Health care professionals' accuracy in predicting patients' preferred code status.

BACKGROUND: In spite of the emphasis on physician and patient communication in the new guidelines for the use of do-not-resuscitate orders published by the American Medical Association, informal information indicates that physicians and other health care professionals often formulate code status decisions without formal knowledge of the patient's wishes. The purpose of this study was to determine how accurately health care professionals are able to predict a patient's desired code status given a profile of the patient's medical history. METHODS: A consecutive sample of physicians and other health care professionals attending on-site primary care and long-term rehabilitation staff meetings were asked to participate in the study. Subjects read profiles of actual patients and attempted to predict the patients' desired code status. Subjects also highlighted factors of the patient profile that they deemed important in predicting each patient's desired code status. RESULTS: For the 12 patient profiles examined, the respondents accurately estimated patients' desired code status an average of only 6.5 times. Patient ability to perform the basic activities of daily living was the patient profile factor cited most frequently as influential in determining code status. CONCLUSIONS: Given only clinical and demographic data, health care professionals are only slightly better than chance in determining patients' desired code status. Health care professionals working with long-term care patients should become familiar with individual patient's values and desires for code status decisions.

In vivo sensitivity of Plasmodium falciparum to chloroquine in rural areas of Côte d'Ivoire.

In vivo testing of Plasmodium falciparum sensitivity to chloroquine was carried out in four rural sites of differing socio-geographical environment in Côte d'Ivoire. Of a total of 1282 patients of all ages with fever or previous history of fever, 649 were slide positive, with 435 patients with a pure P. falciparum infection; 191 fulfilled all the criteria for inclusion in this study, and 113 completed it. Treatment failure rates ranged from 9.7% (Djébonoua) to 38.1% (Tiéviéssou), and were most often associated with higher degrees of resistance (RII = 54.2%; RIII = 37.5%). Blood chloroquine levels measured by ELISA test suggest that many people take chloroquine routinely; furthermore 37.5% of resistance cases occurred in subjects who had high blood chloroquine concentrations on day 0. Twenty-three out of 24 cases of resistance were found in children under 7 years of age. Nearly all children with persisting parasitaemia were afebrile on day 7, even those (7/8) with RIII resistance. Children aged < 7 years represent the the best sentinel group for monitoring P. falciparum sensitivity to chloroquine in Côte d'Ivoire.