Arch Intern Med
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The literature on outcomes of intensive care for the elderly with regard to intensive care unit utilization, mortality, hospital costs and charges, and quality of life after intensive care were reviewed. Publications in the English literature, which evaluated intensive care and included elderly populations, were obtained from review of Index Medicus and MEDLINE. ⋯ A therapeutic trial and appropriately discontinuing life support may lead to better utilization of intensive care. Additional data are needed on long-term mortality and quality of life after hospital discharge.
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Multicenter Study
The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group.
Widely publicized court cases have focused national attention on the importance of advance directives. In spite of initiatives such as the Patient Self-Determination Act of 1991, fewer than 10% of Americans have prepared advance directives. One way to increase the preparation of advance directives may be to increase the frequency and quality of discussions about them between individual patients and their physicians. We performed a multicenter observational study to assess the opinions of primary care patients and physicians regarding these discussions. ⋯ We defined a discrepancy between the preferences of primary care patients and physicians regarding the timing of the discussion about advance directives. We propose physician education regarding patient preferences as the most effective way to accomplish the goal of improving the frequency and quality of discussions about advance directives.
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Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. ⋯ Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.
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Bystander cardiopulmonary resuscitation (CPR) is performed on only a small percentage of patients who suffer cardiac arrest. We conducted a study to elucidate attitudes toward and potential obstacles to performance of bystander CPR. ⋯ Concerns regarding mouth-to-mouth ventilation appear to create substantial barriers to performance of bystander CPR. Intensified educational efforts and investigations of new approaches to bystander CPR are warranted.