A cry for help....

memphispanda, RN · Feb 24, 2003

I looked in my CINAHL, and it doesn't have the full article either. It may not be available online through them.

Whisper · Feb 24, 2003

Thanks very much for trying

Rena RN 2003, RN · Feb 24, 2003

sorry whisper. i didn't try CINHAL (they suck :chuckle ) but i did look through many of ebscohost which has a much better journal database (academic search premier, alt healthwatch, & health source) and i couldn't find "journal of christian nursing" anywhere.

good luck in your search.

Imafloat, BSN, RN · Dec 2, 2004

The artile is :
Resuscitation decision making and older people. Marcena Walker
If anyone can acssess this article, and email me the text, I would be more than willing to return the favour if you are having the same problem trying to get hold of a British journal article. My Cinahl password lets me onto more UK articles than US articles.
Whisper

Whisper,

My University does subscribe to that journal, but it is only in print version. It is not online. When is your assigment due?

NursingSchoolWife · Dec 2, 2004

i can't get the article you were looking for, but surely it's not the only article that would give you background on this issue? if you post your paper topic maybe the good folk here could help find other resources?

for example, maybe . . .

title: 'do not resuscitate': how? why? and when?

authors: skerritt, ursula1 pitt, brice2

source: international journal of geriatric psychiatry; jun97, vol. 12 issue 6, p667, 4p, 4 charts, 1 graph

document type: article

subject terms:

*cardiopulmonary system

*diagnosis

*hospitals

*mental illness

*resuscitation

author-supplied keywords:

guidelines

cardiopulmonary resuscitation (cpr)

do not resuscitate (dnr)

naics/industry codes: 622 hospitals

abstract: objective . the main objective was to discover who had 'do not resuscitate' (dnr) status, why, how, when and by whom these decisions were made. design, setting and patients . the medical and nursing notes of all inpatients (139) (age range 16-100 years) in an inner city district general hospital on a single day were examined to determine the resuscitation status, age, sex and diagnosis of each patient. result . a decision not to resuscitate had been taken in 28 (20%) of the cases. 'do not resuscitate' (dnr) patients were significantly older and more likely to suffer from malignant and cardiorespiratory disease. patients with dementia and other psychiatric disorders were not significantly more often labelled dnr. evidence of consultation for these decisions was lacking and the recording erratic. conclusions . (1) there is a great need to devise and implement comprehensive guidelines. (2) there is need for appropriate and comprehensive documentation outlining the reasons why and how the decision was taken, who was consulted and review date. (3) this is an important area for audit. [abstract from author]

author affiliations: 1senior registrar, intensive care unit, park royal centre for mental health, london, uk

2professor of old age psychiatry, academic department of psychiatry of old age, st mary's hospital medical school, london, uk

issn: 0885-6230

accession number: 11820840

database: academic search premier

---

title: do-not-resuscitate decisions: too many, too few, too late?

authors: davey, basiro1

source: mortality; nov2001, vol. 6 issue 3, p247, 18p

document type: article

subject terms:

*do-not-resuscitate orders

*right to die

geographic terms: great britain

abstract: in april 2000 age concern england publicized an account of a do-not-resuscitate (dnr) decision written in the hospital notes of an older patient without her knowledge, and the british media claimed doctors 'let older patients die' who could have been resuscitated. this paper explores this belief in the context of an ethnographic study of communication between medical and nursing staff on two acute surgical wards, which took place shortly before this media outcry. dnr decisions emerged as a key area in which staff felt their communication with each other, with patients and (to a lesser extent) with relatives was poor. contrary to media accounts that 'too many' dnr decisions occurred, the need to consider withholding resuscitation was generally neglected by doctors in these wards, in contravention of british medical association/royal college of nursing guidelines. nurses and junior doctors thought 'too few' dnr decisions were taken and sometimes 'too late' to prevent serious harm to dying patients subjected to futile resuscitation attempts. evidence of ageism in dnr decision making was weak, but reflections are offered on the influence of 'social worth' and 'moral imperatives' in dnr decision making. the process of unearthing unexpected findings during ethnographic research and testing emerging themes opportunistically is briefly considered. [abstract from author]

author affiliations: 1the open university, united kingdom

issn: 1357-6275

doi: 10.1080/13576270120082925

accession number: 5493439

database: academic search premier

---

title: focus.

source: australian nursing journal; nov2003, vol. 11 issue 5, p27, 2p

document type: article

subject terms:

*older people -- medical care

*dementia

*hormone therapy

*hospice care

*nursing

*resuscitation

abstract: presents news briefs on nursing as of november 2003. study on the ethical challenge posed by active resuscitation of hospice patients; conditions warranting physician visits by the elderly; link between hormone therapy and dementia.

full text word count: 608

issn: 1320-3185

accession number: 11332500

database: academic search premier

---

title: determining resuscitation preferences of elderly inpatients: a review of the literature.

authors: frank, christopher

heyland, daren k.

chen, benjamin

farquhar, donald

myers, kathryn

iwaasa, ken

source: cmaj: canadian medical association journal; 10/14/2003, vol. 169 issue 8, p795, 5p

document type: article

subject terms:

*older people -- hospital care

*cardiac resuscitation

*geriatrics

*physician & patient

*resuscitation

abstract: studies have shown that discussions with elderly hospital patients about cardiopulmonary resuscitation (cpr) preferences occur infrequently and have variable content. our objective was to identify themes in the existing literature that could be used to increase the frequency and improve the quality of such discussions. we found that patients and families are familiar with the concept of cpr but have limited understanding of the procedure and overestimate its benefit. most patients are interested in being involved in discussions about cpr and in sharing responsibility for decisions with physicians; however, older patients who participate in these discussions may have variable decision-making capacity. physicians do not routinely discuss cpr with older patients, and patients do not initiate such discussions. when discussions do occur, the information provided to patients or families about resuscitation and its outcomes is not always consistent. physicians should initiate cpr discussions, consider patients' levels of understanding and decision-making capacity, share responsibility for decisions where appropriate and involve the family where possible. documentation of discussions and patient preferences may help to minimize misunderstandings and increase the stability of the decision during subsequent admissions to hospital. [abstract from author]

full text word count: 4265

issn: 0820-3946

accession number: 10984290

database: academic search premier

---

more, with full citation available if any would work: (i'm just not pulling up the full citation or article without knowing if it would even help; don't mind if it would)

family involvement in end-of-life hospital care. by: tschann, jeanne m.; kaufman, sharon r.; micco, guy p.. journal of the american geriatrics society, jun2003, vol. 51 issue 6, p835, 6p; abstract: objectives: to examine whether the end-of-life treatment provided to hospitalized patients differed for those who had a family member present at death and those who did not. design: a retrospective cohort analysis. setting: an urban community hospital. participants: all 370 inpatients who died during a 1-year period. measurements: medical records were examined for whether life-support treatments were provided or withdrawn, occurrence and timing of do-not-resuscitate (dnr) orders, and use of comfort measures such as narcotics and sedation. results: dnr orders were written for 85% of patients. for patients who had a dnr order written, the average time from the dnr order to death was 4.8 days. only 26% of patients had one or more treatments withdrawn. sixty-seven percent of patients received narcotics before death, and 22% received sedatives. patients aged 75 and older and african americans were less likely to have a family member present at death. after adjusting for age and ethnicity, patients who had a family member present at death were more likely to have dnr orders written, to have treatments withdrawn, and to receive narcotics before death. patients with a family member present at death also had a shorter time to death after dnr orders were written. conclusion: the presence of a family member at death appears to be an indirect measure of family involvement during patients' hospitalization. family involvement before death may reduce the use of technology and increase the use of comfort care as patients die. [abstract from author]; doi: 10.1046/j.1365-2389.2003.51266.x; (an 9849235)

pdf full text (66k)

5. patterns of mortality in patients with motor neurone disease. by: chaudri, m. b.; kinnear, w. j. m.; jefferson, d.. acta neurologica scandinavica, jan2003, vol. 107 issue 1, p50, 4p; abstract: objective - motor neurone disease (mnd) is a rapidly fatal condition with survival of less than 4 years. patients can deteriorate quickly in the preterminal stages resulting in inappropriate resuscitation or admission to intensive care units (icu) or accident and emergency (a & e). material and methods - we looked at patterns of mortality with emphasis on the place of death. a retrospective study was performed of all patients attending an mnd clinic, who had died within a 10-year period. results - of 179 patients (63 female), 81 patients (45%) died at home, in a hospice or in a nursing home. sixty-five patients (36%) died in hospital (11 in icu or a & e). nine of the latter were previously known to have mnd and six admissions were probably avoidable. most ward patients died of respiratory causes and were treated conservatively. conclusion - the proportion of patients dying in a & e or icu was small but could have been reduced further. a number of those who died on the wards could probably have been managed conservatively at home. older patients and those with bulbar disease had a poorer prognosis. [abstract from author]; doi: 10.1034/j.1600-0404.2003.02048.x; (an 8912564)

pdf full text (108k)

6. do not resuscitate orders and older patients: findings from an ethnographic study of hospital wards for older people. by: costello, john. journal of advanced nursing, sep2002, vol. 39 issue 5, p491, 9p; abstract: background and aim. this paper reports on the findings from an ethnographic study involving three wards in two hospitals in the northwest of england and focuses on the controversial issue of do not resuscitate (dnr) orders. the study aimed to explore the way in which terminal care was provided to older patients and examined the way in which dnr orders were a socially constructed part of the practices of both nurses and doctors. method. an ethnographic approach was adopted that used participant observation and semi-structured interviews with nurses and doctors. a purposive sample of 28 qualified nurses and five medical staff were interviewed. the decision-making process of dnr orders became the focus of the interview questions. findings. the findings reveal that dnr decision-making was largely socially constructed from the interactions of hospital staff. patients were not asked their preference and were excluded from any decision-making about cardiopulmonary resuscitation (cpr) or dnr orders. two major findings emerge. first, dnr orders and the non-use of cpr could be seen as a form of medical beneficence, resulting from the often described paternalistic attitudes of hospital doctors. second, there was a clear indication that dnr orders and the non-use of cpr for certain patients was based on improving the quality of patients' lives. conclusion. the study raises issues about the quality of care received by frail older patients whom the nurses felt would not survive a futile medical procedure. the conclusion considers the need for hospitals to formulate and implement cpr policies, particularly in the prevailing climate in which patients are encouraged to become active participants in their own health care. [abstract from author]; doi: 10.1046/j.1365-2648.2002.02314.x; (an 7163978)

pdf full text (84k) html full text

7. decision-making in the treatment of elderly people: a cross-cultural comparison between swedish and german physicians and nurses. by: richter, jörg; eisemann, martin r; bauer, barbara; kreibeck, hannelore; åström, sture. scandinavian journal of caring sciences, jun2002, vol. 16 issue 2, p149, 8p; abstract: decision-making in the treatment of elderly people: a cross-cultural comparison between swedish and german physicians and nurses the aim of the study was to evaluate the comparability of decisions in the treatment of severely ill incompetent elderly patients among physicians and nurses from a cross-cultural perspective. convenience samples of 192 doctors and 182 nurses from germany and 104 doctors and 122 nurses from sweden have been investigated by a questionnaire in a cross-sectional study. between 39 and 58% of the subjects in the various groups have chosen treatment options, which are not consistent with the patient's will. however, nurses showed a significantly higher compliance than doctors. the probability of choosing cardio-pulmonary resuscitation decreased with increasing information about the patient's wish. ethical concerns and the patient's wishes appeared as the most important determinants of treatment decisions, whereas the hospital costs as well as the physicians' religion were of minor importance. the inconsistencies concerning decision- making within and between the groups reflect differences in underlying values and lack of societal consensus, which represent a prerequisite for the improvement of patient autonomy. to focus more frequently and to a larger extent onto the problems related to the treatment of severely ill elderly patients as well as onto the training of communication skills with an orientation towards informed consent in the medical training seems to be warranted. [abstract from author]; doi: 10.1046/j.1471-6712.2002.00072.x; (an 6652426)

pdf full text (85k)

8. the use of life-sustaining treatments in hospitalized persons aged 80 and older. by: somogyi-zalud, emese; zhong, zhenshao; hamel, mary beth; lynn, joanne. journal of the american geriatrics society, may2002, vol. 50 issue 5, p930, 5p; abstract: objectives: to characterize the use of life-sustaining treatments in hospitalized patients aged 80 and older. design: a prospective cohort study. setting: four teaching hospitals in the united states that participated in the hospitalized elderly longitudinal project (help). participants: hospitalized patients aged 80 and older. measurements: we report the rates of admissions to intensive and coronary care units and the rates of use of cardiopulmonary resuscitation (cpr), ventilators, right heart catheterization, artificial nutrition and hydration, surgical interventions, hemodialysis, and blood transfusions. results: of the 1,266 patients enrolled in help, 72 died during the enrollment hospitalization. the median age of those who died was 86 (range 83-89). of the patients who died, the median number of activities of daily living impairments was two (range 1-4) before hospitalization, and 70% reported their baseline quality of life as fair or poor. most patients who died had stated that they did not want aggressive care; 70% wanted their care focused on comfort rather than prolonging life, and 80% had a do-not-resuscitate order. however, the majority (63%) of the patients received one or more life-sustaining treatments before they died. fifty-four percent were admitted to intensive or coronary care units, 43% were on a ventilator, 18% received cpr, 18% received tube feeding, 17% underwent surgery, 15% had right heart catheterization, 14% received blood transfusions, and 6% had hemodialysis. intensive care did not affect survival time. conclusion: the use of life-sustaining treatments was prevalent in very old patients who died in the course of hospitalization, despite the fact that the majority had a preference for comfort care. this lack of congruence warrants further investigation and efforts to provide care that is more consistent with patients' preferences. [abstract from author]; doi: 10.1046/j.1532-5415.2002.50222.x; (an 6697781)

pdf full text (57k)

9. community-acquired pneumonia and do not resuscitate orders. by: marrie, thomas j; fine, michael j; kapoor, wishwa n; coley, christopher m; singer, daniel e; obrosky, d. scott. journal of the american geriatrics society, feb2002, vol. 50 issue 2, p290, 10p, 6 charts; abstract: focuses on community-acquired pneumonia in adults and do not resuscitate orders. prevalence of pneumonia in older people; aversion of cardiopulmonary resuscitation in patients; development of do not resuscitate policies.; doi: 10.1046/j.1532-5415.2002.50061.x; (an 5920114)

pdf full text (104k)

10. outcome and cost-effectiveness of cardiopulmonary resuscitation after in-hospital cardiac arrest in octogenarians. by: paniagua, david; lopez-jimenez, francisco; mangione, carol m.; fleischmann, kirsten; lamas, gervasio a.; londoño, juan c.. cardiology, 2002, vol. 97 issue 1, p6, 6p, 1 chart, 1 graph; abstract: context: octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (cpr) after in-hospital cardiac arrest in this population. objective: we sought to investigate the clinical benefit and cost-effectiveness of cpr after in-hospital cardiac arrest in octogenarians. main outcome measure: years of life saved. design: effectiveness data were obtained from a review of 91,372 hospital discharges from january 1st, 1993 until june 30th, 1996. cardiac arrest was reported in 956 patients. the study group consisted of 474 patients ≥80 years old. cpr costs included equipment and training, physician and nursing time and medications. post-cpr expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. life expectancy of the patients who were still alive at the end of the study was estimated from census data. a utility of 0.8 was used to calculate quality-adjusted-life years saved (qalys). we used a societal perspective for analysis. results: the study population was 86 ± 4.8 years old (range 80-103), and 42% were male. fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. assuming that a cardiac arrest without cpr has 100% mortality, 12 octogenarians required treatment with cpr in order to save one life to hospital discharge. similarly, 29 octogenarian patients with cardiac arrest have to be treated with cpr to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). the cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was usd 50,412 per year of life saved, and usd 63,015 per qalys. however, a utility of 0.5 yielded a cost of usd 100,825 per qalys. conclusion: in comparison with other life-saving strategies, cpr in octogenarians is effective. the favorable... [abstract from author]; doi: 10.1159/000047412; (an 11374633)

pdf full text (170k)

(cont'd next post)

NursingSchoolWife · Dec 2, 2004

11. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. By: van Lommel, Pim; van Wees, Ruud; Meyers, Vincent; Elfferich, Ingrid. Lancet, 12/15/2001, Vol. 358 Issue 9298, p2039, 7p, 5 charts; Abstract: Summary: Background: Some people report a near-death experience (NDE) after a life-threatening crisis. We aimed to establish the cause of this experience and assess factors that affected its frequency, depth, and content. Methods: In a prospective study, we included 344 consecutive cardiac patients who were successfully resuscitated after cardiac arrest in ten Dutch hospitals. We compared demographic, medical, pharmacological, and psychological data between patients who reported NDE and patients who did not (controls) after resuscitation. In a longitudinal study of life changes after NDE, we compared the groups 2 and 8 years later. Findings: 62 patients (18%) reported NDE, of whom 41 (12%) described a core experience. Occurrence of the experience was not associated with duration of cardiac arrest or unconsciousness, medication, or fear of death before cardiac arrest. Frequency of NDE was affected by how we defined NDE, the prospective nature of the research in older cardiac patients, age, surviving cardiac arrest in first myocardial infarction, more than one cardiopulmonary resuscitation (CPR) during stay in hospital, previous NDE, and memory problems after prolonged CPR. Depth of the experience was affected by sex, surviving CPR outside hospital, and fear before cardiac arrest. Significantly more patients who had an NDE, especially a deep experience, died within 30 days of CPR (p

PDF Full Text (919K) HTML Full Text

12. Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study. By: Cook, Deborah J; Guyatt, Gordon; Rocker, Graeme; Sjokvist, Peter; Weaver, Bruce; Dodek, Peter; Marshall, John; Leasa, David; Levy, Mitchell; Varon, Joseph; Fisher, Malcolm; Cook, Richard. Lancet, 12/8/2001, Vol. 358 Issue 9297, p1941, 5p, 3 charts; Abstract: Summary: Background: Resuscitation directives should be a sign of patient's preference. Our objective was to ascertain prevalence, predictors, and procurement pattern of cardiopulmonary resuscitation directives within 24 h of admission to the intensive-care unit (ICU). Methods: We enrolled 2916 patients aged 18 years and older from 15 ICUs in four countries, and recorded whether, when, and by whom their cardiopulmonary resuscitation directives were established. By polychotomous logistic regression we identified factors associated with a resuscitate or do-not-resuscitate directive. Findings: Of 2916 patients, 318 (11%; 95% CI 9.8-12.1) had an explicit resuscitation directive. In 159 (50%; 44.4-55.6) patients, the directive was do-not-resuscitate. Directives were established by residents for 145 (46%; 40.0-51.3) patients. Age strongly predicted do-not-resuscitate directives: for 50-64, 65-74, and 75 years and older, odds ratios were 3.4 (95% CI 1.6-7.3), 4.4 (2.2-9.2), and 8.8 (4.4-17.8), respectively. APACHE II scores greater than 20 predicted resuscitate and do-not-resuscitate directives in a similar way. An explicit directive was likely for patients admitted at night (odds ratio 1.4 [1.0-1.9] and 1.6 [1.2-2.3] for resuscitate and do-not-resuscitate, respectively) and during weekends (1.9 [1.3-2.7] and 2.2 [1.5-3.2], respectively). Inability to make a decision raised the likelihood of a do-not-resuscitate (3.7 [2.6-5.4]) than a resuscitate (1.7 [1.2-2.3]) directive (p=0.0005). Within Canada and the USA, cities differed strikingly, as did centres within cities. Interpretation: Cardiopulmonary resuscitation directives established within 24 h of admission to ICU are uncommon. As well as clinical factors, timing and location of admission might determine rate and nature of resuscitation directives. [ABSTRACT FROM AUTHOR]; (AN 5632600)

PDF Full Text (97K) HTML Full Text

13. Do-not-resuscitate decisions: too many, too few, too late? By: Davey, Basiro. Mortality, Nov2001, Vol. 6 Issue 3, p247, 18p; Abstract: In April 2000 Age Concern England publicized an account of a do-not-resuscitate (DNR) decision written in the hospital notes of an older patient without her knowledge, and the British media claimed doctors 'let older patients die' who could have been resuscitated. This paper explores this belief in the context of an ethnographic study of communication between medical and nursing staff on two acute surgical wards, which took place shortly before this media outcry. DNR decisions emerged as a key area in which staff felt their communication with each other, with patients and (to a lesser extent) with relatives was poor. Contrary to media accounts that 'too many' DNR decisions occurred, the need to consider withholding resuscitation was generally neglected by doctors in these wards, in contravention of British Medical Association/Royal College of Nursing guidelines. Nurses and junior doctors thought 'too few' DNR decisions were taken and sometimes 'too late' to prevent serious harm to dying patients subjected to futile resuscitation attempts. Evidence of ageism in DNR decision making was weak, but reflections are offered on the influence of 'social worth' and 'moral imperatives' in DNR decision making. The process of unearthing unexpected findings during ethnographic research and testing emerging themes opportunistically is briefly considered. [ABSTRACT FROM AUTHOR]; DOI: 10.1080/13576270120082925; (AN 5493439)

PDF Full Text (172K)

14. Geriatric Trauma. By: Newton, Kim. Topics in Emergency Medicine, Sep2001, Vol. 23 Issue 3, p1, 12p, 1 chart; Abstract: As the number of senior citizens in the United States continues to rise, trauma will be a growing concern. Unfortunately, when older people are injured, they are more likely to suffer complications and have a higher mortality rate than their younger counterparts. As a result, traumatized geriatric patients present a special problem for the emergency physician. This article focuses on some of the common injury mechanisms, physiologic changes associated with aging, specific injuries, and the evaluation and treatment of older patients with injuries. Key words: abuse, evaluation, geriatric, injury, mechanism, mortality, resuscitation, trauma [ABSTRACT FROM AUTHOR]; (AN 6873893)

PDF Full Text (159K)

15. Internal Low Energy Atrial Cardioversion: Efficacy and Safety in Older Patients with Chronic Persistent Atrial Fibrillation. By: Boriani, Giuseppe; Biffi, Mauro; Magagnoli, Giorgia; Zannoli, Romano; Branzi, Angelo. Journal of the American Geriatrics Society, Jan2001, Vol. 49 Issue 1, p80, 5p; Abstract: BACKGROUND: Low-energy internal atrial cardioversion is a relatively new technique based on delivery of intracardiac shocks through transvenous catheters placed into the atria or the vessels. OBJECTIVE: The aim of this study was to assess in older and younger patients with chronic persistent atrial fibrillation (AF) the efficacy and safety of transvenous low-energy internal atrial cardioversion performed without routine administration of sedatives or anesthetics. DESIGN: A prospective longitudinal study. SETTING: A cardiological university hospital. PARTICIPANTS: 82 patients, divided into older (≥60 years) (n = 49) and younger (n = 33) subjects. MEASUREMENTS: Atrial defibrillation threshold for internal cardioversion, measured as leading edge voltage (V) and delivered energy (J) of effective shocks, percentage of patients maintaining sinus rhythm at short-term (within 3 days) and at long-term follow-up. METHODS: Patients with chronic persistent AF, treated with oral anticoagulants for at least 3 to 4 weeks, were admitted to hospital. Following a clinical work-up, patients were subjected to low-energy internal atrial cardioversion with shock delivery according to a step-up protocol. RESULTS: Internal cardioversion was effective in restoring sinus rhythm in 90% (44/49) of the older patients and in 94% (31/33) of the younger patients. Shocks were effective at a mean energy between 6 and 8 joules (range 0.923) and administration of sedatives or anesthetics was required during the procedure in 22% (11/49) of older and in 48% (16/33) of younger patients (P = .026 at chisquare). No major complications occurred during the procedure. Pharmacological prophylaxis of AF recurrences was instituted immediately following the procedure. During inhospital stay and during the follow-up (mean 12 ± 9 months for older patients and 15 ± 10 months for younger patients), AF recurred in 39% (17/44) of older patients and in 16% (5/31) of younger subjects (P = .064 at... [ABSTRACT FROM AUTHOR]; (AN 6073297)

PDF Full Text (134K)

16. End-Of-Life Decision Making. By: Rosenfeld, Kenneth E.; Wenger, Neil S.; Kagawa-Singer, Marjorie. JGIM: Journal of General Internal Medicine, Sep2000, Vol. 15 Issue 9, p620, 6p; Abstract: OBJECTIVE: To identify the desired features of end-of-life medical decision making from the perspective of elderly individuals. DESIGN: Qualitative study using in-depth interviews and analysis from a phenomenologic perspective. SETTING: A senior center and a multilevel retirement community in Los Angeles. PARTICIPANTS: Twenty-one elderly informants (mean age 83 years) representing a spectrum of functional status and prior experiences with end-of-life decision making. MAIN RESULTS: Informants were concerned primarily with the outcomes of serious illness rather than the medical interventions that might be used, and defined treatments as desirable to the extent they could return the patient to his or her valued life activities. Advanced age was a relevant consideration in decision making, guided by concerns about personal losses and the meaning of having lived a "full life." Decision-making authority was granted both to physicians (for their technical expertise) and family members (for their concern for the patient's interests), and shifted from physician to family as the patient's prognosis for functional recovery became grim. Expressions of care, both by patients and family members, were often important contributors to end-of-life treatment decisions. CONCLUSIONS: These findings suggest that advance directives and physician-patient discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions, such as cardiopulmonary resuscitation. We propose a model of collaborative surrogate decision making by families and physicians that encourages physicians to assume responsibility for recommending treatment plans, including the provision or withholding of specific life-sustaining treatments, when such recommendations are consistent with patients' and families' goals for care. KEY WORDS: advance care planning; aged; decision making; life-sust... [ABSTRACT FROM AUTHOR]; (AN 5805094)

PDF Full Text (642K)

17. Interactions between nurses during handovers in elderly care. By: Payne, Sheila; Hardey, Michael; Coleman, Peter; Payne, Sheila. Journal of Advanced Nursing, Aug2000, Vol. 32 Issue 2, p277, 9p; Abstract: Interactions between nurses during handovers in elderly care This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n=34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. Data were collected from five acute elderly care wards at a district general hospital in the south of England. Results from this empirical study indicate that handovers were formulaic, partial, cryptic, given at high speed, used abbreviations and jargon, required socialized knowledge to interpret, prioritized biomedical accounts and emphasized physical aspects of care. Patients' resuscitation status was highly salient to all grades of nurse. Doing 'paperwork' was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records. [ABSTRACT FROM AUTHOR]; (AN 5850723)

PDF Full Text (83K) HTML Full Text

18. Adverse Sedation Events in Pediatrics: A Critical Incident Analysis of Contributing Factors. By: Cote, Charles J.; Notterman, Daniel A.; Karl, Helen W.; Weinberg, Joseph A.; McCloskey, Carolyn. Pediatrics, Apr2000 Part 1 of 2, Vol. 105 Issue 4, p805, 10p; Abstract: ABSTRACT. Objective. Factors that contribute to adverse sedation events in children undergoing procedures were examined using the technique of critical incident analysis. Methodology. We developed a database that consists of descriptions of adverse sedation events derived from the Food and Drug Administration's adverse drug event reporting system, from the US Pharmacopeia, and from a survey of pediatric specialists. One hundred eighteen reports were reviewed for factors that may have contributed to the adverse sedation event. The outcome, ranging in severity from death to no harm, was noted. Individual reports were first examined separately by 4 physicians trained in pediatric anesthesiology, pediatric critical care medicine, or pediatric emergency medicine. Only reports for which all 4 reviewers agreed on the contributing factors and outcome were included in the final analysis. Results. Of the 95 incidents with consensus agreement on the contributing factors, 51 resulted in death, 9 in permanent neurologic injury, 21 in prolonged hospitalization without injury, and in 14 there was no harm. Patients receiving sedation in nonhospital-based settings compared with hospital-based settings were older and healthier. The venue of sedation was not associated with the incidence of presenting respiratory events (eg, desaturation, apnea, laryngospasm, ~80% in each venue) but more cardiac arrests occurred as the second (53.6% vs 14%) and third events (25% vs 7%) in nonhospital-based facilities. Inadequate resuscitation was rated as being a determinant of adverse outcome more frequently in nonhospital-based events (57.1% vs 2.3%). Death and permanent neurologic injury occurred more frequently in nonhospital-based facilities (92.8% vs 37.2%). Successful outcome (prolonged hospitalization without injury or no harm) was associated with the use of pulse oximetry compared with a lack of any documented monitoring that was associated with unsuccessful outcome (death or permanent n... [ABSTRACT FROM AUTHOR]; (AN 3009684)

PDF Full Text (1.0MB) HTML Full Text

19. The decision to resuscitate: older people's views. By: Phillips, Karen; Woodward, Valerie; Phillips, Karen. Journal of Clinical Nursing, Nov99, Vol. 8 Issue 6, p753, 9p; Abstract: * The aim of this study was to explore how a healthy sample of the older population feel about resuscitation and the decision not to resuscitate certain patients. * Their views were sought on whether a Do Not Resuscitate decision is appropriate in certain circumstances, whom they think should be involved in the decision, whether they think patients should be consulted, and if they would like to be involved in the decision themselves. * Two focus groups were held in a day care setting in order to collect data, and a thematic analysis was conducted. * Participants thought that a Do Not Resuscitate decision should be discussed with patients and also with relatives if appropriate. * However, there was ambivalence about whether individuals would like to be involved personally in such a decision because of the anxiety this would produce. [ABSTRACT FROM AUTHOR]; DOI: 10.1046/j.1365-2702.1999.00298.x; (AN 5904052)

PDF Full Text (72K) HTML Full Text

20. A Multimedia Intervention on Cardiopulmonary Resuscitation and Advance Directives. By: Yamada, Ryo; Galecki, Andrzej T.; Goold, Susan Dorr; Hogikyan, Robert V.. JGIM: Journal of General Internal Medicine, Sep99, Vol. 14 Issue 9, p559, 5p, 2 charts, 1 diagram; Abstract: OBJECTIVE: To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. DESIGN: Prospective randomized controlled, single blind study of educational interventions. SETTING: General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). PARTICIPANTS: One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. INTERVENTION: The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. MEASUREMENTS AND MAIN RESULTS: Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p

PDF Full Text (211K)

21. No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. By: Martinot, A; Grandbastien, B; Leteurtre, S; Duhamel, A; Leclerc, F. Acta Paediatrica, 9/17/98, Vol. 87 Issue 7, p769, 5p, 3 charts; Abstract: Objective: To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death. Design: A 4-month prospective cohort study. Setting: Nine French multidisciplinary paediatric intensive care units. Patients: All patients who died in PICUs, except premature babies. Main results: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months). Conclusions: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations. [ABSTRACT FROM AUTHOR]; DOI: 10.1080/080352598750013860; (AN 4897749)

PDF Full Text (65K)

22. Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin? By: Reikvam; Abdelnoor; Sivertssen; Reikvam, Asmund. Journal of Internal Medicine, Apr98, Vol. 243 Issue 4, p259, 5p; Abstract: Reikvam Å, Abdelnoor M , Sivertssen E for the European Secondary Prevention Study Group (Ullevål University Hospital, Oslo, Norway). Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin? J Intern Med 1998; 243: 259-63. ObjectivesThere are conflicting views on how hospital mortality with respect to acute myocardial infarction (AMI) has changed since the introduction of thrombolytics and aspirin. Our purpose therefore was to explain this by studying hospital mortality in a nonselected AMI population, and then assess how patients allocated to different treatment groups contribute to overall mortality. DesignExtensive data were collected on all AMI patients admitted to the 10 hospitals in health region 1 (population 850 000) in Norway during a 2 month period. A protocol approved by the European Secondary Prevention Study Group was used. ResultsOf the 487 patients, 32% received thrombolytics, 72% aspirin and 22% none of the treatments. Average in-hospital mortality was 18%. Mortality within the different groups was as follows: no thrombolytics nor aspirin group 35.0% (39/111), aspirin group 13.7% (30/218), thrombolytics group 17.3% (4/23), and thrombolytics plus aspirin group 11.0% (15/135). The characteristics of the non-treated group compared to the aspirin and aspirin plus thrombolytics groups were more females, older, increased frequency of previous AMI, left ventricular failure, cardiopulmonary resuscitation, history of stroke and peptic ulcer, and electrocardiogram (ECG) findings other than ST elevation. ConclusionIn a nonselected AMI population, a patient group receiving neither thrombolytics nor aspirin contributed most significantly to an overall high mortality. This indicates a modest reduction in total AMI mortality after the new therapies were introduced, as the mortality for this group, with a high risk profile, has presumably remained unchanged. [ABSTRACT FROM AUTHOR]; (AN 5661316)

PDF Full Text (144K)

23. 'DO NOT RESUSCITATE': HOW? WHY? AND WHEN? By: Skerritt, Ursula; Pitt, Brice. International Journal of Geriatric Psychiatry, Jun97, Vol. 12 Issue 6, p667, 4p, 4 charts, 1 graph; Abstract: Objective . The main objective was to discover who had 'Do Not Resuscitate' (DNR) status, why, how, when and by whom these decisions were made. Design, setting and patients . The medical and nursing notes of all inpatients (139) (age range 16-100 years) in an inner city district general hospital on a single day were examined to determine the resuscitation status, age, sex and diagnosis of each patient. Result . A decision not to resuscitate had been taken in 28 (20%) of the cases. 'Do Not Resuscitate' (DNR) patients were significantly older and more likely to suffer from malignant and cardiorespiratory disease. Patients with dementia and other psychiatric disorders were not significantly more often labelled DNR. Evidence of consultation for these decisions was lacking and the recording erratic. Conclusions . (1) There is a great need to devise and implement comprehensive guidelines. (2) There is need for appropriate and comprehensive documentation outlining the reasons why and how the decision was taken, who was consulted and review date. (3) This is an important area for audit. [ABSTRACT FROM AUTHOR]; (AN 11820840)

PDF Full Text (109K)

24. Individual differences and surrogate medical decisions: differing preferences for life-sustaining treatments. By: Allen-Burge, R.; Haley, W. E.. Aging & Mental Health, May97, Vol. 1 Issue 2, p121, 11p, 2 graphs; Abstract: Abstract This study examines the relationships between patient characteristics and surrogate decision maker characteristics on surrogates' preferences for life-sustaining treatments. Caucasian and African-American caregivers and noncaregivers (n=110) responded to a vignette involving a medical crisis in a hospitalized older man who suffered cardiac arrest, one of the most common causes of death among older Americans. This man was described as either a cognitively intact or moderately demented family member. Participants made decisions regarding cardiopulmonary resuscitation (CPR), CPR and ventilation, and CPR and tube feeding. Analyses followed a 2 (cognitive status) 2 (caregiving status) 2 (racial background) analysis of covariance design, with education and income used as covariates. In general, participants were less likely to initiate life-sustaining treatments in demented patients. Caucasian caregivers were less likely to initiate CPR and ventilation and CPR and tube feeding. Results indicate that characteristics of the patient and the interplay between cultural issues and experience with caregiving affect surrogate judgements regarding life-sustaining treatments. [ABSTRACT FROM AUTHOR]; DOI: 10.1080/13607869757218; (AN 6654532)

PDF Full Text (957K) HTML Full Text

25. Cardiopulmonary resuscitation and neurological complications in the elderly. By: Carlen, Peter L.; Gordon, Michael. Lancet, 5/20/95, Vol. 345 Issue 8960, p1253, 2p; Abstract: Opinion. Investigates six-month mortality and neurological complications after cardiopulmonary resuscitation (CPR) in elderly patients. Definition of good neurological outcome; Relation between poor neurological status and high mortality rates; Poor survival of elderly patients with medical and cognitive dysfunction; Vulnerability of brain to hypoxic-ischemic insults with age.; (AN 9507104517)

HTML Full Text

26. Resuscitation in the Elderly: A Blessing or a Curse? By: Podrid, Philip J.. Annals of Internal Medicine, 8/1/89, Vol. 111 Issue 3, p193, 3p; Abstract: Editorial. Presents various studies related to the question of survival after resuscitation in the elderly people in the U.S. Reasons for the concern of elderly people with chronic illness; Effect of chronic disease on survival rate; Causes of sudden cardiac death; Implications of the study on the elder people; Role of chronic care in the life of elderly patients; Effects on surviving patients after resuscitation.; (AN 6948057)

PDF Full Text (834K)

27. Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met? II. Training and Equipping Emergency Medical Services Providers for Pediatric Emergencies. By: Seidel, James S.. Pediatrics, Nov86, Vol. 78 Issue 5, p808, 5p; Abstract: Emergency medical services have been organized to meet the needs of adult patients. A study was undertaken to determine the training in pediatrics offered to paramedics and emergency medical technicians throughout the United States and the equipment carried by prehospital care provider agencies. Most training (50%) takes place at colleges and universities and the remainder at hospitals and emergency medical services agencies. Many programs (40%) have less than ten hours of didactic training in pediatrics and 41% offer ten hours or less of clinical experience. Some programs offer no training in pediatric emergency medicine. The most common deficiencies in pediatric equipment included backboards, pediatric drugs, resuscitation masks, and small intravenous catheters. More attention to training and equipping prehospital personnel for pediatric emergencies may help to improve outcomes of out-of-hospital resuscitations of infants and children. Pediatrics 1986;78:808-812; prehospital care, pediatric emergency, emergency medical services, paramedic training, emergency medical technician. [ABSTRACT FROM AUTHOR]; (AN 4746426)

PDF Full Text (386K)

RuthieRN2008 · Dec 2, 2004

hey whisper,

i looked through proquest for you, but i can't find this article either. i found this one though that seems to be really interesting:

resusicitation decisions in the elderly: a discussion of current thinkingbruce-jones, peter n e. journal of medical ethics. london: oct 1996.vol.22, iss. 5; pg. 286, 6 pgs

or this one:

development and implementation of resuscitation guidelines: a personal experienceshaun t o'keefe. age and ageing. oxford: jan 2001.vol.30, iss. 1; pg. 19

hope i could help you out,

ruthie

maire, ASN, RN · Dec 2, 2004

Just an an FYI, this thread was started in February 2003.