Mechanical Ventilation in Older Adults With Dementia: Opportunities to Promote Goal-Concordant Care.

Context: Recent studies show increasing use of mechanical ventilation among people living with dementia. There are concerns that this trend may not be driven by patient preferences.

Objectives: To better understand decision-making regarding mechanical ventilation in people living with dementia.

Factors Associated with Costly Hospital Care among Patients with Dementia and Acute Respiratory Failure.

Understanding contributors to costly and potentially burdensome care for patients with dementia is of interest to healthcare systems and may facilitate efforts to promote goal-concordant care. To identify risk factors, in particular whether an early goals-of-care discussion (GOCD) took place, for high-cost hospitalization among patients with dementia and acute respiratory failure. We conducted an electronic health record-based retrospective cohort study of 298 adults with dementia hospitalized with respiratory failure (receiving ⩾48 h of mechanical ventilation) within an academic healthcare system.

Palliative Care Consultation and Family-Centered Outcomes in Patients With Unplanned Intensive Care Unit Admissions.

Hospitalized patients who experience unplanned intensive care unit (ICU) admissions face significant challenges, and their family members have unique palliative care needs. To identify predictors of palliative care consultation among hospitalized patients with unplanned ICU admissions and to examine the association between palliative care consultation and family outcomes. We conducted a prospective cohort study of patients with unplanned ICU admissions at two medical centers in Seattle, WA.

Long-term health-related quality of life and independence among older survivors of serious injury.

Background: Little is known about the recovery experiences of older trauma intensive care unit (TICU) survivors and the relationship between geriatric trauma care and long-term functional ability and health-related quality of life (HRQOL).

Methods: We conducted a prospective cohort study of 218 patients (age, ≥65 years) admitted to a Level 1 regional trauma center TICU before versus after implementation of a geriatric care bundle with protocolized geriatrics consultations (Geri-T). Survivors or their proxies were interviewed approximately 1 year after hospitalization.

Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness.

Context: Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.

Objectives: To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.

Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19.

Context: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19.

Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19.

Hemoptysis and the Risk for Lung Transplant or Death without Transplant in Individuals with Cystic Fibrosis in the United States.

Hemoptysis is a common and important complication in persons with cystic fibrosis (PwCF). Despite this, there is limited literature on the impact of hemoptysis on contemporary cystic fibrosis (CF) outcomes. Evaluate whether hemoptysis increases the risk of lung transplant or death without a transplant in PwCF.

Frailty subtypes and recovery in older survivors of acute respiratory failure: a pilot study.

Background: Identifying subtypes of acute respiratory failure survivors may facilitate patient selection for post-intensive care unit (ICU) follow-up clinics and trials.

Methods: We conducted a single-centre prospective cohort study of 185 acute respiratory failure survivors, aged ≥ 65 years. We applied latent class modelling to identify frailty subtypes using frailty phenotype and cognitive impairment measurements made during the week before hospital discharge.

Moral distress and burnout in caring for older adults during medical school training.

Background: Moral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics.

Methods: A cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school.

Randomized controlled trial of REbeL: A peer education program to promote positive body image, healthy eating behavior, and empowerment in teens.

Short-term outcomes associated with participation in REbeL, a peer-led dissonance-based eating disorder prevention program for high school students, were evaluated. Seventy-one students across the three high schools were enrolled in the study (REbeL N = 48; Control N = 23) and were assessed on measures of eating attitudes and behaviors, body image, weight bias, self-esteem, empowerment, and mood at the beginning of the school year; 37 REbeL students and 20 control students completed assessments at the end of the school year. Mixed effects GLM compared groups on outcomes at the end of the academic year.

Patterns and Predictors of Frailty Transitions in Older Men: The Osteoporotic Fractures in Men Study.

Objectives: To describe the natural history of frailty transitions in a large cohort of community-dwelling older men and identify predictors associated with progression to or improvement from states of greater frailty.

Design: Prospective cohort study.

Setting: Six U.

Refining Low Physical Activity Measurement Improves Frailty Assessment in Advanced Lung Disease and Survivors of Critical Illness.

Rationale: The frail phenotype has gained popularity as a clinically relevant measure in adults with advanced lung disease and in critical illness survivors. Because respiratory disease and chronic illness can greatly limit physical activity, the measurement of participation in traditional leisure time activities as a frailty component may lead to substantial misclassification of frailty in pulmonary and critical care patients.

Objectives: To test and validate substituting the Duke Activity Status Index (DASI), a simple 12-item questionnaire, for the Minnesota Leisure Time Physical Activity (MLTA) questionnaire, a detailed questionnaire covering 18 leisure time activities, as the measure of low activity in the Fried frailty phenotype (FFP) instrument.

Perceptions of Caring for Adolescents With Eating Disorders Hospitalized on a General Pediatric Unit.

Purpose: To describe the perceptions of inpatient pediatric hospitalist physicians (HPs), registered nurses (RNs), and care assistants (CAs) at a tertiary pediatric hospital regarding caring for children with eating disorders (EDs) who are hospitalized for medical stabilization.

Design And Methods: A qualitative descriptive study was conducted using semi-structured individual interviews with aforementioned health care workers (HCWs) to explore their perspectives on caring for children/adolescents with EDs in relation to recent initiatives to transform their care. These initiatives focused on admitting patients to a designated "ED Unit", development of an ED consult team, providing ED education to staff, and development of ED standardized order sets (SOSs).

The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness.

Objectives: To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs.

Design: A prospective cohort study.

Setting: Urban tertiary care hospital and community hospital.

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation.

Emotion regulation difficulties are implicated in the development and maintenance of anorexia nervosa (AN). However, research has been limited by an almost exclusive reliance on self-report. This study is the first to use the emotion-modulated startle paradigm (EMSP) to investigate emotional reactivity and voluntary emotion regulation in individuals with AN.

Quantitative and Qualitative Analysis of the Quality of Life of Individuals With Eating Disorders.

Objective: To examine the quality of a broad range of life domains using both quantitative and qualitative methodologies.

Method: Forty-eight individuals seeking inpatient treatment for an eating disorder (mean age = 29.8 years, female = 100%, white = 96.

Comparison of obese adults with poor versus good sleep quality during a functional neuroimaging delay discounting task: A pilot study.

This study aimed to determine if obese adults with poor versus good sleep quality demonstrate reduced self-regulatory capacity and different patterns of neural activation when making impulsive monetary choices. Six obese, good quality sleepers (M age=44.7 years, M BMI=38.

Depression screening on a maternity unit: a mixed-methods evaluation of nurses' views and implementation strategies.

Postpartum women often suffer clinically significant depressive symptoms, a problem addressed by nurse-delivered screening programs. In the past, success of these identification programs was measured in terms of screening rates; however, merely evaluating the screening rate does little to inform how to implement depression screening in clinical practice. This article describes the experiences of nurses in implementing depression screening on a maternity unit.

Using the Neuroscience of Obesity, Eating Behavior, and Sleep to Inform the Neural Mechanisms of Night Eating Syndrome.

The development and maintenance of night eating syndrome (NES) is likely influenced by physiological, psychological, and social factors. Within the physiological domain, neural mechanisms (e.g.

How specific are the relationships between eating disorder behaviors and perfectionism?

Perfectionism is associated with several mental disorders, including depression, anxiety, and eating disorders. The goal of this study was to test the specificity of the associations between perfectionism facets and eating disorder behaviors, by examining whether neuroticism and conscientiousness mediated or moderated associations between these variables. Participants from a representative community sample (N = 407; 47% female) completed questionnaires assessing perfectionism, neuroticism, conscientiousness, and eating disorder behaviors.

Development and validation of the Eating Pathology Symptoms Inventory (EPSI).

Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed to assess 20 dimensions of eating pathology.

Current status of transition preparation among youth with special needs in the United States.

Objective: To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement.

Methods: The 2009-2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12 and 18. They are asked about transition to an adult provider, changing health care needs, increasing responsibility for health care needs, and maintaining insurance coverage.

Why do eating disorders and obsessive-compulsive disorder co-occur?

The purpose of this study was to use an alternative, dimensionally based approach to understanding the reasons for comorbidity between eating disorders and obsessive-compulsive disorder. Participants from a representative community sample (N=407; 47% female) completed self-report measures of eating pathology, obsessive-compulsive symptoms, perfectionism, and neuroticism. Hierarchical multiple regression indicated that neuroticism and perfectionism completely mediated associations between most obsessive-compulsive and eating disorder symptoms.