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Background Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections. Methods This was a retrospective cohort of all patients with an ID consult within an academic health system from 1 January 2014 through 31 December 2023, including community, general, and transplant ID consult services. Results There were 60 820 inpatient ID consults (17 235 community, 29 999 general, and 13 586 transplant) involving 37 848 unique patients. The number of consults increased by 94% and the rate rose from 5.0 to 9.9 consults per 100 inpatients (P <.001). In total, 7.5% of patients receiving an ID consult died during admission and 1006 (2.6%) of patients were discharged to hospice. In-hospital mortality was 5.2% for community ID, 7.8% for general ID, and 10.7% for transplant ID patients (P <.001). Six-month mortality was 9% for all nonobstetric admissions versus 19% for community ID, 20.9% for general ID, and 22.3% for transplant ID. In total 2866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization. The index ID consult preceded any palliative consult in the majority (69.5%) of cases. A total of 16.3% of patients had a do-not-resuscitate order during the index hospitalization; 12.2% of all patients with a do-not-resuscitate order had this placed on the same day as the ID consult. Conclusions Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care. [ABSTRACT FROM AUTHOR]

We aimed to synthesize existing research to elucidate the underlying factors and causes responsible for the high prevalence of unwanted cardiopulmonary resuscitation (CPR) occurring outside a hospital setting in Japan despite patients' Do Not Attempt Resuscitation (DNAR) orders. We conducted a narrative review by searching PubMed, EMBASE, and Scopus for English literature, and Google Scholar for Japanese literature. The key factors we identified included lack of documentation of resuscitation preferences, variation in the perception of other life‐sustaining measures associated with DNAR, non‐inclusion of the patient in discussions of goals of care, unlegislated and unstandardized DNAR orders, emergency medical service activation by the family or facility, the Fire Service Act that mandates life‐saving measures irrespective of the presence of advance directives, fire department protocols and CPR decision‐making, and death pronouncement authorization limited to physicians. This study identified the multifaceted factors and the potential triggers for unwanted CPR despite DNAR orders. These findings underscore the urgent need for comprehensive interventions encompassing educational initiatives, ethical considerations, systemic reforms, and legal adjustments to prevent future unwanted CPRs in Japan. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Due to advances in medical treatments, students with terminal illnesses are more likely to attend public schools, increasing the possibility that they may die on school property. However, educational health plans often fail to consider end-of-life care decisions. In the absence of federal or state statutes, school boards are left to navigate the issue of minors with Do Not Resuscitate Orders while at school. We examine state statutes and school board polices for minors with Do Not Resuscitate Orders attending or wishing to attend school. Themes from school district policies are discussed, and recommendations for federal, state, and local policymakers are made. [ABSTRACT FROM AUTHOR]

Background: Black and Hispanic people are more likely to contract COVID-19, require hospitalization, and die than White people due to differences in exposures, comorbidity risk, and healthcare access. Objective: To examine the association of race and ethnicity with treatment decisions and intensity for patients hospitalized for COVID-19. Design: Retrospective cohort analysis of manually abstracted electronic medical records. Patients: 7,997 patients (62% non-Hispanic White, 16% non-Black Hispanic, and 23% Black) hospitalized for COVID-19 at 135 community hospitals between March and June 2020 Main Measures: Advance care planning (ACP), do not resuscitate (DNR) orders, intensive care unit (ICU) admission, mechanical ventilation (MV), and in-hospital mortality. Among decedents, we classified the mode of death based on treatment intensity and code status as treatment limitation (no MV/DNR), treatment withdrawal (MV/DNR), maximal life support (MV/no DNR), or other (no MV/no DNR). Key Results: Adjusted in-hospital mortality was similar between White (8%) and Black patients (9%, OR=1.1, 95% CI=0.9–1.4, p=0.254), and lower among Hispanic patients (6%, OR=0.7, 95% CI=0.6–1.0, p=0.032). Black and Hispanic patients were significantly more likely to be treated in the ICU (White 23%, Hispanic 27%, Black 28%) and to receive mechanical ventilation (White 12%, Hispanic 17%, Black 16%). The groups had similar rates of ACP (White 12%, Hispanic 12%, Black 11%), but Black and Hispanic patients were less likely to have a DNR order (White 13%, Hispanic 8%, Black 7%). Among decedents, there were significant differences in mode of death by race/ethnicity (treatment limitation: White 39%, Hispanic 17% (p=0.001), Black 18% (p<0.0001); treatment withdrawal: White 26%, Hispanic 43% (p=0.002), Black 28% (p=0.542); and maximal life support: White 21%, Hispanic 26% (p=0.308), Black 36% (p<0.0001)). Conclusions: Hospitalized Black and Hispanic COVID-19 patients received greater treatment intensity than White patients. This may have simultaneously mitigated disparities in in-hospital mortality while increasing burdensome treatment near death. [ABSTRACT FROM AUTHOR]

Introduction and Objective: The do not resuscitate (DNR) order is a decision taken by the patient or other people about medical care in the end stages of life to prevent resuscitation from causing cardiac or respiratory arrest. This study was conducted to evaluate the attitudes of patients' relatives in the end stages about DNR order. Materials and Methods: In a cross-sectional study, 150 relatives of patients who had been prescribed DNR orders were included in the educational hospitals affiliated to the Kermanshah University of Medical Sciences. The data collection tool was a researcher-developed questionnaire consisting of 29 attitudes questions related to DNR orders. The data were collected and analyzed in the SPSS software version 19 using descriptive tests. Results: According to the results of present study, although the relatives of pationts consider doctors thoroughly responsible for making decision related with DNR, and follow their order either way, they strongly disagree with a single doctor making individual decision in this domain. They believe that the patient and their relatives should be engaged in this decision. Although most participants tended to stay as close as possible to the patients and engage in patient care. Conclusion: Given that there are a few studies in Iran on the attitudes of patients and their relatives about DNR, and there are no specific rules and guidelines in this regard. It is recommended that further studies be conducted on the subject. Engaging of patients and families in this important decision is necessary.

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Approximately 2500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence. Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018–2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events. A total of 3638 hospital medical records were reviewed and 1109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55–94%). IHCA incidence was 2.9/1000 hospital admissions and 12.4/1000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events. IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures. [ABSTRACT FROM AUTHOR]

With the enactment of the ‘Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life’ (Act No. 14013) in Korea, there is growing concern about the practicality of this law. In this review, we discuss definitions, ethics, and practical issues related to this law.

Introduction and Objective: The do not resuscitate (DNR) order is a decision taken by the patient or other people about medical care in the end stages of life to prevent resuscitation from causing cardiac or respiratory arrest. This study was conducted to evaluate the attitudes of patients' relatives in the end stages about DNR order. Materials and Methods: In a cross-sectional study, 150 relatives of patients who had been prescribed DNR orders were included in the educational hospitals affiliated to the Kermanshah University of Medical Sciences. The data collection tool was a researcher-developed questionnaire consisting of 29 attitudes questions related to DNR orders. The data were collected and analyzed in the SPSS software version 19 using descriptive tests. Results: According to the results of present study, although the relatives of pationts consider doctors thoroughly responsible for making decision related with DNR, and follow their order either way, they strongly disagree with a single doctor making individual decision in this domain. They believe that the patient and their relatives should be engaged in this decision. Although most participants tended to stay as close as possible to the patients and engage in patient care. Conclusion: Given that there are a few studies in Iran on the attitudes of patients and their relatives about DNR, and there are no specific rules and guidelines in this regard. It is recommended that further studies be conducted on the subject. Engaging of patients and families in this important decision is necessary. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Do not resuscitate order (DNR) is one of the most challenging issues in end of life care. The attitude of health care providers has an important role in legalization of this procedure. The aim of the present study was to investigate the viewpoints of nursing students on DNR orders. One hundred and eighty six nursing students from Tabriz University of Medical Sciences (TUOMS) and Kurdistan University of Medical Sciences (KUMS) participated in the present study. Data collection was performed by Attitude on DNR Order Questionnaire that consisted of 25 items. The results showed that nursing students have a negative attitude toward many aspects of DNR orders, had many misconceptions about this procedure and tended to acquire more information about it. Also, students reported a negative attitude about passive euthanasia and reported that cultural and religious factors are important in their attitude toward DNR orders. Moreover, there was no statistical difference between the attitudes of nursing students from these two universities with two different cultural and religious backgrounds (P > 0.05). Considering the lack of knowledge of nursing students about DNR orders it is suggested that nursing students should be educated on the subject. Due to little research evidence conducting further studies is recommended. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Heart failure is a progressive disease with significant morbidity and mortality, but prognostication often is difficult. Many of the evidence-based therapies for heart failure provide symptomatic benefit, but may have intolerable side effects for patients with advanced disease. At the end of life, there is evidence of varying strengths for pharmacologic and nonpharmacologic relief of common symptoms like dyspnea, fatigue, pain, and depression. Patients also may benefit from inotropic therapy, ventricular assist devices, and hospice care. It is important for physicians to encourage patients to formulate advance directives, including decisions about do not resuscitate orders and deactivation of implantable cardioverter-defibrillators and ventricular assist devices. [ABSTRACT FROM AUTHOR]

Objectives: To study the utilization of public health care by advanced cancer patients in their last 6 months of life and their end-of-life process within the last 2 weeks of life. Methods: This was a retrospective study on 494 cancer deaths from four public hospitals in 2005. This sample was selected from all in-patient cancer deaths by the ratio of one in four. Data were collected by review of charts and an electronic data base. Results: A total of 494 cancer deaths were analysed. The mean age of all cancer patients ( n=494) was 72.6 years. Two-thirds of cancer patients received palliative care and half died in palliative care setting. Patients were categorized into three groups according to palliative care coverage and the place of death. The first group comprised of patients who received palliative care service and died in palliative care units (PCS-PCD group, n=247); the second group of patients who received palliative care service within the last 6 months of life but died in non-palliative care wards ( n=86); and the third group of patients who never received palliative care and who died in non-palliative care wards (NPCS-NPCD group, n=161). Differences among groups were tested by one way ANOVA. During the last 6 months of life, patients in the PCS-PCD group had less admission to acute care wards (P < 0.012), shorter duration of stay in acute care wards (P < 0.003), and less admission to an intensive care unit setting (P < 0.001). Within the last 2 weeks of life, the PCS-PCD group had fewer interventions initiated (P < 0.001); had higher number of symptoms documented in patient's record (P < 0.001); and were more likely to receive analgesics (P < 0.001), adjuvant analgesics (P < 0.001) and sedatives (P < 0.001). Patients in PCS-PCD group were more physically dependent in the last 2 weeks of life (P < 0.001), but mentally more alert at 72 hours before death (P < 0.001). Patients in the NPCS-NPCD group had fewer patients with a do not resuscitate order present (P < 0.001), and more patients with cardiopulmonary resuscitation performed (P < 0.001). Conclusion: Our results suggest that palliative care service has played a role in improving end-of-life cancer care in Hong Kong. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the knowledge, utilization, and experience of primary care physicians (PCPs) with nonhospital do-not-resuscitate (NH-DNR) orders. An anonymous survey was sent to all PCPs in a single northeastern county. Up to two surveys were mailed to each PCP. Descriptive statistics were used to report provider responses. The main variable of interest was issuance of NH-DNR orders. Surveys were mailed to 820 PCPs; 348 (42%) were returned. Respondents had practiced an average 17 ± 11 years, and cared for an average of 720 patients per month, 7 of whom were terminally ill. Seventy percent issued NH-DNR orders. Twenty-five percent reported resuscitation had been attempted for at least one patient with a NH-DNR order; 64% reported this had happened more than once. Of respondents who had a NH-DNR order ignored, 14% had instructed family members to call police, fire, or EMS following death of the patient. Of the PCPs who did not issue NH-DNR orders, 71% reported not caring for any appropriate patients, yet 41% reported caring for at least 1 terminally ill patient per month. Seventy-nine percent disagreed that intubation and mechanical ventilation were appropriate treatment for DNR patients in severe respiratory distress, and 71% disagreed that cardioversion was appropriate treatment for an unconscious DNR patient with unstable ventricular tachycardia. In conclusion, a majority of respondents issued NH-DNR orders and one quarter reported these orders had not been followed. A majority felt intubation, mechanical ventilation, and cardioversion should not be performed for noncardiac arrest DNR patients with an indication, but not in cardiac arrest. [Copyright &y& Elsevier]

Various protocols and advance directives can prepare physician assistants for difficult conversations with patients about end-of-life care. This case scenario explores the roles and influences that complicated one patient's care and how the situation was resolved [ABSTRACT FROM AUTHOR]