Abstract:
OBJECTIVES:Code status specifies the action that healthcare providers should take in the event of cardiac arrest. Studies have shown, however, that patients with do-not-resuscitate/do-not-intubate (DNR/DNI) orders have worse outcomes and do not consistently receive the standard of care. Several studies have demonstrated that physicians behave differently toward patients with DNR/DNI orders, but little research exists into whether DNR/DNI status affects the practice of other members of the care team. Our objective was to determine whether code status affects decision making by nursing staff. METHODS:This was an anonymous, self-administered survey of nurses between April 2018 and March 2019 using SurveyMonkey. The survey contained four previously published clinical vignettes followed by a series of questions regarding specific interventions tailored to reflect nursing escalation of care. Our focus was two local hospitals: one large academic quaternary-referral center and one large community hospital. Registered nurses on medical-surgical units identified based on available unit-specific e-mail listservs from both hospitals were the participants. Nurses in higher-acuity units were excluded. RESULTS:Nurses are significantly less likely to call rapid response or a physician when a patient undergoes certain changes in clinical status if the patient is labeled as DNR/DNI rather than full code. For all of the vignettes, respondents were less likely to say they would call rapid response or a physician for patients with a DNR/DNI status who developed tachycardia (P < 0.001). Nurses also were less likely to escalate care for patients with DNR/DNI status who developed tachypnea or mental status changes. Nurses were equally likely to call a physician for the development of abdominal pain or new hypotension (P > 0.05). Nurses with >3 years of experience were less likely to escalate care throughout the vignettes (odds ratio <1). CONCLUSIONS:This study is the first to demonstrate that code status affects decision making by nursing staff. It highlights the limitations that code status designations create with regard to patient care. By acknowledging that patients with DNR/DNI orders receive different care, we can create systems in which patients are treated equally, regardless of their code status.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Engels R,Graziani C,Higgins I,Thompson J,Kaplow R,Vettese TE,Massart Adoi
10.14423/SMJ.0000000000001112subject
Has Abstractpub_date
2020-07-01 00:00:00pages
330-336issue
7eissn
0038-4348issn
1541-8243pii
SMJ50803journal_volume
113pub_type
杂志文章abstract::Thoracic splenosis is rare, with fewer than two dozen reported cases. Patients uniformly have a history of splenectomy with combined abdominal and thoracic trauma. Clinical signs and symptoms are usually absent, and the condition is most often discovered on routine chest radiography. The interval between trauma and cl...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199811000-00013
更新日期:1998-11-01 00:00:00
abstract::The "wink" sign of nerve root cut-off seen on metrizamide-enhanced computerized tomography correlates well with compression of a lumbar nerve by a herniated disk. Seven of 46 patients had normal or equivocal myelograms, but had definite nerve root cut-off on metrizamide-enhanced CT scan. All seven patients were found ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198605000-00009
更新日期:1986-05-01 00:00:00
abstract::A patient with thioridazine-hydrochloride-associated agranulocytosis is described and eight previously reported cases are reviewed. This complication is most likely due to a direct toxic effect on the bone marrow. As in our case, markers for an immunologically mediated mechanism have not been found. Thioridazine-hydro...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197701000-00051
更新日期:1977-01-01 00:00:00
abstract::Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smoo...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197801000-00012
更新日期:1978-01-01 00:00:00
abstract::Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a seven-year period, I surgically treated 19 children, aged 3 to 17 (mean 10.5 years), with a total of 28 keloids. After aseptic skin preparation, the interface between the keloid and normal skin ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198806000-00013
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS:Charts of 311 consecutive psychiatric ER patients were reviewed...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract::Bullous pemphigoid (BP) is an immunobullous disease characterized by circulating IgG antibodies directed towards cutaneous basement zone antigens. We report the case of a patient who had BP localized to a stoma site. At initial examination, a nodule was noted on the temple, which proved to be a large cell lymphoma, B-...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199912000-00019
更新日期:1999-12-01 00:00:00
abstract::We have reported a case of partial hypopituitarism involving deficient ACTH, LH, FSH, and growth hormone production and elevated prolactin. The hypopituitarism was caused by injury to the pituitary resulting from a parachute accident without direct craniocerebral trauma. The pathogenesis of this pituitary injury as ei...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1979-12-01 00:00:00
abstract::This descriptive study prospectively examined the performance and supervision of interpretive and procedural skills during an internal medicine clerkship. Students (N = 150) documented having done 7 required and 12 elective skills. Preceptors of required skills were interns (44%), residents (29%), attending physicians...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199606000-00009
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Use of health services in rural communities has not been well studied. We explored how black and white children used health services in a rural Mississippi community. METHODS:Data were prospectively collected for 396 children attending a private practice to determine if race was associated wi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000232966.81950.a4
更新日期:2006-09-01 00:00:00
abstract::Solitary abscesses of the spleen may occur as a consequence of septicemia from various septic foci, particularly intra-abdominal sites. A variety of causative organisms, including the clostridia, have been isolated. We have described a patient with multiple myeloma who had a solitary splenic abscess due to Clostridium...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198710000-00029
更新日期:1987-10-01 00:00:00
abstract::Hypersplenism is a known complication of portal hypertension secondary to cirrhosis of the liver. Although thrombocytopenia secondary to hypersplenism does not cause clinically significant hemostatic defect, it may need to be addressed in selective circumstances, such as preoperative preparation for a surgery. This re...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000157558.62378.0B
更新日期:2005-04-01 00:00:00
abstract::A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature. The disease is characterized by an acute febrile illness with painful plaques involving the extremities, face, and neck, and ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197811000-00010
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:Colorectal cancer (CRC) is predominantly a disease of the elderly population, but it sometimes occurs in young patients. The diagnosis of CRC in youngsters is often overlooked by physicians or presentation may be delayed. METHODS:With assistance from the cancer registry center of Taipei Veterans General Hos...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Increasing numbers of the adult population are using alternative or complementary health resources in the treatment of chronic medical conditions. Systemic hypertension affects more than 50 million adults and is one of the most common risk factors for cardiovascular morbidity and mortality. This study evalua...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00007611-200111000-00015
更新日期:2001-11-01 00:00:00
abstract::Though low, the incidence of malaria in the United States is not insignificant and can be the source of infection in febrile travelers returning from endemic areas. Clinicians practicing in the United States must have a basic understanding of the malaria life cycle and its treatments to properly diagnose and treat thi...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.smj.0000189904.50838.eb
更新日期:2005-12-01 00:00:00
abstract::Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastri...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197612000-00010
更新日期:1976-12-01 00:00:00
abstract:BACKGROUND:Ventilator-associated pneumonia (VAP) is one of the most frequent infections in intensive care units (ICUs), and nearly 50% of patients with VAP develop septic shock. Septic shock is an independent predictor for mortality in these patients. OBJECTIVE:To investigate the predictors for septic shock in VAP pat...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181827891
更新日期:2008-12-01 00:00:00
abstract::This is a prospective clinical study of 41 consecutive patients with isolated tears of the medial meniscus who underwent meniscectomy by conventional arthrotomy. The results are presented in terms of length of hospitalization, complications, analgesic requirements during hospitalization, and ability to regain muscle c...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198309000-00021
更新日期:1983-09-01 00:00:00
abstract::Fluoxetine is an antidepressant drug with a unique chemical configuration which enhances serotoninergic transmission by inhibiting serotonin uptake. The chronic presence of serotonin in the synaptic cleft reduces postsynaptic receptors, a postulated explanation for its antidepressant efficacy. Comparative studies show...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:1989-08-01 00:00:00
abstract::Clotrimazole is a new antifungal agent which is effective topically in dermatophytosis, cutaneous candidiasis, and tinea vesicolor. The authors performed a controlled double-blind clinical trial comparing topical clotrimazole with its vehicle in the treatment of 66 patients with dermatophytic infections of the skin of...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章
doi:10.1097/00007611-197701000-00021
更新日期:1977-01-01 00:00:00
abstract::In the ten-year period from 1978 through 1987, 261 patients with intussusception were admitted to Chang Gung Memorial Hospital. The diagnosis was established by barium enema or at laparotomy. The patients were divided into two groups; there were 228 children ranging in age from 1 month to 14 years, and 33 adults. Amon...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:This study was designed to identify differences among internists in their attitudes about diabetes and how those attitudes influence practice behavior. METHODS:A cross-sectional study of 55 internists in an academic medical center was done using the Diabetes Attitude Scale (DAS-3), a valid and reliable meas...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:This study examined patient perceptions and attitudes toward various aspects of the male and female physician's professional appearance in the family practice setting. METHODS:Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionna...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000077011.58103.C1
更新日期:2003-12-01 00:00:00
abstract::We reviewed the results of lymphocyte karyotypes from 232 couples who had had two or more pregnancy losses (spontaneous abortions or stillbirths). Despite the use of strict criteria to correct for possible bias of ascertainment, 8% of these couples (19 of 232) had a chromosome abnormality. Six of these abnormalities w...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198812000-00014
更新日期:1988-12-01 00:00:00
abstract::The results of a large randomized prospective clinical trial conducted by the Veterans Administration Co-operative Urological Research Group (VACURG) in 1968 are updated and reevaluated. In this study, placebo, diethylstilbestrol (DES, 5 mg/day), orchiectomy plus placebo, and orchiectomy plus DES were compared in pati...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1977-12-01 00:00:00
abstract:BACKGROUND:In the 19th century, deaths from acute exposure to hydrogen sulfide (H2S) portended permanent brain injury from nonlethal doses. The neurobehavioral effects of H2S exposures lasting from moments to years were compared in 16 subjects, 2 years to 22 years afterward. METHODS:Neurophysiologic and psychologic te...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199710000-00006
更新日期:1997-10-01 00:00:00
abstract::Granular cell tumors (GCT) are rare, usually benign neoplasms of Schwann cell origin. Since discovery in 1926, fewer than 80 cases of GCT involving the lung have been reported. This report presents a 45-year-old male who presented with symptoms consistent with chronic pancreatitis associated with night sweats, weight ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000182134.44098.01
更新日期:2005-10-01 00:00:00
abstract::Cardiac rupture due to blunt trauma has been recognized with increasing frequency over the past two decades. The mortality rate is high and the majority of patients die before they arrive at the emergency department. A high index of suspicion and prompt surgical intervention are crucial for survival. We report the man...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199707000-00019
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVES:This study seeks to determine the effect of the Texas motorcycle helmet law on fatalities since the repeal of the universal helmet law in 1997. METHODS:Texas monthly motorcycle accident data between 1994 and 2004 were obtained from the National Highway Transportation Safety Administration's Fatality Analysi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181c35653
更新日期:2010-01-01 00:00:00