End of Life Care for Older Patients at a Tertiary Academic Medical Center

Objective: To examine the intensity and amount of care at the end of life given to elderly patients at a tertiary academic medial center. Methods: Review of a decedent care database that contains basic information on all deaths occurring at its associated academic medical center. Data was examined for deaths of patients 55 and older that occurred between July 1, 2000 and March 31, 2002. Data related to specific location of death were reclassified into the categories "ICU" and "Floor," and data related to the specific service on which death occurred were reclassified into the categories "Medical" and "Surgical. " Essential demographic information including gender, race, and service were analyzed for all patients. Location of death was analyzed as a proxy variable for intensity of care received at the end of life, and length of stay before death was analyzed as a proxy variable for the amount of care received at the end of life. Analyses were performed using the age categories of 55-65, 65-75, 75-85, and >85 years of age. Results: There were no statistically significant differences in gender, race and service among the different age categories of patients at the end of life. There were statistically significant differences in location of death with increasing age of patients (Age 55-65: 64% ICU, 36% Floor; Age 65-75: 58% ICU, 42% Floor; Age 75-85.· 49% JCU, 51% Floor, Age >85: 41% ICU, 59% Floor). These differences remained statistically significant after controlling for gender, race and service (p85. 7.2 (4.0, 104)) These differences remained statistically significant after controlling for gender, race, location and service (p~0.001). When stratified by location, the differences in length of stay before death remained statistically significant for both deaths occurring in the ICU (p<0.05) and deaths occurring outside the ICU (p~0.05). Conclusions: At a major tertiary academic medical center, older patients are less likely to receive end-of-life care equal in intensity or amount to the care received by younger patients.Master of Public Healt

End of Life Care for Older Patients at a Tertiary Academic Medical Center

Objective: To examine the intensity and amount of care at the end of life given to elderly patients at a tertiary academic medial center. Methods: Review of a decedent care database that contains basic information on all deaths occurring at its associated academic medical center. Data was examined for deaths of patients 55 and older that occurred between July 1, 2000 and March 31, 2002. Data related to specific location of death were reclassified into the categories "ICU" and "Floor," and data related to the specific service on which death occurred were reclassified into the categories "Medical" and "Surgical. " Essential demographic information including gender, race, and service were analyzed for all patients. Location of death was analyzed as a proxy variable for intensity of care received at the end of life, and length of stay before death was analyzed as a proxy variable for the amount of care received at the end of life. Analyses were performed using the age categories of 55-65, 65-75, 75-85, and >85 years of age. Results: There were no statistically significant differences in gender, race and service among the different age categories of patients at the end of life. There were statistically significant differences in location of death with increasing age of patients (Age 55-65: 64% ICU, 36% Floor; Age 65-75: 58% ICU, 42% Floor; Age 75-85.· 49% JCU, 51% Floor, Age >85: 41% ICU, 59% Floor). These differences remained statistically significant after controlling for gender, race and service (p85. 7.2 (4.0, 104)) These differences remained statistically significant after controlling for gender, race, location and service (p~0.001). When stratified by location, the differences in length of stay before death remained statistically significant for both deaths occurring in the ICU (p<0.05) and deaths occurring outside the ICU (p~0.05). Conclusions: At a major tertiary academic medical center, older patients are less likely to receive end-of-life care equal in intensity or amount to the care received by younger patients.Master of Public Healt

The Effects of Different Types of Internal Controls on Self-Control

One reason companies implement internal controls is to reduce the likelihood of unethical behavior. Yet, ego depletion theory suggests that some controls may cause reductions in employees’ self-control, which could undermine the ability of controls to reduce unethical behavior. We examine whether various types of controls impact self-control and ethical judgments. Our results show that contrary to the ego depletion hypothesis, we find no significant relation between self-control and internal controls. Furthermore, we find that controls have no effect on ethical judgments or ethical ideology. Thus, our results suggest that internal controls do not differentially impact self-control and ethical decision-making

Morally Respectful Listening and its Epistemic Consequences

What does it mean to listen to someone respectfully, that is, insofar as they are due recognition respect? This paper addresses that question and gives the following answer: it is to listen in such a way that you are open to being surprised. A specific interpretation of this openness to surprise is then defended

Major flaws in conflict prevention policies towards Africa : the conceptual deficits of international actors’ approaches and how to overcome them

Current thinking on African conflicts suffers from misinterpretations oversimplification, lack of focus, lack of conceptual clarity, state-centrism and lack of vision). The paper analyses a variety of the dominant explanations of major international actors and donors, showing how these frequently do not distinguish with sufficient clarity between the ‘root causes’ of a conflict, its aggravating factors and its triggers. Specifically, a correct assessment of conflict prolonging (or sustaining) factors is of vital importance in Africa’s lingering confrontations. Broader approaches (e.g. “structural stability”) offer a better analytical framework than familiar one-dimensional explanations. Moreover, for explaining and dealing with violent conflicts a shift of attention from the nation-state towards the local and sub-regional level is needed.Aktuelle Analysen afrikanischer Gewaltkonflikte sind häufig voller Fehlinterpretationen (Mangel an Differenzierung, Genauigkeit und konzeptioneller Klarheit, Staatszentriertheit, fehlende mittelfristige Zielvorstellungen). Breitere Ansätze (z. B. das Modell der Strukturellen Stabilität) könnten die Grundlage für bessere Analyseraster und Politiken sein als eindimensionale Erklärungen. häufig differenzieren Erklärungsansätze nicht mit ausreichender Klarheit zwischen Ursachen, verschärfenden und auslösenden Faktoren. Insbesondere die richtige Einordnung konfliktverlängernder Faktoren ist in den jahrzehntelangen gewaltsamen Auseinandersetzungen in Afrika von zentraler Bedeutung. Das Diskussionspapier stellt die große Variationsbreite dominanter Erklärungsmuster der wichtigsten internationalen Geber und Akteure gegenüber und fordert einen Perspektivenwechsel zum Einbezug der lokalen und der subregionalen Ebene für die Erklärung und Bearbeitung gewaltsamer Konflikte

1967: Abilene Christian College Bible Lectures - Full Text

LIFTING UP THE CHRIST” Being the Abilene Christian College Annual Bible Lectures 1967 $3.95 Published by ABILENE CHRISTIAN COLLEGE STUDENTS EXCHANGE ACC Station Abilene, Texa

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared to mobilized peripheral blood stem cells (PBSC). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita (GNI) and region/countries into four groups. Groups analyzed were high income countries (HIC), which were further divided into US-Canada (N=486) and other HIC (N=1264), upper middle-income (UMIC) (N=482), and combined lower middle, low income countries (LM-LIC) (N=142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared to PBSC in all countries or BM in UMIC or LM-LIC (p<0.001). There was no significant difference in OS between BM and PBSC in UMIC (p=0.32) or LM-LIC (p=0.23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSC compared to BM (97% vs. 77%, p<0.001). Chronic GVHD was significantly higher with PBSC in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSC may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications

Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome

To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS)

Vitamin D and Foot and Ankle Trauma: An individual or societal problem?

Background Vitamin D deficiency is a worldwide health concern. Hypovitaminosis D may adversely affect recovery from bone injury. The authors aimed to perform an audit of the Vitamin D status of patients in three centres in the United Kingdom presenting with foot and ankle osseous damage. Methods Serum 25-hydroxyvitamin-D (vitamin D) levels were obtained in patients presenting with imaging confirmed foot and ankle osseous trauma. Variables including age, gender, ethnicity, location, season, month, anatomical location and type of bone injury were recorded. Results 308 patients were included from three different centres. 66.6% were female. The average age was 47.7 (range; 10–85). The mean hydroxyvitamin-D levels were 52.0 nmol/L (SD 28.5). 18.8% were grossly deficient, 23.7% deficient, 34.7% insufficient and 22.7% within normal range. 351 separate bone injuries were identified of which 104 were categorised as stress reactions, 134 as stress fractures, 105 as fractures and 8 non-unions. Age, gender, anatomical location and fracture type did not statistically affect vitamin D levels. Ethnicity did affect Vitamin D levels: non-Caucasians mean levels were 32.4 nmols/L compared to Caucasian levels of 53.2 nmol/L (p = 0.0026). Conclusion Only 18.8% of our trauma patients had a normal Vitamin D level and 22.7% were grossly deficient. Patient age, gender, anatomical location and injury type did not statistically affect vitamin D levels. No difference between trauma and elective patients were found. Hypovitaminosis D is a problem of society in general rather than specific to certain foot and ankle injury patterns or particular patient groups sustaining trauma. Level of evidence 2b

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy