Journal of the American Medical Directors Association
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Comparative Study
Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians.
To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians' perceptions of their patients' preferences and agreement between patients' and physicians' preferences, estimation of prognosis, and assessment of quality of life. ⋯ The majority of hospitalized patients 80 years older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians' estimates of patients' prognoses were less optimistic than patients' estimates, raising the possibility that physicians' knowledge of older patients' poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older.
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To describe the impact of a Tennessee Department of Health regulation amendment requiring that all nursing home residents 65 years of age or older demonstrate documentation of pneumococcal vaccination, or documented medical contraindication, or patient refusal. ⋯ Pneumococcal immunization rates of at least 75% were associated with facility size, location, and record-keeping practices. Pneumococcal vaccination rates improved only modestly between 1998 and 1999, coincident with the health department amendment. Those who found the policy useful had the greatest improvement in rates.
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Practice Guideline Guideline
Ethics and research in long-term care: a position statement from the American Medical Directors Association.