Department of Anesthesiology and Critical Care Medicine, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, United States.
Published: June 2021
AI Article Synopsis
Article Abstract
Background: A code status documents the decision to receive or forgo cardiopulmonary resuscitation in the event of cardiac arrest. For patients who undergo a rapid response team activation (RRT) for possible escalation to an intensive care unit (ICU), the presence or absence of a code status represents a critical inflection point for guiding care decisions and resource utilization. This study characterizes the prevalence of code status at the time of RRT and how code status at RRT affects rates of intensive treatments in the ICU.
Methods: We conducted a single-center retrospective cohort study of 895 rapid response activations occurring over six months. The study included all rapid response team activations for non-obstetric adult inpatients documented in the patient chart. All data was obtained through retrospective chart review. STROBE reporting guidelines were followed.
Results: At the time of RRT activation, 56% of patients had a documented code status. Code status prevalence was much higher among medical rather than surgical services (74% vs. 13%). For patients escalated to the ICU, having a DNR code status at RRT was not associated with decreased odds of receiving cardioactive medications or advanced respiratory support. Before RRT activation, palliative care utilization was low (9%) but more than doubled after RRT (24% before discharge).
Conclusions: Barely half of the patients had an active code status at the time of RRT activation. Similar rates of invasive ICU treatments among full code and DNR patients suggest that documented code statuses do not reflect in-depth goals of care discussions, nor does it guide medical teams caring for the patient at times of decompensation.
Introduction: In an emergency room, triage is a crucial element that determines the clinical urgency of patients. Triage can dictate important decisions on the use of resources and the treatment that patients need. Many patients are seen later than necessary, wasting resources and time, and some may even be discharged without being seen, risking their lives.
Background: To describe the epidemiology and clinical characteristics of migraine and the status of treatment in Colombia. Additionally, the use of health resources by patients was measured.
Methods: This was a non-interventional, retrospective, descriptive study conducted in one Colombian Health Management Organization (HMO) from 2018 to 2022 with a follow-up period of 5 years.
Introduction: There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.
Research Design And Methods: We used visit-level data from the Georgia 2016-2019 Healthcare Cost and Utilization Project database and obtained transportation variables from open sources. Using Bayesian spatial-temporal models, we assessed the associations between transportation and DFU-related amputations within each quartile of poverty status indicators at the ZIP code tabulation area (ZCTA) level.
Study Question: Is it possible to predict an euploid chromosomal constitution and identify a transcriptomic profile compatible with extended embryonic development from RNA sequencing (RNA-Seq) data?
Summary Answer: It has been possible to obtain a karyotype comparable to preimplantation genetic testing for aneuploidy (PGT-A), in addition to a transcriptomic signature of embryos which might be suggestive of improved implantation capacity.
What Is Known Already: Conventional assessment of embryo competence, based on morphology and morphokinetic, lacks knowledge of molecular aspects and faces controversy in predicting ploidy status. Understanding the embryonic transcriptome is crucial, as gene expression influences development and implantation.
Introduction: Depression is among the most common mental illnesses, with an estimated 8.1% of adults in the United States living with the condition. Despite its prevalence, the effect of depression on surgical outcomes is not well studied.
