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At least 73 records · Page 4Linked to original sources
PubMed1990

Effect of New York State's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice.

PURPOSE: On April 1, 1988, New York State enacted legislation governing the withholding of cardiopulmonary resuscitation (CPR). Suggestions that the mandated protocol for withholding CPR is too cumbersome and will result in an increase in CPR attempts led us to study the effect of the new law on in-hospital resuscitation practice. PATIENTS AND METHODS: We retrospectively reviewed the charts of 245 adult in-patients at a county teaching hospital who died during three-month periods before and after the law took effect. RESULTS: There was a statistically nonsignificant decline in the frequency of CPR attempts at the time of death, from 59 (50%) of 119 patients in 1987 to 57 (45%) of 126 patients in 1988. Use of explicit written "do-not-resuscitate" (DNR) orders increased significantly from 13 (22%) of 60 patients who died without CPR in 1987 to 64 (93%) of 69 patients in 1988. Patient and family involvement in decisions to withhold CPR was common before the law and did not change significantly. CONCLUSION: Although changing the way DNR decisions are documented, the legislation resulted in no significant change either in the frequency of CPR or in the degree to which patients are involved in these decisions.

Adult↗
PubMed1993

How well is the Patient Self-Determination Act working?: an early assessment.

OBJECTIVES: To assess the association between implementation of the Patient Self-Determination Act (PSDA) and (1) the use of formal, written advance directives, (2) the use of informal advance care arrangements, and (3) discussions between patients and their physicians and proxies an advance care planning and end-of-life treatment preferences. DESIGN: A time-sequence study in which patients discharged from acute care hospitals 1 month before the implementation of the PSDA and 5 months after implementation of the PSDA were interviewed. SETTING: Two medical school-affiliated, major teaching hospitals with more than 500 beds and 3 nonteaching community hospitals with fewer than 400 beds in eastern Massachusetts. PATIENTS: A total of 579 adult patients were interviewed: 258 patients discharged before the implementation of the PSDA (pre-PSDA) and 321 patients discharged 5 months after implementation of the PSDA (post-PSDA). MEASUREMENTS: Patients were asked about their formal, written or informal advance care planning arrangements, about the frequency of inquiries and information provided on advance care planning by the hospitals, and about their discussions of advance care planning and end-of-life treatment preferences with physicians and their proxies. RESULTS: In the pre-PSDA cohort, 60.9% of the patients had some kind of advance care planning, whereas in the post-PSDA cohort, 72.6% did (p = 0.01). However, there was not a significant increase in the proportion of patients who had advance care planning "in a written document" (19.8% of the pre-PSDA cohort compared with 25.5% of the post-PSDA cohort, p = 0.11). The increase in written advance care planning was concentrated in the community, nonteaching hospitals (10.7% pre-PSDA versus 23.7% post-PSDA). Overall, 41.4% of patients recalled inquiries or information about advance care planning during their hospitalization. Implementation of the PSDA was not associated with a significant change in the proportion of patients who discussed advance care planning or end-of-life issues with their physicians (13.6% pre-PSDA versus 17.1% post-PSDA, p = 0.25). However, there was an increase in the proportion of patients with poorer health who spoke with their physicians (15.4% pre-PSDA versus 24.8% post-PSDA). Implementation of the PSDA was associated with an increase in the proportion of patients who had general discussions with proxies about end-of-life issues (61.8% pre-PSDA versus 73.0% post-PSDA, p = 0.024). However, 33.6% of pre-PSDA and 33.2% of post-PSDA patients had detailed discussions with their proxy about specific interventions such as mechanical ventilation or artificial nutrition. Patients with formal proxies had detailed discussions significantly more frequently than other patients (50.0% versus 26.8%, p < 0.0001). CONCLUSIONS: The PSDA was associated with significant effects on general advance care planning issues, increasing the proportion of patients who had (1) some kind of advance care arrangements and (2) general discussions of end-of-life issues with their proxies. However, the PSDA did not appear associated with significant increases (1) in the use of formal, written advance care documents, (2) in the frequency of discussions between patients and their physicians on advance care documents or end-of-life issues, or (3) in the frequency of discussions about specific treatment preferences between patients and their proxies.

Adolescent↗
PubMedDate not supplied

Nationwide practices for screening and reporting prenatal cocaine abuse: a survey of teaching programs.

Questionnaires surveying policies and opinions about prenatal cocaine abuse were sent to training programs nationwide. Eighty-one pediatric and 81 obstetric programs from 42 states responded. Although respondents favored routinely screening all patients by maternal history (81%) and by urine toxicology (36%), only 64% and 8%, respectively, reported these as established policy. Physicians reporting higher regional prenatal cocaine abuse rates more commonly favored universal perinatal screening (p = .009), but established policies were similar regardless of local prevalence (p = .19). Fifty-two percent of respondents were unaware of their state's requirements for reporting prenatal cocaine abuse. While most physicians favored interventions such as voluntary drug rehabilitation (64%) and family support services (64%), some physicians favored foster care placement for the infants (28%) and involuntary drug rehabilitation (31%). Only 3% felt that criminal prosecution of the mother was appropriate. Policies for managing prenatal cocaine abuse often did not reflect physicians' opinions. A multidisciplinary medical, social, and legal approach is needed to develop effective management policies.

Cocaine↗