Background: Current guidelines recommend deferring prognostication for 48 to 72 hours after resuscitation from inhospital cardiac arrest. It is unknown whether hospitals vary in making patients who survive an arrest Do-Not-Resuscitate (DNR) early after resuscitation and whether a hospital's rate of early DNR is associated with its rate of favorable neurological survival.
Methods: Within Get With the Guidelines-Resuscitation, we identified 24,899 patients from 236 hospitals who achieved return of spontaneous circulation (ROSC) after inhospital cardiac arrest between 2006 and 2012. Hierarchical models were constructed to derive risk-adjusted hospital rates of DNR status adoption ≤12 hours after ROSC and risk-standardized rates of favorable neurological survival (without severe disability; Cerebral Performance Category ≤2). The association between hospitals' rates of early DNR and favorable neurological survival was evaluated using correlation statistics.
Results: Of 236 hospitals, 61.7% were academic, 83% had ≥200 beds, and 94% were urban. Overall, 5577 (22.4%) patients were made DNR ≤12 hours after ROSC. Risk-adjusted hospital rates of early DNR varied widely (7.1%-40.5%, median: 22.7% [IQR: 19.3%-26.1%]; median OR of 1.48). Significant hospital variation existed in risk-standardized rates of favorable neurological survival (3.5%-44.8%, median: 25.3% [IQR: 20.2%-29.4%]; median OR 1.72). Hospitals' risk-adjusted rates of early DNR were inversely correlated with their risk-standardized rates of favorable neurological survival (r=-0.179, P=.006).
Conclusions: Despite current guideline recommendations, many patients with inhospital cardiac arrest are made DNR within 12 hours after ROSC, and hospitals vary widely in rates of early DNR. Higher hospital rates of early DNR were associated with worse meaningful survival outcomes.
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http://dx.doi.org/10.1016/j.ahj.2017.05.017 | DOI Listing |
Infect Control Hosp Epidemiol
January 2025
Virology Department, AP-HP, Hôpital Saint-Louis, Paris, France.
Objective: Patients with chronic kidney disease suffer from immune dysfunction, increasing susceptibility to infections. The aim of the study was to investigate air contamination with respiratory viruses in a dialysis unit at a quaternary hospital using molecular detection techniques and to analyze airflow dynamics through computational fluid dynamics (CFD) simulations for a comprehensive assessment of air transmission risks.
Methods: We conducted dialysis unit air sampling using AerosolSense™ samplers.
Worldviews Evid Based Nurs
February 2025
School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
Background: Coronary artery disease (CAD) is a major health problem of atherosclerotic cardiovascular (CV) disease and early intervention is regarded important. Given the proven effect of a lifestyle intervention with nursing telephone counselling and mHealth use in health care, yet the comparisons of both support are lacking, this study is proposed.
Objectives: This study aimed to compare the effects of a coronary artery disease (CAD) support program using a mobile application versus nurse phone advice on exercise amount and physical and psychological outcomes for clients at risk of CAD.
Cureus
December 2024
Ophthalmology, Calderdale Royal Hospital, Halifax, GBR.
Diabetic retinopathy is the most common sight-threatening complication of diabetes, necessitating regular monitoring of progression via diabetic eye screening (DES). The National Institute for Health and Care Excellence (NICE) recommends DES annually for diabetic patients aged 12 years and older. This retrospective clinical audit assessed the reasons behind non-attendance and evaluated the adherence to guidelines set by NICE in a general practice with approximately 9000 patients.
View Article and Find Full Text PDFIntroduction Chronic obstructive pulmonary disease (COPD) is a significant contributor to global morbidity and mortality. Despite well-established management protocols, treatment remains suboptimal due to high costs and mortality rates. This study aims to compare the impact of initial oxygenation status, Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF), and National Early Warning Score 2 (NEWS2) scores on management outcomes in COPD patients.
View Article and Find Full Text PDFEur J Case Rep Intern Med
December 2024
Intensive Care Unit, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, Portugal.
Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome marked by excessive immune activation. It can be triggered by various factors, including infections, malignancies, and autoimmune diseases, making the diagnosis challenging due to its overlap with other severe conditions.
Case Reports: We discuss two intensive care unit (ICU) cases illustrating the diverse manifestations of HLH and the critical importance of early recognition and treatment.
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