Objectives: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.
Design: Retrospective cohort study.
Setting: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults.
Participants: HRS decedents aged 66 and older (N = 3,069).
Measurements: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.
Results: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51-0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54-0.94), cancer (AOR = 0.60, 95% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48-3.13) and black race (AOR = 2.02, 95% CI = 1.52-2.69) each doubled one's odds of undergoing an intensive procedure.
Conclusion: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.
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http://dx.doi.org/10.1111/jgs.13104 | DOI Listing |
Prehosp Disaster Med
January 2025
Department of Pediatric Emergency Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Background: Drowning persists as a preventable pediatric cause of severe morbidity and mortality. This study aims to investigate the risk factors, circumstances, and medical consequences associated with pediatric drowning incidents in order to identify patterns that can inform targeted interventions.
Methods: This was a retrospective analysis of a cohort of pediatric drowning cases.
Eur J Neurol
January 2025
Epilepsy Center, Department of Neurology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
Background: Epileptiform activity, including status epilepticus (SE), occurs in up to one-third of comatose survivors of cardiac arrest and may predict poor outcome. The relationship between SE and hypoxic-ischemic brain injury (HIBI) is not established.
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Cochrane Database Syst Rev
January 2025
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of transtracheal ultrasound for detecting endotracheal intubation in adult patients. Secondary objectives Secondary objectives include assessing the diagnostic accuracy of transtracheal ultrasound amongst the following subgroups: setting (e.
View Article and Find Full Text PDFASAIO J
January 2025
Department of Intensive Care Medicine Inselspital, Bern University Hospital University of Bern Bern, Switzerland.
Ann Med
December 2025
Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain.
Background: Delayed gastric emptying (DGE) is a frequent complication of pancreatoduodenectomy (PD) and is associated with prolonged hospital stay, readmission, increased hospital costs and decreased quality of life. However, the pathophysiology of DGE remains unclear.
Methods: This is a retrospective study of patients who underwent PD for pancreatic or periampullary tumours.
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