Later GOCDs were associated with greater risk of aggressive interventions and death as an inpatient and greater odds of ICU admission. Goals of care discussion should be done routinely and early during the hospitalization of terminally ill patients.

OBJECTIVES:To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/ American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia. DESIGN: Multicenter, mixed-mode, anonymous questionnaire. SETTING: Three tertiary and four community hospitals in New York. PARTICIPANTS: Internal medicine physicians (N = 168). MEASUREMENTS: Physician knowledge and perceptions regarding PEG tubes in individuals with advanced dementia. RESULTS: Ninety-nine percent of physicians reported having cared for someone with advanced dementia; 95% had been involved in the PEG decision-making process; 38% were unsure whether the ABIM/AGS Choosing Wisely recommendations advise for or against PEG tubes in advanced dementia. Physicians who agreed that there is enough evidence to recommend against PEG placement for individuals with advanced dementia were more likely to know the ABIM/AGS Choosing Wisely recommendations (71% vs 28%, P < .001). Fifty-two percent felt in control of the PEG placement decision, and 27% expressed concerns about potential litigation. The most common factor influencing physicians was patient or decision-maker request (70%); 63% stated that families request PEG placement even when physician would not recommend it. Only 4% of the physicians would choose to have a PEG tube if they had advanced dementia. CONCLUSION: Despite the scientific evidence supporting the ABIM/AGS Choosing Wisely recommendations against the use of PEG tubes in individuals with advanced dementia, numerous incentives for placement complicate the decision for PEG placement. In today's healthcare environment, it is incumbent upon healthcare practitioners to be aware of the available evidence and to provide leadership to guide this complex decision-making process to promote true person-centered care. J Am Geriatr Soc 66:64-69, 2018.

Objective:To determine satisfaction, change in selfesteem, and maintenance of ethnic characteristics in African American patients after rhinoplasty.Patients: African American male (n = 21) and female (n=54) patients aged 14 through 58 years (mean,33.8 years) who underwent rhinoplasty.Methods: Open structure rhinoplasty, using the 3-tiered approach, was performed on all 75 patients. An anonymous questionnaire addressed postoperative patient satisfaction, maintenance of ethnic characteristics, selfesteem, and nasofacial harmony. The rate of complications was determined by medical record review.

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