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dc.creatorSulmasy, Daniel P.en
dc.creatorGeller, Gailen
dc.creatorFaden, Ruthen
dc.creatorLevine, David M.en
dc.date.accessioned2015-05-05T18:29:42Zen
dc.date.available2015-05-05T18:29:42Zen
dc.date.created1992-02-05en
dc.date.issued1992-02-05en
dc.identifier10.1001/jama.1992.03480050086030en
dc.identifier.bibliographicCitationJAMA. 1992 Feb 5; 267(5): 682-686.en
dc.identifier.issn0098-7484en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=The+Quality+of+Mercy:+Caring+for+Patients+with+"do+Not+Resuscitate"+orders&title=JAMA.++&volume=267&issue=5&pages=682-686&date=1992&au=Sulmasy,+Daniel+P.en
dc.identifier.urihttp://dx.doi.org/10.1001/jama.1992.03480050086030en
dc.identifier.urihttp://hdl.handle.net/10822/735719en
dc.description.abstractObjective. -- To assess (1) the effect of an ethics education intervention for medical house officers on practices surrounding "Do Not Resuscitate" (DNR) orders and (2) the association of DNR care with patient diagnosis and demographic variables. Design. -- A 1-year randomized, controlled trial. Setting. -- An urban, university teaching hospital. Participants. -- Eighty-eight internal medicine house officers. Intervention. -- House officers were arbitrarily assigned to four "firms". One firm was randomized to an extensive ethics education intervention (EI), one to a limited intervention, and two served as controls. Main Outcome Measures. -- Charts of patients with DNR orders were reviewed for compliance with the hospital's DNR policy, which instructs that when DNR orders are written there should be (1) an attending signature, (2) documentation of reasons, (3) appropriate consent, and (4) attention to 11 concurrent care concerns (CCCs) (eg, the appropriateness of intubation, tube feedings, hospice). Results. -- Thirty-nine charts were reviewed before the intervention and 57 after. The number of CCCs per DNR order fell among patients cared for by controls and rose among patients cared for by the EI group. Compliance with the DNR policy varied among patients with differing diagnoses. "Do Not Resuscitate" orders were signed less frequently for patients with the acquired immunodeficiency syndrome (AIDS) (65%) compared with patients who had other diagnoses (85%) or malignancy (91%). Similarly, appropriate consent was recorded for 59% of patients with AIDS, 83% of others, and 85% of those with malignancy. The number of CCCs per DNR was 0.7 for AIDS, 1.4 for others, and 2.4 for malignancy. In multivariate regression analysis, house officer ethics education and patient diagnosis, but not patient gender, age, race, or insurance status, were predictors of the number of CCCs per DNR. Conclusions. -- (1) An extensive ethics education intervention can improve care for DNR patients, especially with respect to CCCs. (2) In this setting, quality of care for DNR patients varied systematically with diagnosis. These results have implications for the design and implementation of ethics education programs.en
dc.formatArticleen
dc.languageenen
dc.sourceBRL:KIE/34590en
dc.subjectAidsen
dc.subjectAllowing to Dieen
dc.subjectArtificial Feedingen
dc.subjectAttitudesen
dc.subjectAcquired Immunodeficiency Syndromeen
dc.subjectCanceren
dc.subjectCaringen
dc.subjectConsenten
dc.subjectDiagnosisen
dc.subjectDNR Ordersen
dc.subjectDrugsen
dc.subjectDo Not Resuscitate Ordersen
dc.subjectEducationen
dc.subjectEthicsen
dc.subjectEvaluationen
dc.subjectEvaluation Studiesen
dc.subjectHealthen
dc.subjectHealth Careen
dc.subjectHealth Personnelen
dc.subjectHospicesen
dc.subjectHospitalsen
dc.subjectInformed Consenten
dc.subjectInstitutional Policiesen
dc.subjectInsuranceen
dc.subjectInternal Medicineen
dc.subjectMedical Educationen
dc.subjectMedical Ethicsen
dc.subjectMedical Recordsen
dc.subjectMedicineen
dc.subjectPatient Careen
dc.subjectPatientsen
dc.subjectPhysician Patient Relationshipen
dc.subjectPhysiciansen
dc.subjectRecordsen
dc.subjectResuscitationen
dc.subjectResuscitation Ordersen
dc.subjectResidencyen
dc.subjectSelection for Treatmenten
dc.subjectTerminal Careen
dc.subjectWithholding Treatmenten
dc.titleThe Quality of Mercy: Caring for Patients With `Do Not Resuscitate Orders'en
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


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