BACKGROUND: Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections.
METHODS: This was a retrospective cohort of all patients with an ID consult within an academic health system 1/1/2014 - 12/31/2023, including community, general, and transplant ID consult services.
RESULTS: There were 60,820 inpatient ID consults (17,235 community, 29,999 general, and 13,586 transplant) involving 37,848 unique patients. The number of consults increased by 94% and the rate rose from 5.0 to 9.9 consults per 100 inpatients (p<0.001). In total, 7.5% of patients receiving an ID consult died during admission, and 1,006 (2.6%) of patients were discharged to hospice. In-hospital mortality was 5.2% for community ID, 7.8% for general ID, and 10.7% for transplant ID patients (p<0.001). Six-month mortality was 9% for all non-obstetric admissions, , vs. 19% for community ID, 20.9% for general ID, and 22.3% for transplant ID.In total 2,866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization. The index ID consult preceded any palliative consult in the majority (69.5%) of cases. 16.3% of patients had a do-not-resuscitate order during the index hospitalization. 12.2% of all patients with a do-not-resuscitate order had this placed on the same day as the ID consult.
CONCLUSIONS: Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care.

BACKGROUND: Approximately 2500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence.
METHODS: Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events.
RESULTS: A total of 3638 hospital medical records were reviewed and 1109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1000 hospital admissions and 12.4/1000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events.
CONCLUSIONS: IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures.

Black and Hispanic people are more likely to contract COVID-19, require hospitalization, and die than White people due to differences in exposures, comorbidity risk, and healthcare access.
To examine the association of race and ethnicity with treatment decisions and intensity for patients hospitalized for COVID-19.
Retrospective cohort analysis of manually abstracted electronic medical records.
7,997 patients (62% non-Hispanic White, 16% non-Black Hispanic, and 23% Black) hospitalized for COVID-19 at 135 community hospitals between March and June 2020 MAIN MEASURES: Advance care planning (ACP), do not resuscitate (DNR) orders, intensive care unit (ICU) admission, mechanical ventilation (MV), and in-hospital mortality. Among decedents, we classified the mode of death based on treatment intensity and code status as treatment limitation (no MV/DNR), treatment withdrawal (MV/DNR), maximal life support (MV/no DNR), or other (no MV/no DNR).
Adjusted in-hospital mortality was similar between White (8%) and Black patients (9%, OR=1.1, 95% CI=0.9-1.4, p=0.254), and lower among Hispanic patients (6%, OR=0.7, 95% CI=0.6-1.0, p=0.032). Black and Hispanic patients were significantly more likely to be treated in the ICU (White 23%, Hispanic 27%, Black 28%) and to receive mechanical ventilation (White 12%, Hispanic 17%, Black 16%). The groups had similar rates of ACP (White 12%, Hispanic 12%, Black 11%), but Black and Hispanic patients were less likely to have a DNR order (White 13%, Hispanic 8%, Black 7%). Among decedents, there were significant differences in mode of death by race/ethnicity (treatment limitation: White 39%, Hispanic 17% (p=0.001), Black 18% (p<0.0001); treatment withdrawal: White 26%, Hispanic 43% (p=0.002), Black 28% (p=0.542); and maximal life support: White 21%, Hispanic 26% (p=0.308), Black 36% (p<0.0001)).
Hospitalized Black and Hispanic COVID-19 patients received greater treatment intensity than White patients. This may have simultaneously mitigated disparities in in-hospital mortality while increasing burdensome treatment near death.

UNASSIGNED: A Do Not Resuscitate (DNR) order should only impede the performance of cardiopulmonary resuscitation in case of cardiac or respiratory arrest; it should not interfere with any other treatment decisions.
UNASSIGNED: To study the impact of DNR order placement on daily clinical care of patients.
UNASSIGNED: This was a retrospective cohort study of 72 patients in a tertiary care centre in Saudi Arabia. Daily clinical care measures were collected for 2 weeks prior and 2 weeks after DNR order placement and included vital signs, nursing care, comfort measures, documentation, visits by senior and junior physicians, and tests completed.
UNASSIGNED: Malignancy was the most common diagnostic category (43.1%). There was a significant reduction in vital signs documentation, tests completed, documentation, and visits by physicians after DNR orders, with no change in nursing care and comfort measures. No differences were seen for place of DNR order (intensive care unit vs medical ward), category of disease, or sex, but there were differences for documentation (more in females) and vital signs (more in males). More vital signs were documented and more tests were done in patients who survived compared to those who died. Regression analysis showed that the frequency of post-DNR order vital signs measurements and investigations done was not related to sex, age, diagnosis, time from admission to DNR order, or location of patients. Time to death was only related to sex and post-DNR order summary documentation.
UNASSIGNED: Placement of DNR orders significantly reduced vital signs measurements, investigations done, documentation and visits by physicians but not nursing care and comfort measures.
تردد المرضى في قبول أمر \"عدم الإنعاش\": الآثار المترتبة على الرعاية السريرية.
أمل الفرحان، منال الحارثي، منيرة بن موسى، عفاف مُقدم، حمدان جحدلي ، جنان شامو، عبد الله السياري، سليم باهارون.
UNASSIGNED: يجب أن يمنع أمر \"عدم الإنعاش\" أداءَ الإنعاش القلبي الرئوي فقط في حالة تَوَقُّف القَلْب أو التنفس؛ ولا يجب أن يتداخل مع أي قرارات أخرى للعلاج.
UNASSIGNED: دراسة أثر تنفيذ أمر \"عدم الإنعاش\" على الرعاية السريرية اليومية للمرضى.
UNASSIGNED: أُجريت دراسة أترابية استرجاعية شملت 72 مريضاً في أحد مراكز الرعاية الثالثية في المملكة العربية السعودية. وقد حُصرت تدابير الرعاية السريرية اليومية لمدة أسبوعين قبل أمر \"عدم الإنعاش\" وأسبوعين آخرين بعده، وشملت العلامات الحيوية، والرعاية التمريضية، وتدابير تحقيق الراحة، والتوثيق، وزيارات كبار وشباب الأطباء، وإتمام الفحوص.
UNASSIGNED: كان التشخيص بالإصابة بورم خبيث أكثر الفئات التشخيصية الشائعة (43.1٪). وقد حدث انخفاض ملحوظ في توثيق العلامات الحيوية، وإتمام الفحوص، والتوثيق، وزيارات الأطباء عقب إصدار أوامر \"عدم الإنعاش\"، مع عدم وجود أي تغيير في الرعاية التمريضية وتدابير تحقيق الراحة. ولم يُلاحَظ أي تغيير في تنفيذ أمر \"عدم الإنعاش\" (وحدة الرعاية المركزة مقابل الجناح الطبي)، أو فئة المرض، أو نوع الجنس، ولكن لوحظ بعض التباين من حيث التوثيق (أكثر في الإناث) والعلامات الحيوية (أكثر في الذكور). وكان معدل توثيق العلامات الحيوية وإجراء مزيد من الفحوص أعلى في المرضى الذين نجوا وظلوا على قيد الحياة عنه في الذين تُوفُّوا. وقد بيّ تحليل الانحدار أن وتيرة أخذ قياسات العلامات الحيوية والاستقصاءات عقب أمر \"عدم الإنعاش\" غير مرتبطة بنوع الجنس، أو العمر، أو التشخيص، أو المدة الزمنية من وقت دخول المستشفى وحتى صدور الأمر، أو مكان المرضى. وارتبطت الفترة الزمنية حتى الوفاة فقط بنوع الجنس وتوثيق ملخص ما بعد أمر \"عدم الإنعاش\".
UNASSIGNED: أدى تنفيذ أمر \"عدم الإنعاش\" بصورة كبيرة إلى خفض قياسات العلامات الحيوية، وإتمام الاستقصاءات، والتوثيق، وزيارات الأطباء، ولكن الأمر كان مختلفاً بالنسبة للرعاية التمريضية وتدابير تحقيق الراحة.
Réticence du patient à accepter l’ordre de ne pas réanimer : conséquences sur les soins cliniques.
UNASSIGNED: Un ordre de ne pas réanimer doit seulement empêcher l’exécution de la réanimation cardio-respiratoire en cas d’arrêt cardiaque ou respiratoire ; il ne doit pas interférer avec d’autres décisions thérapeutiques.
UNASSIGNED: Étudier les conséquences de l’ordre de ne pas réanimer sur les soins cliniques quotidiens des patients.
UNASSIGNED: Il s’agissait d’une étude de cohorte rétrospective portant sur 72 patients d’un centre de soins tertiaires en Arabie saoudite. Des mesures des soins cliniques quotidiens ont été recueillies pendant deux semaines avant et deux semaines suite à l’émission de l’ordre de ne pas réanimer. Elles ont notamment pris en considération les signes vitaux, les soins infirmiers, les mesures de confort, la documentation, les visites des médecins principaux ou assistants et les examens effectués.
UNASSIGNED: La malignité était la catégorie de diagnostic la plus courante (43,1 %). On a constaté une réduction significative des mesures des signes vitaux, des examens effectués, de la documentation et des visites des médecins suite à l’émission des ordres de ne pas réanimer, sans aucun changement au niveau des soins infirmiers et des mesures de confort. Aucune différence n’a été constatée en ce qui concerne le lieu associé à l’ordre de ne pas réanimer (unité de soins intensifs ou service d’hospitalisation), la catégorie de la maladie ou le sexe, mais des différences ont été observées pour la documentation (plus détaillée chez les femmes) et la mesure des signes vitaux (plus fréquente chez les hommes). Les signes vitaux avaient davantage été documentés et plus d’examens avaient été effectués chez les patients qui ont survécu que chez ceux qui sont décédés. L’analyse de régression a montré que la fréquence de la mesure des signes vitaux et des examens effectués suite à l’émission de l’ordre de ne pas réanimer n’était pas liée au sexe, à l’âge, au diagnostic, au temps écoulé entre l’admission et l’émission de l’ordre de ne pas réanimer, ni au lieu de prise en charge du patient. Le délai avant le décès n’était lié qu’au sexe et à la documentation sommaire établie à la suite de l’émission de l’ordre.
UNASSIGNED: L’émission d’un ordre de ne pas réanimer réduisait de manière significative la mesure des signes vitaux, les examens effectués, la documentation et les visites des médecins, mais pas les soins infirmiers ni lesmesures de confort.

Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.

Background A do-not-resuscitate (DNR) order is a medical decision that instructs healthcare providers to withhold cardiopulmonary resuscitations (CPR) to patients in case of cardiopulmonary arrest in respect to their wishes. In Saudi Arabia, the decision is usually made by physicians based on the Fatwa number 12086 regardless of the patients\' or their families\' desires. Assessing the knowledge, perception, and attitude of Saudi family members towards this medical decision may help guide medical practitioners to make decisions that are legally and ethically acceptable for the patients and their family. Therefore, this study aimed to assess their knowledge, perception, and attitude about DNR decisions and to determine demographic variables that affect their attitude towards DNR decisions. Method This cross-sectional study was conducted from December 2017 to January 2018 utilizing survey distribution through emails and different social media outlets including Facebook, Twitter, Pinterest, and LinkedIn. A self-administered questionnaire was employed to elicit responses regarding knowledge, perception, and attitude towards DNR decisions. Statistical Package for the Social Sciences Windows version 17 (SPSS v.17) (IBM Corporation, USA) was used for data management and analysis. Result Of the 1882 participants who filled the questionnaire, only 1693 participants were eligible as the study sample population and were included in the final data analysis. Most of the participants were from the Makkah region (72.2%) and were mainly from the general population (61.66%). Participants were mainly females (66%) and within the median age of 30 years (IQR: 21). As expected, participants who had heard about the DNR practice were from the medical field (58.6%) and they were mainly distant relatives. Almost 76% of the participants had two to four incorrect answers about the DNR practice, and it indicated that participants have inadequate knowledge about a DNR order. Most of the participants (43.2%) refused to be on a DNR order if they were diagnosed with a terminal illness. However, most participants (69.9%) wanted to have an involvement in the decision-making of being on a DNR order. In terms of willingness to understand and learn about the DNR decision, 1475 (87.1%) of the participants wanted to learn more about the DNR practice. Being a relative of a terminally ill cancer patient did not have a significant effect on the knowledge and perceptions of participants about being on a DNR order. However, having a background in medicine was found to be significantly associated with their acceptance to be on a DNR order. The knowledge score regarding DNR was found to be significantly associated with higher acceptance towards DNR orders. Conclusion The majority of participants had a lack of knowledge about the DNR practice. Their religion\'s concept of hope and virtue is considered as the major reason for their DNR order refusal. However, proper education about the DNR practice and involvement in the DNR order decision-making will increase the participants\' knowledge and will improve their acceptance of the DNR practice.

OBJECTIVE: The do not resuscitate (DNR) order is a decision taken by the patient or other people about medical care in the end stages of life to prevent resuscitation from causing cardiac or respiratory arrest. This study was conducted to evaluate the attitudes of patients\' relatives in the end stages about DNR order.
METHODS: In a cross-sectional study, 150 relatives of patients who had been prescribed DNR orders were included in the educational hospitals affiliated to the Kermanshah University of Medical Sciences. The data collection tool was a researcher-developed questionnaire consisting of 29 attitudes questions related to DNR orders. The data were collected and analyzed in the SPSS software version 19 using descriptive tests.
RESULTS: According to the results of present study, although the relatives of pationts consider doctors thoroughly responsible for making decision related with DNR, and follow their order either way, they strongly disagree with a single doctor making individual decision in this domain. They believe that the patient and their relatives should be engaged in this decision. Although most participants tended to stay as close as possible to the patients and engage in patient care.
CONCLUSIONS: Given that there are a few studies in Iran on the attitudes of patients and their relatives about DNR, and there are no specific rules and guidelines in this regard. It is recommended that further studies be conducted on the subject. Engaging of patients and families in this important decision is necessary.

With the enactment of the \'Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life\' (Act No. 14013) in Korea, there is growing concern about the practicality of this law. In this review, we discuss definitions, ethics, and practical issues related to this law.

The life of an accomplished, independent 53-year-old woman is completely changed after surgery for a large, invasive spinal cord tumor. A lengthy, unsuccessful attempt at recovery and rehabilitation, compromised by multiple complications and hospitalizations, led to the patient\'s choice to come off the ventilator. Her end-of-life decision allowed her to die peacefully, surrounded by family and friends, all of whom were profoundly affected by the experience.