This position paper provides an overview of the assessment and management of both acute and chronic graft‐versus‐host disease (GvHD). There is a focus on the use of ruxolitinib, a selective inhibitor of Janus kinase (JAK)1 and JAK2, for the treatment of corticosteroid‐refractory and corticosteroid‐dependent GvHD. [ABSTRACT FROM AUTHOR]
Berry‐Kilgour, Niamh A. H., Paulin, Jono R., Psirides, Alex, and Pegg, Tammy J.
Subjects
*CARDIOPULMONARY resuscitation, *HEALTH facility employees, *EVALUATION of medical care, *WORK experience (Employment), *CLINICAL deterioration, *PROFESSIONS, *DO-not-resuscitate orders, *INDIVIDUALIZED medicine, *MEDICAL care research, *PSYCHOSOCIAL factors, *QUESTIONNAIRES, *DESCRIPTIVE statistics, *SECONDARY care (Medicine), *THEMATIC analysis, *ELECTRIC countershock, *DECISION making in clinical medicine, *EVALUATION
Abstract
Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]