Nontreatment of Fever in Extended-Care Facilities

Abstract

In a study of decisions not to treat febrile patients, we reviewed the medical records of 1256 people admitted to nine extended-care facilities in Seattle during 1973. Fever, defined as two temperatures of 38.33 degrees C to 38.83 degrees C (101 to 101.9 degrees F), within 24 hours or one temperature greater than or equal to 38.88 degrees C (102 degrees F), developed in 190 patients before two years of stay. Active treatment, defined as antibiotics or hospitalization (or both), was ordered for fever in 109 patients, of whom 10 (9 per cent) died. Active treatment was not ordered for 81 patients, of whom 48 (59 per cent) died. The pre-decision factors that showed a significant relation (P less than 0.05) to such nontreatment were: diagnosis, mental status, mobility, pain, narcotics prescribed, size of the facility, relation of the physician to the patient and medical-record statements documenting the patient's deterioration or plans for nontreatment in general. This pattern of nontreatment suggests that physicians and nurses did not intend to treat these patients actively and that high mortality was expected.

Percutaneous Endoscopic Gastrostomy in Geriatric Patients: Attitudes of Health Care Professionals

“…A large proportion of subjects in this study felt that PEG had a role in dementia. This is in difference to previous studies in which impaired cognition correlated negatively with willingness to treat and referral for tube feed ing [ 15,[24][25][26], A previous study [ 15] has also shown that more experienced geriatricians were less willing to favour tube feeding in severely demented patients. The reason for this divergence of opinion is not clear, but may be due to the fact that the geriatricians in our study may be more open to the needs of carers when faced with the problem of oral feeding in patients with dementia.…”

Perceptions of "futile care" among caregivers in intensive care units

“…Often nurses and residents have been found to be more pessimistic about dignity and quality of death than attending physicians and family members, 41 which potentially leads to careerending moral distress. [42][43][44] Nurses have also been found in general to be less satisfied with end-of-life decision-making than physicians 42,45,46 and are often the first team members to feel that life-support should be withdrawn, 19,[47][48][49] which can lead to conflict with physicians. 50 Nevertheless, nurses may predict mortality more accurately than physicians, 19 and physicians frequently offer treatment that does not reflect the poor prognosis of seriously ill patients.…”

Trends of Airborne Particulate Lead in Ontario: 1971–1979

“…In 1975, unleaded gasoline was introduced which, by 1979, comprised 38% of the gasoline sales in Ontario. 2 The usage of unleaded gasoline, along with the reduction of Pb content in leaded gasoline, has reduced the 1979 emissions of Pb in Ontario 68% compared with the 1970 emissions.…”

“…obtained from Ethyl Canada Inc. 2 for the annual gasoline sales in Ontario, the annual leaded gasoline sales, and the average Pb content of the total gasoline pool (Table II). From these figures, the annual Pb consumption (taken as product of total gasoline consumption and average Pb content) has been calculated.…”