bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age‐Related Differences in Care Preferences, Treatment Decisions, and Clinical Outcomes of Seriously Ill Hospitalized Adults: Lessons from SUPPORT
Authors: Hamel Mary Beth , Lynn Joanne , Teno Joan M. , Covinsky Kenneth E. , Wu Albert W. , Galanos Anthony , Desbiens Norman A. , Phillips Russell S. 
Published: April 2015

OBJECTIVES: To review previously published findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).DESIGN: An observational prospective study.SETTING: Five acute care hospitals.PARTICIPANTS: A total of 9105 seriously ill patients enrolled in SUPPORT.MEASUREMENTS: The outcomes examined included patients' preferences for aggressive care, decision making regarding cardiopulmonary resuscitation and use of other life‐sustaining treatments, hospital costs, intensity of resource use, and survival.RESULTS: Although older patients preferred less aggressive care than younger patients, many older patients wanted cardiopulmonary resuscitation and care focused on life extension. Patients' families and healthcare providers underestimated older patients' desire for aggressive care. After adjustment for illness severity, comorbidity, baseline function, and patients' preferences for aggressive care, older age was associated with lower hospital costs and resource intensity and higher rates of decisions to withhold life‐sustaining treatments. In adjusted analyses, older age was associated with a slight survival disadvantage. This survival disadvantage persisted, even after adjustment for aggressiveness of care, suggesting that the relation between age and survival is not accounted for by less aggressive treatment of older patients.CONCLUSIONS: Even after adjustment for patients' prognoses and care preferences, seriously ill hospitalized older patients were treated less aggressively than younger patients. SUPPORT cannot fully identify whether the relationship between older age and less aggressive treatment is better explained by the withholding of potentially beneficial treatments from older patients, or by the excessive provision of ineffective treatment to younger patients. However, the latter explanation is favored by the SUPPORT finding that less aggressive treatment for older patients does not contribute to the modest survival disadvantage associated with older age.
Blood Transfusion Administration in Seriously Ill Patients: An Evaluation of SUPPORT Data
Authors: Borum Marie L. , Lynn Joanne , Zhong Zhenshao 
Published: April 2015

BACKGROUND: Administration of blood transfusion in seriously ill patients is highly variable. Limited data are available to guide transfusion decisions.OBJECTIVE: To explore characteristics of patients who received blood transfusions and decisions to forgo transfusions in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).DESIGN: Prospective study of preferences, decision‐making, and outcomes.SETTING: Five teaching hospitals.PARTICIPANTS: 9105 patients aged 18 years and older meeting defined diagnostic and illness severity criteria.MEASUREMENT: Data included blood transfusions, demographic characteristics, diagnoses, comorbid conditions, acute physiology score (APS), nutritional support, and functional status before hospitalization.RESULTS: A total of 2863 patients (31.4%) received blood transfusions, usually early in their hospitalization. Transfused patients were more likely male (57.3%; P = .008), with a younger mean age (56 vs 64 years), significantly higher APS (P < .001), and significantly lower 2‐ and 6‐month survival predictions (P < .001). The patients with acute respiratory failure or multiorgan system failure with sepsis (1714; 59.9% of all patients receiving transfusions), multiorgan system failure with malignancy (480, 16.8%), and cirrhosis (248, 8.7%) were more likely to receive blood than those with other diseases. Few patients made a decision not to receive blood before (5; 0.05%) or after (126; 1.4%) study entry. Most patients with decisions to forgo transfusions also had decisions against trying resuscitation.CONCLUSIONS: Most transfusions occurred in patients with acute respiratory or multiorgan system failure. Few patients decide to forgo transfusions. Additional investigation is necessary to evaluate blood transfusion practices in seriously ill patients.
A Prospective Study of Patient‐Physician Communication About Resuscitation
Authors: Golin Carol E. , Wenger Neil S. , Liu Honghu , Dawson Neal V. , Teno Joan M. , Desbiens Norman A. , Lynn Joanne , Oye Robert K. , Phillips Russell S. 
Published: April 2015

OBJECTIVE: To evaluate prospectively seriously ill patients' characteristics, perceptions, and preferences associated with discussing resuscitation (CPR) with their physicians.DESIGN: Prospective cohort.SETTING: Five academic medical centers.PARTICIPANTS: Patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments who had not communicated with their physicians about CPR at admission to a hospital for life‐threatening illness (n = 1288).MEASUREMENTS: Baseline surveys of patients' characteristics, health status, desires for participation in medical decision making, and cardiopulmonary resuscitation. Two month follow‐up surveys of patients' communication of resuscitation preference. Chart reviews for clinical indicators.RESULTS: Thirty percent of patients communicated their resuscitation preference to their physician during a 2 month‐period following hospital admission. Patients whose preference was to forgo CPR (odds ratio (OR) 2.9; (95% CI, 1.9‐4.2)) and whose preference had changed from desiring to forgoing CPR (OR 1.6; (95% CI, 1.1–2.4)) were more likely to communicate their preference than patients who continued to prefer to receive CPR. However, only 50% of patients who maintained a preference to forgo CPR communicated this over a 2‐month period. Having an advance directive and remaining in the hospital at 2‐month follow‐up were also independently associated with communication, whereas patients' preference for participation in decision‐making, health status, and prognostic estimate were not.CONCLUSIONS: Communication about resuscitation preferences occurred infrequently after hospital admission for a serious illness, even among patients wishing to forgo resuscitation. Factors such as declining quality of life, which were expected to be associated with communication, were not. An invitation to communicate about CPR preference is important after hospital admission for a serious illness. Novel approaches are needed to promote physician‐patient discussions about resuscitation.
Predicting Functional Status Outcomes in Hospitalized Patients Aged 80 Years and Older
Authors: Wu Albert W. , Yasui Yutaka , Alzola Carlos , Galanos Anthony N. , Tsevat Joel , Phillips Russell S. , Connors Alfred F. , Teno Joan M. , Wenger Neil S. , Lynn Joanne 
Published: April 2015

OBJECTIVE: To develop a model estimating the probability of a patient aged 80 years or older having functional limitations 2 months and 12 months after being hospitalized.DESIGN: A prospective cohort study.SETTING: Four teaching hospitals in the US.PARTICIPANTS: Enrolled patients were nonelective hospital admissions aged 80 years or older who stayed in hospital at least 48 hours. The 804 patients who survived and completed an interview at 2 months and the 450 who completed an interview at 12 months were from the 1266 patients in the Hospitalized Elderly Longitudinal Project (HELP) (76% and 47% of survivors, respectively). Median age of the 2‐month survivors was 84.7 years.MEASUREMENTS AND MAIN OUTCOMES: Patient function 2 and 12 months after enrollment was defined by the number of dependencies in Activities of Daily Living (ADLs). Ordinal logistic regression models were constructed to predict functional status. Predictors included demographic characteristics, disease category, geriatric conditions, severity of physiologic imbalance, current quality of life, and exercise capacity and ADLs 2 weeks before study admission.RESULTS: Before admission, 39% of patients were functionally independent in ADLs. Of patients who survived and were interviewed at 2 months, 32% were functionally independent, and at 12 months, 36% were independent. Among patients with no baseline dependencies, 42% had developed one or more limitations 2 months later, and 41% had limitations 12 months later. The patient's ability to perform activities of daily living at baseline was the most important predictor of functional status at both 2 and 12 months. In a multivariable predictive model, independent predictors of poorer functional status at 2 months included: worse baseline functional status and quality of life; depth of coma, if any; lower serum albumin level; presence of dementia, depression, or incontinence; being bedridden; medical record documentation of need for nursing home; and older age. Model performance, assessed using Somers' D, was 0.61 for 2 months and 0.57 for 12 months (Receiver Operating Characteristic (ROC) area = 0.81 and .79, respectively.) Bootstrap validation of the month 2 model also yielded a Somers' D = 0.60. The models were well calibrated over the entire risk range. The ROC area for prediction of the loss of independence was 0.76 for 2 months and 0.68 for 12 months.CONCLUSIONS: Many older patients are functionally impaired at the time of hospitalization, and many develop new functional limitations. A limited amount of readily available clinical information can yield satisfactory predictions of functional status 2 months after hospitalization. Models like this may prove to be useful in clinical care. This work illuminates a potential method for risk adjustment in research studies and for monitoring quality of care.
Decision‐Making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients
Authors: Teno Joan M. , Fisher Elliot , Hamel Mary Beth , Wu Albert W. , Murphy Donald J. , Wenger Neil S. , Lynn Joanne , Harrell Frank E. 
Published: April 2015

BACKGROUND: Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision‐making and outcomes for patients with prolonged ICU stays.OBJECTIVES: To evaluate decision‐making and outcomes for seriously ill patients with an ICU stay of at least 14 days.DESIGN: A prospective cohort study.SETTING: Five teaching hospitals.PARTICIPANTS: Seriously ill patients enrolled in the Study To Understand Prognoses and Preferences for Risks and Outcomes of Treatments (SUPPORT).MEASUREMENT: Patients, their surrogate decision‐makers, and their physicians were interviewed about prognosis, communication, and goals of medical care. Based on age, diagnoses, comorbid illnesses, and acute physiology data, the SUPPORT Prognostic Model provided estimates of 6‐month survival on study days 1, 3, 7, and 14. Hospital costs were estimated from hospital billing data.RESULTS: Of the 9105 patients enrolled in SUPPORT, 1494 (16%) had ICU stays of 14 days or longer. The median length of stay in an ICU was 4 days for the entire SUPPORT cohort and 35 days for patients who were treated in an ICU for 14 days or longer. Median hospital costs were $76,501 for patients who had ICU stays 14 days or longer and $10,916 for patients who did not have long ICU stays. Fifty‐five percent of patients with long ICU stays had died by 6 months, and an additional 19% had substantial functional impairment. Among patients with ICU stays of at least 14 days, only 20% had estimates of 6‐month survival that fell below 10% at any time during their hospitalization. For patients with long ICU stays, the mean predicted probability of 6‐month survival was 0.46 on study Day 3 and 0.47 on study Day 14. Fewer than 40% of patients (or their surrogates) reported that their physicians had talked with them about their prognoses or preferences for life‐sustaining treatment. Among the patients who preferred a palliative approach to care, only 29% thought that their care was consistent with that aim. Those who discussed their preferences for care with a physician were 1.9 times more likely to believe that treatment was in accord with their preferences for palliation (95% CI, 1.4–2.5)CONCLUSIONS: Prolonged ICU stays were expensive and were often followed by death or disability. Patients reported low rates of discussions with their physicians about their prognoses and preferences for life‐sustaining treatments. Many preferred that care focus on palliation and believed that care was inconsistent with their preferences. Patients were more likely to receive care consistent with their preferences if they had discussed their care preferences with their physicians.
Patients Who Want their Family and Physician to Make Resuscitation Decisions for Them: Observations from SUPPORT and HELP
Authors: Puchalski Christina M. , Zhong Zhensbao , Jacobs Michelle M. , Fox Ellen , Lynn Joanne , Harrold Joan , Galanos Anthony , Phillips Russell S. , Califf Robert , Teno Joan M. 
Published: April 2015

OBJECTIVE: To determine the extent to which older or seriously ill inpatients would prefer to have their family and physician make resuscitation decisions for them rather than having their own stated preferences followed if they were unable to decide themselves.DESIGN: Analysis of existing data from the Hospitalized Elderly Longitudinal Project (HELP) and the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT).SETTING: Five teaching hospitals in the United States.PARTICIPANTS: 2203 seriously ill adult inpatients (SUPPORT) and 1226 older inpatients (HELP) who expressed preferences about resuscitation and about advance decision‐making.MEASURES: We used a logistic regression model to determine which factors predicted preferences for family and physician decision‐making.RESULTS: Of the 513 HELP patients in this analysis, 363 (70.8%) would prefer to have their family and physician make resuscitation decisions for them whereas 29.2% would prefer to have their own stated preferences followed if they were to lose decision‐making capacity. Of the 646 SUPPORT patients, 504 (78.0%) would prefer to have their family and physician decide and 22.0% would prefer to have their advance preferences followed. Independent predictors of preference for family and physician decision‐making included not wanting to be resuscitated and having a surrogate decision‐maker.CONCLUSIONS: Most inpatients who are older or have serious illnesses would not want their stated resuscitation preferences followed if they were to lose decision‐making capacity. Most patients in both groups would prefer that their family and physician make resuscitation decisions for them. These results underscore the need to understand resuscitation preferences within a broader context of patient values.
Effects of T'ai Chi Training on Function and Quality of Life Indicators in Older Adults with Osteoarthritis
Authors: Hartman Catherine A. , Manos Tina M. , Winter Christa , Hartman Dwight M. , Li Baiqing , Smith John C. 
Published: April 2015

OBJECTIVE: To determine the effects of T'ai Chi training on arthritis self‐efficacy, quality of life indicators, and lower extremity functional mobility in older adults with osteoarthritis.DESIGN: A prospective, randomized, controlled clinical trial. Intervention length was 12 weeks, with outcomes measured before and after intervention using blinded testers. Group (T'ai Chi vs Control) × time (2 × 2) mixed factorial ANOVA.SETTING: Allied Health Sciences Center at Springfield College, Springfield, MAPARTICIPANTS: A total of 33 community‐dwelling participants (mean age 68) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks.INTERVENTION: T'ai Chi training included two 1‐hour T'ai Chi classes per week for 12 weeks.MEASUREMENTS: Arthritis self‐efficacy (Arthritis Self‐Efficacy Scale), quality of life indicators (Arthritis Impact Measurement Scale), functional outcomes (one‐leg standing balance, 50‐foot walking speed, time to rise from a chair).RESULTS: T'ai Chi participants experienced significant (P < .05) improvements in self‐efficacy for arthritis symptoms, total arthritis self‐efficacy, level of tension, and satisfaction with general health status.CONCLUSIONS: A moderate T'ai Chi intervention can enhance arthritis self‐efficacy, quality of life, and functional mobility among older adults with osteoarthritis. T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis.
A Double‐Blind, Placebo‐Controlled, Multicenter Study of Cerebrolysin for Alzheimer's Disease
Authors: Bae Chul‐Young , Cho Choo‐Yon , Cho Kyunghee , Oh Byoung Hoon , Choi Kyoung Gyu , Lee Hong Soo , Jung Seung Pil , Kim Dae Hyun , Lee Sangdo , Choi Gyu‐Dong , Cho Hangsuk , Lee Hotaek 
Published: April 2015

OBJECTIVE: To assess the efficacy and safety of Cerebrolysin over 4 weeks in patients with probable Alzheimer's disease (AD).DESIGN: A 4‐week randomized, double‐blind, placebo‐controlled, multicenter clinical trial. An unequal (Cerebrolysin:placebo = 2:1) randomization was used to assign more patients to the treatment group.SETTINGS: University medical centers and community geriatric hospitals in Korea.PARTICIPANTS: Fifty‐three men and women at least 50 years of age admitted to hospitals with mild to moderate AD and otherwise in good health.INTERVENTION: The treatment group (n = 34) received Cerebrolysin (30 mL Cerebrolysin in 100 mL physiologic saline IV) once a day from Monday to Friday for 4 weeks. The control group (n = 19) received placebo.MEASUREMENTS: Primary outcome measures were the Alzheimer's Disease Assessment Scale‐Cognitive subscale (ADAS‐Cog) and the Clinical Global Impression of Severity/Change (CGIS/C). Secondary outcome measures included Mini‐Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Katz Index of Activities of Daily Living (ADL), and Lawton Instrumental Activities of Daily Living (IADL) Scale.RESULTS: After 4 weeks of treatment, Cerebrolysin‐treated patients demonstrated significant improvements in the ADAS‐Cog (P = .02), CGIS/C (P = .01), and MMSE (P = .04) compared with placebo‐treated patients. Among Cerebrolysin‐treated patients, 82%, 62%, and 44% were rated improved on ADAS‐Cog, CGIS/C, and MMSE, respectively, compared with 31.6%, 22%, and 17% of placebo‐treated patients, respectively. However, there were no significant improvements in the Cerebrolysin group compared with the placebo group on the GDS, ADL, and IADL. There were no dropouts in either groups, with 100% compliance to Cerebrolysin and placebo. Only one patient reported a febrile sensation, which was transient and mild in severity.CONCLUSIONS: This study indicates that Cerebrolysin is a safe drug that improves the cognitive deficits and global function in patients with mild to moderate AD. Long‐term efficacy and safety of Cerebrolysin in Alzheimer's patients should be evaluated in the future.
Physical Inactivity and Smoking Increase Risk for Serious Infections in Older Women
Authors: Leveille Suzanne G. , Gray Shelly , LaCroix Andrea Z. , Ferrucci Luigi , Black Douglas J. , Guralnik Jack M. 
Published: April 2015

OBJECTIVE: This study examined health and behavioral risk factors for infections that required hospitalization in postmenopausal women who were enrollees of a large health maintenance organization (HMO).METHODS: Participants were 1365 generally healthy women aged 55 to 80 years who were followed for up to 6 years. Infection diagnoses listed first in the automated hospital discharge records were used to identify hospitalizations for which infections were the primary cause of admission. Potential risk factors for these serious infections were identified from baseline questionnaire information and automated HMO records from before baseline and during follow‐up. Risks for infections associated with hospital admission were examined using multivariate logistic regression methods.RESULTS: Seventy‐three women had a total of 90 hospital admissions in which infection was the primary discharge diagnosis. Behaviors that were independent predictors of infection were physical inactivity (adj. odds ratio = 4.08; 95% CI, 1.73–9.63) and smoking (adj. odds ratio = 2.64; 95% CI, 1.11–6.26). Incident cancer and lung disease were also associated with increased risk of infection. These associations were independent of age, body mass index, functional status, and other measures of health.CONCLUSIONS: Modifiable risk factors such as physical inactivity and smoking may place older women at risk for serious infections although the causal link is yet to be explained. Further research in this area may lead to new strategies aimed at reducing the serious burden of infections in the older population.
Legionnaires' Disease in a Newly Constructed Long‐Term Care Facility
Authors: Stout Janet E. , Brennen Carole , Muder Robert R. 
Published: April 2015

OBJECTIVES: To determine whether a newly‐constructed long‐term care facility would become colonized with Legionella and whether Legionnaires' disease would occur in residents of this new facility.DESIGN: Prospective environmental surveillance of the hospital's water distribution system for the presence of Legionella pneumophila during construction. Utilization of diagnostic tests for Legionnaires' disease in cases of nosocomial pneumonia.SETTING: The Pittsburgh VA Health Care System, Aspinwall Division, a two‐building 400‐bed complex.PARTICIPANTS: Six patients who acquired Legionnaires' disease while in the facility.INTERVENTION: Installation of copper‐silver ionization systems.MEASUREMENTS: Isolation of L. pneumophila from potable water and the occurrence of Legionnaires' disease.RESULTS: L. pneumophila serogroup 1 was recovered from the water distribution system within 1 month of operation; 74% (61/82) of distal sites were positive during construction. In the first 2 years of occupancy, six cases of legionellosis were diagnosed. Both clinical isolates of L. pneumophila were identical to environmental isolates by pulsed field gel electrophoresis (PFGE). Copper‐silver ionization systems were installed to control Legionella in the water system.CONCLUSIONS: We conclude that long‐term care residents are at risk for acquiring nosocomial Legionnaires' disease in the presence of a colonized water system, even in a newly constructed building.