ABSTRACT
Background: During the coronavirus disease 2019 (COVID-19) pandemic, older adults experienced high mortality rates, and their deaths were often preceded by sudden health deterioration and acute respiratory failure. This prompted older adults and their families to make rapid goals-of-care decisions. Objective: This study aimed at determining the prevalence of and factors associated with COVID-19-related do-not-attempt resuscitation (DNR) decisions among older adults. Design: This was a cross-sectional population-based survey. Setting: Well-looking active (mobile) community-dwelling adults aged ≥60 years and residing in the Bangkok district, Thailand, between April and May 2020, were included in this study. We excluded older adults who (1) were unable to speak Thai, (2) had severe cognitive impairment, or (3) were blind or deaf. We interviewed participants about their perceptions regarding end-of-life decisions in case they got infected with COVID-19 and experienced respiratory arrest. Results: We recruited 848 participants with a mean age of 70.5 (±6.74) years. When asked about their choice, 49.8% chose a DNR status, 44.5% chose full life support, and 5.8% were undecided. The three most common reasons provided by the DNR group for their choice were old age (54.9%), acceptance of death (15.6%), and fear of pain (8.5%). Conclusion: Almost half of the older Thai adults chose a DNR status for scenarios in which they were infected with COVID-19 and suffered from cardiac arrest during the pandemic period. Future studies should include an in-depth examination of participants' lifestyles, family life expectancy, and religious faith to understand their end-of-life decisions.
ABSTRACT
INTRODUCTION: Point-of-care ultrasonography (POCUS) is increasingly utilized in emergency departments (EDs) throughout Thailand. Although emergency medicine (EM) residents are trained in POCUS, Thai medical students receive limited training. An introductory POCUS course was implemented for medical students to prepare them for internships. OBJECTIVE: This study described the perception and use of POCUS by graduates of an introductory POCUS course. MATERIALS AND METHODS: Medical students who completed the POCUS course were surveyed during their intern year from 2012 to 2015. The survey collected demographic characteristics. The Likert Scale was used to assess POCUS practice patterns and perceptions of the course. RESULTS: There were 230 respondents (98% response rate). All thought that POCUS was important. Furthermore, 96% of respondents felt that the POCUS course meaningfully impacted their ability to deliver care. POCUS use was greatest for obstetrics/gynecology and trauma cases. Over half of respondents (55.2%) felt very confident with using extended-Focused Assessment with Sonography in Trauma. Most respondents (81.8%) were positively impacted by the course, and 61.7% were satisfied with the scope of the course. Recommendations for improvement included increasing the course length, the content, and the hands-on time for POCUS practice. CONCLUSION: Graduates positively perceived the course and felt it dramatically impacted their clinical practice as novice physicians. An introductory POCUS course should be incorporated into the medical school curriculum to prepare graduates for practice. Future goals include increasing the scope of POCUS practice to help guide interns and residents in emergency patient care such as lung ultrasound in COVID-19 or pneumonia patients and studying the impact this course has on patient outcomes.