Abstract Background The Physician Orders for Life-Sustaining Treatment (POLST) form translates patient treatment preferences into medical orders. The Oregon POLST Registry provides emergency ...personnel 24-h access to POLST forms. Objective To determine if Emergency Medical Technicians (EMTs) can use the Oregon POLST Registry to honor patient preferences. Methods Two telephone surveys were developed: one for the EMT who made a call to the Registry and one for the patient or the surrogate. The EMT survey was designed to determine if the POLST form accessed through the Registry changed the care of the patient. The patient/surrogate survey was designed to determine if the care provided matched the preferences on the POLST. When feasible, the Emergency Medical Services (EMS) record was reviewed to determine whether or not treatment was provided. Results During the study period there were 34 EMS calls with matches to patients' POLST forms, and 23 interviews were completed with EMS callers, for a response rate of 68%. In seven cases (30%) the patient was in cardiopulmonary arrest; one patient had a respiratory arrest with a pulse. Eight respondents (35%) reported that the patient was conscious and apparently able to make decisions about preferences. For 10 cases (44%) the POLST orders changed treatment, and in six instances (26%) they affected the decision to transport the patient. For the 10/11 patients or surrogates interviewed, the care reportedly matched their wishes. Conclusion This small study suggests that an electronic registry of POLST forms can be used by EMTs to enhance their ability to locate and honor patient preferences regarding life-sustaining treatments.
A case description is offered concerning a patient showing a slow and steady decline and was ultimately admitted to hospice care. Copyright U.S. Cancer Pain Relief Committee. Published by Elsevier ...Inc.
Leukocytes are involved in the pathogenesis of idiopathic inflammatory myopathies (IIMs). Immunoglobulin G (IgG) receptors (FcγR) link the specificity of IgG to the effector functions of leukocytes. ...Several FcγR subclasses display functional polymorphisms that determine in part the vigour of the inflammatory response. FcγRIIIa genotypes were differentially distributed among 100 IIM patients compared with 514 healthy controls with a significant increase of the homozygous FcγRIIIa‐V‐158 genotype (3 × 2 contingency table, χ2 = 6.3, P = 0.04). Odds ratios (ORs) increased at the addition of each FcγRIIIa‐V‐158 allele, in particular among patients with non‐specific myositis and dermatomyositis {OR 2.1 95% confidence interval (CI) 1.1–4.3 and 2.7 (95% CI 1.1–6.4) for FcγRIIIa‐V/F158 and FcγRIIIa‐V/V158 genotypes, respectively, using FcγRIIIa‐F/F158 as a reference group}. These data suggest that the FcγRIIIa‐V‐158 allele may constitute a genetic risk marker for IIM.
Abstract Clinicians may feel conflicted when a patient’s legal decision maker is making decisions that seem inconsistent with a patient’s living will. We provide evidence-based information to help ...clinicians consider whether a surrogate’s inconsistent decisions are ethically appropriate. Surrogates are not flawless translators of their loved one’s preferences; they are influenced by their own hopes and the current clinical context. Patients may be aware of this, are often concerned about burdening their loved ones, and often grant their surrogates leeway in interpreting their wishes. When appropriate, clinicians should respect surrogates’ interpretations of patient values and take steps to decrease surrogate stress during the decision-making process. Finally, if clinicians are cognizant of their own values and preferences, they may recognize how these may affect their responses to certain clinical cases.
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