Knowledge and attitudes of physicians in Chile toward Do-Not-Attempt-Resuscitation orders: A cross-sectional nation-wide study.

Objective: Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic efforts in cases where it may be futile. The decision not to resuscitate a patient is a process that involves a series of ethical, legal, and clinical considerations. Still, it also requires a process in which priority is given to the patients and their autonomy. The objective of this study was to describe the knowledge and attitudes of physicians working in Chile toward Do-Not-Attempt-Resuscitation orders. Methods: A cross-sectional study was conducted, in which a digital questionnaire was sent to physicians from different regions of Chile. Quantitative variables were analyzed using measures of central tendency and dispersion (e.g., median and interquartile range), while qualitative variables were evaluated using frequencies and percentages. Results: Four hundred and thirty-one physicians completed the survey. 85.4% were familiar with the ethical and legal guidelines for cardiopulmonary resuscitation and the rights and duties of the patient. 39.2% believed that patients should have the final decision Do-Not-Attempt-Resuscitation orders, especially if they themselves requested not to be resuscitated. 87.7% mentioned that the Do-Not-Attempt-Resuscitation orders should be reassessed if the patient's prognosis improves. In addition, it was found that the decision not to resuscitate was not always discussed with the patient or their family. Conclusions: The study revealed an ethical conflict regarding Do-Not-Attempt-Resuscitation orders and their management by Chilean physicians. Therefore, it is necessary to create recommendations and provide training to guide professionals in this process, which should also involve patients and their families.

El déficit de vitamina B12 y ácido fólico en la población mayor de 65 años: estudio descriptivo / Vitamin B12 and folic acid deficiency in the population over 65 years: A descriptive study

Introducción. El objetivo de este estudio es conocer la prevalencia de déficit de vitamina B12 y ácido fólico en la población de 65 y más años de una zona semiurbana y rural, así como conocer los factores del riesgo de dicho déficit en esta población y su relación con la prevalencia de patología cardiovascular y cognitiva concomitante. Material y método. Estudio transversal realizado en la consulta de Geriatría durante el periodo comprendido entre 2008 y 2010. Se han recogido variables demográficas, clínicas y de laboratorio en 3 momentos diferentes. Se ha realizado un análisis bivariante con las variables resultado (déficit de vitamina B12 y ácido fólico). Resultados. El 16,5% de la muestra presentó déficit de la vitamina B12. No hubo pacientes con déficit de ácido fólico. Se ha encontrado una fuerte asociación del déficit de vitamina B12 con enfermedades cardiológicas y cerebro-vasculares, así como con factores de riesgo vascular y fármacos administrados en prevención de eventos cardíacos e isquémicos cerebrales. Conclusiones. Existe una mayor prevalencia de déficit de vitamina B12 en la población anciana del área de influencia de Medina del Campo en relación a la encontrada en la literatura, no así con el déficit aislado de ácido fólico(AU)

Introduction. The aim of this study is to establish the prevalence of vitamin B12 and folic acid deficiency in the population of 65 years and over in semi-urban and rural area, as well as investigating the risk factors, and the determining factors of this deficiency in this population and its relationship with the prevalence of concomitant cardiovascular and cognitive diseases. Materials and methods. A cross-sectrionall study conducted in the Geriatrics Outpatients in the period between 2008 and 2010. Demographic, clinical and laboratory were collected at 3 different times.A bivariate analysis was performed with lack of vitamin B12 and folic acid, as the outcome variables. Results. Vitamin B12 defieciency was found in 16.5% of the sample, and no folic acid deficiency. A strong association was found with vitamin B12 deficiency and cardiac and cerebrovascular diseases, vascular risk factors and drugs administered in prevention of cardiac events and ischaemic stroke. Conclusions. There was a higher prevalence of vitamin B12 deficiency in the elderly population in the catchment area of Medina del Campo compared to that found in the literature, but not so with the isolated deficiency of folic acid(AU)

[Vitamin B12 and folic acid deficiency in the population over 65 years: a descriptive study]. / El déficit de vitamina B12 y ácido fólico en la población mayor de 65 años: estudio descriptivo.

INTRODUCTION: The aim of this study is to establish the prevalence of vitamin B12 and folic acid deficiency in the population of 65 years and over in semi-urban and rural area, as well as investigating the risk factors, and the determining factors of this deficiency in this population and its relationship with the prevalence of concomitant cardiovascular and cognitive diseases. MATERIALS AND METHODS: A cross-sectrionall study conducted in the Geriatrics Outpatients in the period between 2008 and 2010. Demographic, clinical and laboratory were collected at 3 different times.A bivariate analysis was performed with lack of vitamin B12 and folic acid, as the outcome variables. RESULTS: Vitamin B12 defieciency was found in 16.5% of the sample, and no folic acid deficiency. A strong association was found with vitamin B12 deficiency and cardiac and cerebrovascular diseases, vascular risk factors and drugs administered in prevention of cardiac events and ischaemic stroke. CONCLUSIONS: There was a higher prevalence of vitamin B12 deficiency in the elderly population in the catchment area of Medina del Campo compared to that found in the literature, but not so with the isolated deficiency of folic acid.

Factors associated with the appropriate use of preoperatory hospital stays: historical cohort study.

BACKGROUND: To ensure the highest efficiency, health services should be provided with the least possible complexity. The aim of this study is to quantify the degree of appropriateness in preoperatory hospital stays and to analyse those factors associated with a greater inappropriate use. METHODS: Historical cohort study. The histories of 440 hospitalised patients who underwent at least one surgical procedure were analysed. Data collection was carried out by doctors not involved in the services studied, following the Appropriateness Evaluation Protocol. A bivariate and multivariate analysis of the factors associated with the appropriateness of preoperatory stays was carried out. RESULTS: The mean number of days of preoperatory stay was 5.5 (SD 5.11), of which a mean number of 2.5 days were considered to be inappropriate (SD 4.11). The overall rate of inappropriateness was 45.2% (CI 95% 43.3-47.1). The multivariate analysis showed a positive association of the inappropriateness of the preoperatory stay with weekend days, programmed admission, hospital stays longer than 7 days, medical records incorrectly or incompletely documented and the age groups of 45-65 and the >65 with respect to the <45 age group. Sex and an incorrect or incomplete nursing register did not show such an association. CONCLUSION: The inappropriate use of hospital stay during preoperatory care affects almost half the period and there are some risk determinants that could act as indicators at admission. In addition, the efficiency of care provision was found to vary greatly from the point of view of its appropriateness.