]; Parents/px [Psychology]; 7 died at home and 2 died at a hospital. Eight of the children's advance directives were followed during the dying process; 9 are deceased; Advance Care Planning/organization & administration; including preserving their child's quality of life and avoiding unnecessary suffering.; individuals in the community raised concerns about the child's advance directive. CONCLUSIONS: Even though the topic of their child's death is difficult; the majority of the interviewed parents found the advance care planning process for the child helpful because it assured the best care for the child; while 1 was not. Th irteen parents were interviewed. Twelve stated that the process of advance care planning benefited their children and their family. Rarely
Creator
An entity primarily responsible for making the resource
Hammes BJ; Klevan J; Kempf M; Williams MS
Description
An account of the resource
OBJECTIVE: This study describes the process and population involved in pediatric advance care planning at one Midwest medical center. The outcomes and the parents' perceptions of this planning are also discussed., METHODS: Pediatric patients with advance directives were identified from ethics consultations records. Information about the type of advance directive, the patient's medical condition and care received was obtained from the medical records. Parents of the children were then contacted and interviewed in regard to the advance care planning process done for their child. The interviews were audiotaped and transcribed. Transcribed interviews were reviewed and themes were identified., RESULTS: Seventeen children from 16 families were included in the study. Almost all of the patients had progressive disorders other than cancer. Of the 17 children, 9 are deceased, 7 died at home and 2 died at a hospital. Eight of the children's advance directives were followed during the dying process, while 1 was not. Thirteen parents were interviewed. Twelve stated that the process of advance care planning benefited their children and their family. Rarely, individuals in the community raised concerns about the child's advance directive., CONCLUSIONS: Even though the topic of their child's death is difficult, the majority of the interviewed parents found the advance care planning process for the child helpful because it assured the best care for the child, including preserving their child's quality of life and avoiding unnecessary suffering.
2005
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1089/jpm.2005.8.766" target="_blank" rel="noreferrer">10.1089/jpm.2005.8.766</a>
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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
7 died at home and 2 died at a hospital. Eight of the children's advance directives were followed during the dying process
9 are deceased
Advance Care Planning/og [Organization & Administration]
Advance Care Planning/organization & Administration
Backlog
Child
DNAR
DNAR Outcomes
Female
Hammes BJ
Humans
including preserving their child's quality of life and avoiding unnecessary suffering.
individuals in the community raised concerns about the child's advance directive. CONCLUSIONS: Even though the topic of their child's death is difficult
Infant
Interviews As Topic
Journal Article
Journal of Palliative Medicine
Kempf M
Klevan J
Male
Newborn
Parents/psychology
Parents/px [psychology]
Pediatrics
PedPal Lit
Preschool
the majority of the interviewed parents found the advance care planning process for the child helpful because it assured the best care for the child
while 1 was not. Th irteen parents were interviewed. Twelve stated that the process of advance care planning benefited their children and their family. Rarely
Williams MS
Wisconsin
-
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/bf03018408" target="_blank" rel="noreferrer">http://doi.org/10.1007/bf03018408</a>
Dublin Core
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Title
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Simple changes can improve conduct of end-of-life care in the intensive care unit.
Publisher
An entity responsible for making the resource available
Canadian Journal Of Anaesthesia
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; Attitude of Health Personnel; Aged; Middle Aged; Resuscitation Orders; Intervention Studies; Patient Admission; Pastoral Care; retrospective studies; cause of death; DNAR; cardiopulmonary resuscitation; Intensive Care Units; Life Support Care; Palliative Care; Withholding Treatment; Analgesics/tu [Therapeutic Use]; Diazepam/tu [Therapeutic Use]; DNAR Outcomes; Hypnotics and Sedatives/tu [Therapeutic Use]; Nurses/px [Psychology]; Physicians/px [Psychology]
Creator
An entity primarily responsible for making the resource
Hall RI; Rocker GM; Murray D
Description
An account of the resource
PURPOSE: To describe changes to the conduct of withdrawal of life support (WOLS) in two teaching hospital tertiary care medical surgical intensive care units (ICUs) in a single centre over two distinct time periods., METHODS: We used a retrospective chart review with a before and after comparison. We assessed aspects of end-of-life care for ICU patients dying after a WOLS before and after we introduced instruments to clarify do not resuscitate (DNR) orders and to standardize the WOLS process, sought family input into the conduct of end-of-life care, and modified physicians' orders regarding use of analgesia and sedation., RESULTS: One hundred thirty-eight patients died following life support withdrawal in the ICUs between July 1996 and June 1997 (PRE) and 168 patients died after a WOLS between May 1998 and April 1999 (POST). Time from ICU admission to WOLS (mean +/- SD) was shorter in the POST period (191 +/- 260 hr PRE vs 135 +/- 205 hr POST, P = 0.05). Fewer patients in the POST group received cardiopulmonary resuscitation in the 12-hr interval prior to death (PRE = 7; POST = 0: P < 0.05). Fewer comfort medications were used (PRE: 1.7 +/- 1.0 vs POST: 1.4 +/- 1.0; P < 0.05). Median cumulative dose of diazepam (PRE: 20.0 vs POST: 10.0 mg; P < 0.05) decreased. Documented involvement of physicians in WOLS discussions was unchanged but increased for pastoral care (PRE: 10/138 vs POST: 120/168 cases; P < 0.05). The majority of nurses (80%) felt that the DNR and WOLS checklists led to improved process around WOLS., CONCLUSION: Simple changes to the process of WOLS can improve conduct of end-of-life care in the ICU.
2004
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1007/bf03018408" target="_blank" rel="noreferrer">10.1007/bf03018408</a>
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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
Aged
Analgesics/tu [Therapeutic Use]
Attitude Of Health Personnel
Backlog
Canadian Journal Of Anaesthesia
Cardiopulmonary Resuscitation
Cause Of Death
Diazepam/tu [Therapeutic Use]
DNAR
DNAR Outcomes
Female
Hall RI
Humans
Hypnotics and Sedatives/tu [Therapeutic Use]
Intensive Care Units
Intervention Studies
Journal Article
Life Support Care
Male
Middle Aged
Murray D
Nurses/px [Psychology]
Palliative Care
Pastoral Care
Patient Admission
Physicians/px [Psychology]
Resuscitation Orders
Retrospective Studies
Rocker GM
Withholding Treatment
-
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/10.1001/jama.1986.03380090104026" target="_blank" rel="noreferrer">http://doi.org/10.1001/jama.1986.03380090104026</a>
<a href="http://dx.doi.org/10.1001/jama.1986.03380090104026" target="_blank" rel="noreferrer">http://dx.doi.org/10.1001/jama.1986.03380090104026</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
Do-not-resuscitate decisions in a community hospital: Incidence, implications, and outcomes
Publisher
An entity responsible for making the resource available
Jama
Date
A point or period of time associated with an event in the lifecycle of the resource
1986
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Lipton H
Description
An account of the resource
To investigate intensity of care after do-not-resuscitate (DNR) designation, the implications of DNR decisions were analyzed in a 450-bed community hospital. All 333 patients who received written DNR orders in a six-month period were studied. These 333 patients constituted 3% of all discharges, but 70% of patients who died in hospital. Treatment goals for care provided after DNR designation were not documented in 60% of the patients' medical records. Intensity of care, as measured by hospital charges, decreased significantly after DNR designation. Although many types of care were provided after DNR, most were noninvasive. These findings suggest that although many DNR policies consider DNR status fully compatible with aggressive care, in actual clinical practice the DNR order usually leads to less intensive care. Results further suggest that the DNR decision should properly become part of a comprehensive patient care plan individualizing treatment goals for patients.(JAMA 1986;256:1164-1169)
1986-09
Identifier
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<a href="http://doi.org/10.1001/jama.1986.03380090104026" target="_blank" rel="noreferrer">10.1001/jama.1986.03380090104026</a>
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Type
The nature or genre of the resource
Journal Article
1986
Backlog
DNAR Outcomes
JAMA
Journal Article
Lipton H
-
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/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">http://doi.org/10.1001/archinte.1995.00430190049007</a>
<a href="http://dx.doi.org/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">http://dx.doi.org/10.1001/archinte.1995.00430190049007</a>
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Title
A name given to the resource
Outcomes of patients with do-not-resuscitate orders: Toward an understanding of what do-not-resuscitate orders mean and how they affect patients
Publisher
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Archives Of Internal Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
1995
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Wenger NS; Pearson ML; Desmond KA; Brook RH; Kahn KL
Description
An account of the resource
Objectives: To evaluate the outcomes of hospitalized patients with do-not-resuscitate (DNR) orders and to identify variables that may elucidate the high mortality of patients with DNR orders.Methods: Among a nationally representative sample of Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture, we retrospectively studied in-hospital and 180-day mortality and hospital lengths of stay for patients without DNR orders, with early (day 1 or 2) DNR orders, and with late (day 3 or later) DNR orders, before and after adjustment for sickness at hospital admission and patient and hospital characteristics.Results: In-hospital mortality for patients with DNR orders exceeded that for patients without DNR orders before adjustment (59% vs 8%, P<.001), and after accounting for differences in sickness at admission and patient and hospital characteristics (40% vs 9%, P<.001). Sicker patients were assigned earlier DNR orders. Yet, patients with early DNR orders had a lower adjusted in-hospital mortality (31% vs 49%, P<.001) and shorter hospital stay (10 vs 18 days, P<.001) than did patients with late DNR orders.Conclusions: Hospitalized older patients with DNR orders have a much higher mortality than predicted by admission demographic and clinical characteristics. The differential association of early and late DNR orders with mortality indicates that DNR orders represent a heterogeneous group of interventions that may be a marker of unmeasured sickness and a determinant of quality of care. A better understanding of what the DNR order represents and its effect on patient care is needed to ensure optimal use.(Arch Intern Med. 1995;155:2063-2068)
1995-10
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1001/archinte.1995.00430190049007" target="_blank" rel="noreferrer">10.1001/archinte.1995.00430190049007</a>
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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
1995
Archives Of Internal Medicine
Backlog
Brook RH
Desmond KA
DNAR Outcomes
Journal Article
Kahn KL
Pearson ML
Wenger NS
-
Text
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Backlog
URL Address
<a href="http://doi.org/10.1001/jama.1995.03530200027032" target="_blank" rel="noreferrer">http://doi.org/10.1001/jama.1995.03530200027032</a>
<a href="http://dx.doi.org/10.1001/jama.1995.03530200027032" target="_blank" rel="noreferrer">http://dx.doi.org/10.1001/jama.1995.03530200027032</a>
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Title
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A controlled trial to improve care for seriously lli hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (support)
Publisher
An entity responsible for making the resource available
Jama
Date
A point or period of time associated with an event in the lifecycle of the resource
1995
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Connors AF; Jr; Dawson NV; Desbiens NA; et al
Description
An account of the resource
Objectives. —To improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying.Design. —A 2-year prospective observational study (phase I) with 4301 patients followed by a 2-year controlled clinical trial (phase II) with 4804 patients and their physicians randomized by specialty group to the intervention group (n=2652) or control group (n=2152).Setting. —Five teaching hospitals in the United States.Patients. —A total of 9105 adults hospitalized with one or more of nine life-threatening diagnoses; an overall 6-month mortality rate of 47%.Intervention. —Physicians in the intervention group received estimates of the likelihood of 6-month survival for every day up to 6 months, outcomes of cardiopulmonary resuscitation (CPR), and functional disability at 2 months. A specially trained nurse had multiple contacts with the patient, family, physician, and hospital staff to elicit preferences, improve understanding of outcomes, encourage attention to pain control, and facilitate advance care planning and patient-physician communication.Results. —The phase I observation documented shortcomings in communication, frequency of aggressive treatment, and the characteristics of hospital death: only 47% of physicians knew when their patients preferred to avoid CPR; 46% of do-not-resuscitate (DNR) orders were written within 2 days of death; 38% of patients who died spent at least 10 days in an intensive care unit (ICU); and for 50% of conscious patients who died in the hospital, family members reported moderate to severe pain at least half the time. During the phase II intervention, patients experienced no improvement in patient-physician communication (eg, 37% of control patients and 40% of intervention patients discussed CPR preferences) or in the five targeted outcomes, ie, incidence or timing of written DNR orders (adjusted ratio, 1.02; 95% confidence interval [Cl], 0.90 to 1.15), physicians' knowledge of their patients'preferences not to be resuscitated (adjusted ratio, 1.22; 95% Cl, 0.99 to 1.49), number of days spent in an ICU, receiving mechanical ventilation, or comatose before death (adjusted ratio, 0.97; 95% Cl, 0.87 to 1.07), or level of reported pain (adjusted ratio, 1.15; 95% Cl, 1.00 to 1.33). The intervention also did not reduce use of hospital resources (adjusted ratio, 1.05; 95% Cl, 0.99 to 1.12).Conclusions. —The phase I observation of SUPPORT confirmed substantial shortcomings in care for seriously ill hospitalized adults. The phase II intervention failed to improve care or patient outcomes. Enhancing opportunities for more patient-physician communication, although advocated as the major method for improving patient outcomes, may be inadequate to change established practices. To improve the experience of seriously ill and dying patients, greater individual and societal commitment and more proactive and forceful measures may be needed.(JAMA. 1995;274:1591-1598)
1995-11
Identifier
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<a href="http://doi.org/10.1001/jama.1995.03530200027032" target="_blank" rel="noreferrer">10.1001/jama.1995.03530200027032</a>
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Type
The nature or genre of the resource
Journal Article
1995
Backlog
Connors AF
Dawson NV
Desbiens NA
DNAR Outcomes
et al
JAMA
Journal Article
Jr
-
Text
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Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1378/chest.110.1.249" target="_blank" rel="noreferrer">http://doi.org/10.1378/chest.110.1.249</a>
<a href="http://dx.doi.org/10.1378/chest.110.1.249" target="_blank" rel="noreferrer">http://dx.doi.org/10.1378/chest.110.1.249</a>
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Title
A name given to the resource
Patients with amyotrophic lateral sclerosis receiving long-term mechanical ventilation : Advance care planning and outcomes
Publisher
An entity responsible for making the resource available
Chest
Date
A point or period of time associated with an event in the lifecycle of the resource
1996
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Moss AH; Oppenheimer EA; Casey P; Cazzolli PA; Roos RP; Stocking C; Siegler M
Description
An account of the resource
Objective: To examine advance care planning and outcomes of patients with amyotrophic lateral sclerosis (ALS) receiving long-term mechanical ventilation (LTMV).Design: Case series.Setting: Population-based study in homes and chronic care facilities in four states, and Home Ventilator Program of California Kaiser Permanente.Patients: Seventy-five ALS patients receiving LTMV were identified; 11 died prior to interview, and 6 were totally locked in; 50 of 58 (86%) who were able to communicate consented to structured interviews, of whom 36 lived at home and 14 in an institution.Results: Thirty-eight patients (76%) had completed advance directives, and 96% wanted them. Thirty-eight patients wished to stop LTMV in certain circumstances, of whom 30 had completed advance directives. Those who had completed advance directives were more likely to have communicated their preference to stop LTMV to family and physician than those who had not (76 vs 29%; p=0.05). Patients living at home rated their quality of life on a 10-point scale better than those in an institution (7.2 vs 5.6; p=0.0052), and their yearly expenses were less ($136,560 vs $366,852; p=0.0018).Conclusions: Most ALS patients receiving LTMV would want to stop it under certain circumstances, and the process of advance care planning enhances communication of patient preferences to family and physicians. Home-based LTMV is less costly and associated with greater patient satisfaction.
1996-07
Identifier
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<a href="http://doi.org/10.1378/chest.110.1.249" target="_blank" rel="noreferrer">10.1378/chest.110.1.249</a>
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Type
The nature or genre of the resource
Journal Article
1996
Backlog
Casey P
Cazzolli PA
Chest
DNAR Outcomes
Journal Article
Moss AH
Oppenheimer EA
Roos RP
Siegler M
Stocking C
-
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://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=1524334&site=ehost-live&scope=site" target="_blank" rel="noreferrer">http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=1524334&site=ehost-live&scope=site</a>
Dublin Core
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Title
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Effects of offering advance directives on medical treatments and costs
Publisher
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Annals Of Internal Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
1992
Subject
The topic of the resource
Humans; Personal Autonomy; Withholding Treatment; Prospective Studies; California; Hospitals; Empirical Approach; Professional Patient Relationship; Death and Euthanasia; DNAR Outcomes; Resource Allocation; Health Care and Public Health; Veterans; University; Advance Directives/ec [Economics]; Advance Directives/psychology; California Durable Power of Attorney for Health Care; Control Groups; Cost Control/methods; Life Support Care/utilization; Life Support Care/economics; Patient Satisfaction/statistics & numerical data; Risk Assessment
Creator
An entity primarily responsible for making the resource
Schneiderman LJ; Kronick R; Kaplan RM; Anderson JP; Langer RD
Description
An account of the resource
Objective: To examine the effects of advance directives on medical treatments and on patient satisfaction and well-being and to determine whether the enhancement of patient autonomy through advance directives provides a more ethically feasible approach to cost control than does the imposition of limits through rationing.; Design: Randomized, controlled trial.; Setting: University and Veterans Affairs medical center.; Patients: Two hundred and four patients with life-threatening illnesses, 100 of whom died after enrollment in the study.; Intervention: Patients randomly assigned to the experimental group were offered the California Durable Power of Attorney (a typical proxy-instruction directive), and patients assigned to the control group were not offered the advance directive. Hospital admissions were monitored to assure that a summary of the document was present in the active medical record at each hospitalization.; Measurements: Cognitive function, patient satisfaction, psychological well-being, health locus of control, sense of coherence, health-related quality of life, receipt of medical treatments, and medical treatment charges.; Results: No significant differences were found between advance-directive and control groups regarding psychosocial variables, health outcome variables, and medical treatments or charges. Patients offered an advance directive had an average hospital stay of 40.8 days (95% CI, 32.2 to 49.4 days), compared with an average of 33.1 days (95% CI, 26.0 to 40.2 days) for controls. Patients offered an advance directive were charged an average of $19,502 (95% CI, $13,030 to $25,974) for medical treatments in the last month of life compared with $19,700 (95% CI, $13,704 to $25,696) for controls.; Conclusions: Despite claims that public demand for longer life accounts for rising medical costs, most surveys suggest that patients are calling for less, not more, of the expensive, high-technology treatment often used in terminal phases of illness. Executing the California Durable Power of Attorney for Health Care and having a summary copy placed in the patient's medical record had no significant positive or negative effect on a patient's well-being, health status, medical treatments, or medical treatment charges.;
1992-10
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Type
The nature or genre of the resource
Journal Article
1992
Advance Directives/ec [Economics]
Advance Directives/psychology
Anderson JP
Annals Of Internal Medicine
Backlog
California
California Durable Power of Attorney for Health Care
Control Groups
Cost Control/methods
Death and Euthanasia
DNAR Outcomes
Empirical Approach
Health Care and Public Health
Hospitals
Humans
Journal Article
Kaplan RM
Kronick R
Langer RD
Life Support Care/economics
Life Support Care/utilization
Patient Satisfaction/statistics & Numerical Data
Personal Autonomy
Professional Patient Relationship
Prospective Studies
Resource Allocation
Risk Assessment
Schneiderman LJ
University
Veterans
Withholding Treatment
-
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://www.jstor.org.ezproxy.library.ubc.ca/stable/3766574" target="_blank" rel="noreferrer">http://www.jstor.org.ezproxy.library.ubc.ca/stable/3766574</a>
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Title
A name given to the resource
Changes over Time in the Use of Do Not Resuscitate Orders and the Outcomes of Patients Receiving Them
Publisher
An entity responsible for making the resource available
Medical Care
Date
A point or period of time associated with an event in the lifecycle of the resource
1997
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
Wenger NS; Pearson ML; Desmond KA; Kahn KL
Description
An account of the resource
Objectives. Do not resuscitate (DNR) orders are increasingly common, though there has been little evaluation of their changing use. The authors contrasted the use and outcomes of DNR orders for nationally representative samples of Medicare patients hospitalized with specific diagnoses in 1981 to 1982 and 1985 to 1986. Methods. Using ordinary least squares regression to adjust for patient and hospital characteristics, the authors compared use, timing and predictors of DNR orders, and survival to hospital discharge of patients with DNR orders between the two time periods. Results. After adjustment for sickness at admission and for patient and hospital factors, more patients received DNR orders in 1985 to 1986 than in 1981 to 1982 (13% versus 10%, P <0.001), with most of the increase among patients with the greatest sickness at admission. Disparity in DNR order use by age, diagnosis, functional status, preadmission residence, and gender found in 1981 to 1982 was still present in 1985 to 1986. DNR orders were written earlier in hospitalization during the latter time period. Patients with DNR orders were more likely to survive to hospital discharge in 1985 to 1986 than in 1981 to 1982 (44% versus 36%, P = 0.001), but their 30-day survival did not differ. Conclusions. Although use increased, disparities in DNR order assignment persisted in these 1980s data. Examination is needed into whether these differences persist and whether they reflect patient preferences. Systems should be developed to preserve and review the preferences of the increasing number of patients discharged after in-hospital DNR orders.
1997-04
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Type
The nature or genre of the resource
Journal Article
1997
Backlog
Desmond KA
DNAR Outcomes
Journal Article
Kahn KL
Medical Care
Pearson ML
Wenger NS
-
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/10.1046/j.1525-1497.1999.00312.x" target="_blank" rel="noreferrer">http://doi.org/10.1046/j.1525-1497.1999.00312.x</a>
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496551/" target="_blank" rel="noreferrer">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496551/</a>
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Title
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The Timing of Do-Not-Resuscitate Orders and Hospital Costs
Publisher
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Journal Of General Internal Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
1999
Subject
The topic of the resource
DNAR Outcomes
Creator
An entity primarily responsible for making the resource
De Jonge KE; Sulmasy DP; Gold Karen G; Epstein A; Harper Michael G; Eisenberg John M; Schulman KA
Description
An account of the resource
The relation between the timing of do-not-resuscitate (DNR) orders and the cost of medical care is not well understood. This prospective observational study compares hospital costs and length of stay of 265 terminally ill patients with admission DNR orders, delayed DNR orders (occurring after 24 hours), or no DNR orders (full code). Patients whose orders remained full code throughout a hospital stay had similar lengths of stay, total hospital costs, and daily costs as patients with admission DNR orders. Patients with delayed DNR orders, by contrast, had a greater mortality, longer length of stay, and higher total costs than full code or admission DNR patients, but similar daily costs. The causes of delay in DNR orders and the associated higher costs are a matter for future research.
1999-03
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1046/j.1525-1497.1999.00312.x" target="_blank" rel="noreferrer">10.1046/j.1525-1497.1999.00312.x</a>
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Type
The nature or genre of the resource
Journal Article
1999
Backlog
De Jonge KE
DNAR Outcomes
Eisenberg John M
Epstein A
Gold Karen G
Harper Michael G
Journal Article
Journal Of General Internal Medicine
Schulman KA
Sulmasy DP
-
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/10.1016/S0300-9572(98)00097-5" target="_blank" rel="noreferrer">http://doi.org/10.1016/S0300-9572(98)00097-5</a>
<a href="http://www.sciencedirect.com/science/article/pii/S0300957298000975" target="_blank" rel="noreferrer">http://www.sciencedirect.com/science/article/pii/S0300957298000975</a>
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Title
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Impact of survival probability, life expectancy, quality of life and patient preferences on do-not-attempt-resuscitation orders in a hospital
Publisher
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Resuscitation
Date
A point or period of time associated with an event in the lifecycle of the resource
1998
Subject
The topic of the resource
decision making; Prognosis; cardiopulmonary resuscitation; quality of life; DNAR Outcomes; Survival
Creator
An entity primarily responsible for making the resource
de Vos R; Koster RW; de Haan RJ
Description
An account of the resource
Consensus exists that a do-not-attempt-resuscitation order (DNAR) is appropriate if a resuscitation attempt is futile. Less agreement exists when this point is reached. We investigated the influence of three major considerations for in-hospital DNAR orders: expected survival probability after resuscitation, prospects of the patients' current condition without a cardiac arrest and the patients' autonomous decision not to want resuscitation. We calculated an expected survival probability according to two multi-morbidity prediction scores for each patient, assuming the event of cardiac arrest. The prospects of the current condition without a cardiac arrest was estimated by the patients' physician, in terms of life expectancy and quality of life (level of dependency after discharge and pain). The patients' preference was documented from the medical records. A total of 470 patients were included in the study. Fifty-eight patients (12%) had a DNAR-order, 11 of these patients (19%) wanted no resuscitation. The patients' prospects (life expectancy, dependency after discharge), and age proved to be independently associated with the presence of a DNAR order. The odds ratio (OR) for the presence of a DNAR order was 37 (CL 14–107) for an estimated life expectancy less than 3 months, 13 (CL 4–41) for a life in a nursing home and four (CL 2–12) for an age of 80 years and older. Expected survival probability after resuscitation and pain were not independently associated with a DNAR order. We conclude that resuscitation is considered futile on the basis of the patients' age and prospects without cardiac arrest and that the impact of expected survival probability on these decisions is small.
1998-11
Identifier
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<a href="http://doi.org/10.1016/S0300-9572(98)00097-5" target="_blank" rel="noreferrer">10.1016/S0300-9572(98)00097-5</a>
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Type
The nature or genre of the resource
Journal Article
1998
Backlog
Cardiopulmonary Resuscitation
de Haan RJ
de Vos R
Decision Making
DNAR Outcomes
Journal Article
Koster RW
Prognosis
Quality Of Life
Resuscitation
Survival
-
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
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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>
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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
-
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/mcp.2010.0747" target="_blank" rel="noreferrer">http://doi.org/10.4065/mcp.2010.0747</a>
Dublin Core
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Title
A name given to the resource
Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy.
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
2011
Subject
The topic of the resource
Female; Humans; Male; Family; Withholding Treatment; Aged; Middle Aged; Interdisciplinary Communication; Severity of Illness Index; patient care team; decision making; retrospective studies; advance care planning; DNAR; quality of life; DNAR Outcomes; referral and consultation; Advance Directives; Palliative Care/mt [Methods]; Heart Failure/th [Therapy]; Heart-Assist Devices; Left/th [Therapy]; Right/th [Therapy]; Ventricular Dysfunction
Creator
An entity primarily responsible for making the resource
Swetz K M; Freeman MR; AbouEzzeddine OF; Carter Kari A; Boilson BA; Ottenberg AL; Park Soon J; Mueller PS
Description
An account of the resource
OBJECTIVE: To assess the benefit of proactive palliative medicine consultation for delineation of goals of care and quality-of-life preferences before implantation of left ventricular assist devices as destination therapy (DT)., PATIENTS AND METHODS: We retrospectively reviewed the cases of patients who received DT between January 15, 2009, and January 1, 2010., RESULTS: Of 19 patients identified, 13 (68%) received proactive palliative medicine consultation. Median time of palliative medicine consultation was 1 day before DT implantation (range, 5 days before to 16 days after). Thirteen patients (68%) completed advance directives. The DT implantation team and families reported that preimplantation discussions and goals of care planning made postoperative care more clear and that adverse events were handled more effectively. Currently, palliative medicine involvement in patients receiving DT is viewed as routine by cardiac care specialists., CONCLUSION: Proactive palliative medicine consultation for patients being considered for or being treated with DT improves advance care planning and thus contributes to better overall care of these patients. Our experience highlights focused advance care planning, thorough exploration of goals of care, and expert symptom management and end-of-life care when appropriate.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.4065/mcp.2010.0747" target="_blank" rel="noreferrer">10.4065/mcp.2010.0747</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
AbouEzzeddine OF
Advance Care Planning
Advance Directives
Aged
Backlog
Boilson BA
Carter Kari A
Decision Making
DNAR
DNAR Outcomes
Family
Female
Freeman MR
Heart Failure/th [Therapy]
Heart-Assist Devices
Humans
Interdisciplinary Communication
Journal Article
Left/th [Therapy]
Male
Mayo Clinic Proceedings
Middle Aged
Mueller PS
Ottenberg AL
Palliative Care/mt [methods]
Park Soon J
Patient Care Team
Quality Of Life
Referral And Consultation
Retrospective Studies
Right/th [Therapy]
Severity Of Illness Index
Swetz K M
Ventricular Dysfunction
Withholding Treatment
-
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/10.1089/jpm.2011.0032" target="_blank" rel="noreferrer">http://doi.org/10.1089/jpm.2011.0032</a>
<a href="http://www.liebertonline.com/doi/abs/10.1089/jpm.2011.0032" target="_blank" rel="noreferrer">http://www.liebertonline.com/doi/abs/10.1089/jpm.2011.0032</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
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Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness
Publisher
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Journal Of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Subject
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DNAR Outcomes
Creator
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Bakitas M; Kryworuchko J; Matlock DD; Volandes AE
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1089/jpm.2011.0032" target="_blank" rel="noreferrer">10.1089/jpm.2011.0032</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
Backlog
Bakitas M
DNAR Outcomes
Journal Article
Journal of Palliative Medicine
Kryworuchko J
Matlock DD
Volandes AE
-
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/10.1542/peds.2011-2695" target="_blank" rel="noreferrer">http://doi.org/10.1542/peds.2011-2695</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
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Barriers to conducting advance care discussions for children with life-threatening conditions.
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2012
Subject
The topic of the resource
Child; Female; Humans; Male; United States; Adult; Medical Staff; Questionnaires; Hospitals; Practice; Pediatric; Attitudes; DNAR; DNAR Outcomes; Palliative Care/st [Standards]; Advance Care Planning/og [Organization & Administration]; Critical Illness/th [Therapy]; Attitude of Health Personnel; Communication Barriers; Health Knowledge; Medical Staff; Hospital/es [Ethics]; Hospital/px [Psychology]; Hospital/st [Standards]
Creator
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Durall A; Zurakowski D; Wolfe J
Description
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BACKGROUND AND OBJECTIVE: Advance care discussions (ACD) occur infrequently or are initiated late in the course of illness. Although data exist regarding barriers to ACD among the care of adult patients, few pediatric data exist. The goal of this study was to identify barriers to conducting ACD for children with life-threatening conditions., METHODS: Physicians and nurses from practice settings where advance care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors regarding ACD., RESULTS: A total of 266 providers responded to the survey: 107 physicians and 159 nurses (54% response rate). The top 3 barriers were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. Nurses identified lack of importance to clinicians (P = .006) and ethical considerations (P < .001) as impediments more often than physicians. Conversely, physicians believed that not knowing the right thing to say (P = .006) was more often a barrier. There are also perceived differences among specialties. Cardiac ICU providers were more likely to report unrealistic clinician expectations (P < .001) and differences between clinician and patient/parent understanding of prognosis (P = .014) as common barriers to conducting ACD. Finally, 71% of all clinicians believed that ACD happen too late in the patient's clinical course., CONCLUSIONS: Clinicians perceive parent prognostic understanding and attitudes as the most common barriers to conducting ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and skills in addressing these barriers may help health care providers overcome perceived barriers.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1542/peds.2011-2695" target="_blank" rel="noreferrer">10.1542/peds.2011-2695</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
2012
Adult
Advance Care Planning/og [Organization & Administration]
Attitude Of Health Personnel
Attitudes
Backlog
Child
Communication Barriers
Critical Illness/th [therapy]
DNAR
DNAR Outcomes
Durall A
Female
Health Knowledge
Hospital/es [Ethics]
Hospital/px [Psychology]
Hospital/st [Standards]
Hospitals
Humans
Journal Article
Male
Medical Staff
Palliative Care/st [standards]
Pediatric
Pediatrics
Practice
Questionnaires
United States
Wolfe J
Zurakowski D