Implementation of Do Not Attempt Resuscitate Orders in a Japanese Nursing Home

Asai, Nobuhiro; Ohkuni, Yoshihiro; Ashworth, Lonny; Kaneko, Norihiro

doi:10.1177/1049909113475866

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…In fact, identification of PDR pathogens, mechanical ventilation and Do Not Attempt Resuscitation (DNAR) order were more frequently seen in the participation-impossible group than in the possible group. In Japan, discussing DNAR order with Japanese family members is still considered to be taboo [27]. Therefore, these results could suggest that patients in the participationimpossible group have a worse prognosis than those in the participation-possible group do.…”

Section: Discussionmentioning

confidence: 99%

A Large Gap in Patients’ Characteristics and Outcomes between the Real-World and Clinical Trial Settings in Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

Asai

Shibata

Sakanashi

et al. 2022

JCM

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(1) Introduction: Evidence-based medicine (EBM) is necessary to standardize treatments for infections because EBM has been established based on the results of clinical trials. Since entry criteria for clinical trials are very strict, it may cause skepticism or questions on whether the results of clinical trials reflect the real world of medical practice. (2) Methods: To examine how many patients could join any randomized clinical trials for the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). We reviewed all the pneumonia patients in our institute during 2014–2017. The patients were divided into two groups: patients who were eligible for clinical trials (participation-possible group), and those who were not (participation-impossible group). Exclusion criteria for clinical trials were set based on previous clinical trials. (3) Results: A total of 406 patients were enrolled in the present study. Fifty-seven (14%) patients were categorized into the participation-possible group, while 86% of patients belonged to the participation-impossible group. Patients in the participation-possible group had less comorbidities and more favorable outcomes than those with the participation-impossible group. As for the outcomes, there were significant differences in the 30-day and in-hospital mortality rates between the two groups. In addition, the participation-possible group showed a longer overall survival time than the participation-impossible group (p < 0.001 by Log-Rank test). (4) Conclusion: There is a difference in patients’ profile and outcomes between clinical trials and the real world. Though EBM is essential to advance medicine, we should acknowledge the facts and the limits of the clinical trials.

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Section: Discussionmentioning

confidence: 99%

A Large Gap in Patients’ Characteristics and Outcomes between the Real-World and Clinical Trial Settings in Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

Asai

Shibata

Sakanashi

et al. 2022

JCM

Self Cite

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show abstract

“…However, identi cation of PDR pathogens, mechanical ventilation and Do Not Attempt Resuscitation (DNAR) order were more frequently seen in the participation possible group than in the impossible group. In Japan, discussing DNAR order with Japanese family members is still considered to be taboo [25]. Therefore, these results could suggest that patients in the participation impossible group have a worse prognosis than those in the participation possible group do.…”

Section: Discussionmentioning

confidence: 98%

To What Degree Could Clinical Trials in Evidence Based Medicine Reflect The Real World in The Treatment of Pneumonia?

Asai

Shibata

Sakanashi

et al. 2021

Preprint

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BackgroundEvidenced based medicine (EBM) is necessary to standardize treatments for infections because EBM　has been established based on the results of clinical trials. Since entry criteria for clinical trials are　very strict, it may cause skepticism or question whether the results of clinical trials　reflect the real world of medical practice.MethodsTo examine how many patients could join any randomized clinical trials for the　treatment of community-onset pneumonia, we reviewed all the pneumonia patients in our institute　during 2014-2017. The patients were divided into two groups: patients who were eligible for clinical　trials (participation possible group), and those who were not (participation impossible group).　Exclusion criteria for clinical trials were set based on previous clinical trials.ResultsA total of 406 patients were enrolled in the present study. Fifty-seven (14%) patients were categorized into the participation possible group, while 86% of patients belonged to the participation impossible group. Patients in the participation possible group had less comorbidities and more favorable outcomes than those with the participation impossible group. As for the outcomes, there were significant differences in the 30-day and in-hospital mortality rates between the two groups. In addition, the participation possible group showed a longer overall survival time than the participation impossible group (p<0.001 by Log-Rank test).ConclusionThere is a difference in patients’ profile and outcomes between clinical trials and the real world. Though EBM is essential to advance medicine, we should acknowledge the facts and the limits of the clinical trial.

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“…However, even if a patient has a poor prognosis, it does not always mean that he/she does not wish to be resuscitated or receive aggressive treatment. As the final decision on DNAR orders will differ according to the attitude of the individual patient,10, 11, 12, 13 it is essential to confirm each and every patient's intentions wherever possible. Apart from these diseases and background factors, patients with sequelae of cerebrovascular disease or dementia or patients in a persistent vegetative state may lack decision‐making capability.…”

Section: Discussionmentioning

confidence: 99%

Do not attempt resuscitation order in Japan

Inokuchi

Kobayashi

Ohkubo

2017

Acute Medicine & Surgery

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AimIn Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR‐related issues, and improve the application of DNAR.MethodsA questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out.ResultsThe results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in‐hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home.ConclusionIt is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.

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Implementation of Do Not Attempt Resuscitate Orders in a Japanese Nursing Home

Cited by 4 publications

References 20 publications

A Large Gap in Patients’ Characteristics and Outcomes between the Real-World and Clinical Trial Settings in Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

A Large Gap in Patients’ Characteristics and Outcomes between the Real-World and Clinical Trial Settings in Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

To What Degree Could Clinical Trials in Evidence Based Medicine Reflect The Real World in The Treatment of Pneumonia?

Do not attempt resuscitation order in Japan

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