Arch Intern Med
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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.
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Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis. ⋯ Health care workers who were exposed during a hospital outbreak of multidrug-resistant tuberculosis had occupationally acquired active disease. The human immunodeficiency virus-infected health care workers with tuberculosis had severe disease and died. The risk of skin test conversion increased during the study period, and higher exposure occupations had elevated risk. Effective infection control is essential to prevent the transmission of tuberculosis to health care workers.
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Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. ⋯ Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families' burdens as they participate in treatment withdrawal decisions.