Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study.

Aim: Our aim was to examine how code status orders for patients hospitalized with COVID-19 changed over time as the pandemic progressed and outcomes improved. Methods: This retrospective cohort study was performed at a single academic center in the United States. Adults admitted between March 1, 2020, and December 31, 2021, who tested positive for COVID-19, were included. The study period included four institutional hospitalization surges. Demographic and outcome data were collected and code status orders during admission were trended. Data were analyzed with multivariable analysis to identify predictors of code status. Results: A total of 3615 patients were included with full code (62.7%) being the most common final code status order followed by do-not-attempt-resuscitation (DNAR) (18.1%). Time of admission (per every six months) was an independent predictor of final full compared to DNAR/partial code status (p = 0.04). Limited resuscitation preference (DNAR or partial) decreased from over 20% in the first two surges to 10.8% and 15.6% of patients in the last two surges. Other independent predictors of final code status included body mass index (p < 0.05), Black versus White race (0.64, p = 0.01), time spent in the intensive care unit (4.28, p = <0.001), age (2.11, p = <0.001), and Charlson comorbidity index (1.05, p = <0.001). Conclusions: Over time, adults admitted to the hospital with COVID-19 were less likely to have a DNAR or partial code status order with persistent decrease occurring after March 2021. A trend toward decreased code status documentation as the pandemic progressed was observed.

If Your Heart Were to Stop: Characterization and Comparison of Code Status Orders in Adult Patients Admitted with COVID-19.

Aim: Our aim is to characterize code status documentation for patients hospitalized with novel coronavirus 2019 (COVID-19) during the first peak of the pandemic, when prognosis, resource availability, and provider safety were uncertain. Methods: This retrospective cohort study was performed at a single tertiary academic medical center. Adult patients admitted between March 1, 2020 and October 31, 2020 who tested positive for COVID-19 were included. Demographic and hospital outcome data were collected. Code status orders during this admission and prior admissions were trended. Data were analyzed with multivariable analysis to identify predictors of code status choice. Results: A total of 720 patients were included. The majority (70%) were full code and 12% were in do-not-attempt resuscitation (DNAR) status on admission; by discharge, 20% were DNAR. Age (p < 0.001), time in the intensive care unit (ICU) (p < 0.001), and having Medicaid (p = 0.04) compared to private insurance were predictors of DNAR. Fourteen percent had no code status order. Older age (p < 0.001), time in the ICU (p = 0.01), and admission to a teaching service (p < 0.001) were associated with having an order. Of patients with a prior admission (n = 227), 33.5% previously had no code status order and 44.5% had a different code status for their COVID-19 admission. Of those with a change, most transitioned to less aggressive resuscitation preferences. Conclusions: Most patients hospitalized with COVID-19 in our study elected to be full code. Almost half of patients with prepandemic admissions had a different code status during their COVID-19 admission, with a trend toward less aggressive resuscitation preference.

Phlegmasia cerulea dolens: a rare cause of shock.

Phelgmasia cerulea dolens (PCD) is a rare cause of shock that can complicate deep venous thrombosis and carries a high risk of mortality. We present a case of extensive bilateral lower extremity deep vein thrombosis associated with an inferior vena cava filter which rapidly progressed to PCD and refractory shock.

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services.

OBJECTIVES: International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. DESIGN: A cross-sectional survey of hospital and community-based DNS in Ireland. METHODS: Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. RESULTS: The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. CONCLUSIONS: Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.

Student nurse mentoring: an evaluative study of the mentor's perspective.

An evaluative study aimed to capture the 'mentor voice' and provide an insight into the mentoring role from the perspective of the nurse mentor. Participants from each of the four fields of nursing practice were asked to comment on the satisfying and frustrating aspects of their mentoring role. The narrative data gleaned from the evaluation were qualitatively analysed and subsequently organised into key themes around the student-mentor relationship and the clinical environment. Given that the landscape of nurse education is set to change, in terms of new standards from the professional bodies and the political drivers, not to mention the changing profile of the student nurse, it is hoped that the findings may help to shape the relationship between the mentor, the student and the higher education institution.

Forensic discrimination of dyed hair color: II. Multivariate statistical analysis.

This research is intended to assess the ability of UV-visible microspectrophotometry to successfully discriminate the color of dyed hair. Fifty-five red hair dyes were analyzed and evaluated using multivariate statistical techniques including agglomerative hierarchical clustering (AHC), principal component analysis (PCA), and discriminant analysis (DA). The spectra were grouped into three classes, which were visually consistent with different shades of red. A two-dimensional PCA observations plot was constructed, describing 78.6% of the overall variance. The wavelength regions associated with the absorbance of hair and dye were highly correlated. Principal components were selected to represent 95% of the overall variance for analysis with DA. A classification accuracy of 89% was observed for the comprehensive dye set, while external validation using 20 of the dyes resulted in a prediction accuracy of 75%. Significant color loss from successive washing of hair samples was estimated to occur within 3 weeks of dye application.

Forensic discrimination of dyed hair color: I. UV-visible microspectrophotometry.

Current protocols for examining hair do not attempt to differentiate hair color using instrumental analysis. In this study, hair samples treated with 55 different red hair dyes were analyzed using UV-visible microspectrophotometry between 200 and 700 nm. Using air as a background reference gave the best results, although mounting media such as glycerin could also be used. The contribution of the hair substrate is predominantly observed in the range of 300-400 nm while the dye peak is evident in the range of 425-550 nm. It was found that the presence of hair dye reduces the overall intrasample variability of the hair color. In addition, visual inspection and spectral interpretation showed that dyed hair exhibits distinct and discernable shades. The color of all samples was stable during storage and while all hair dyes fade with washing, significant fading of the color was only evident after daily washing for 3 weeks.

Implementation and evaluation of a best practice initiative. Venipuncture in the well baby.

Venipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH), Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additional samples for monitoring of hyperbilirubinemia or other laboratory tests. A change from capillary heel sticks to venipuncture was implemented when the lancets in use were discontinued and a suitable replacement could not be found at the time. A review of the literature discovered a Cochrane Neonatal Review that supported newborn venipuncture as a safe, pain-reducing practice when performed by trained phlebotomists. As a result, a quality improvement project was developed to implement the practice of venipuncture for the well newborn. The implementation and evaluation included lectures, demonstrations, return demonstrations, and eventual integration into clinical practice. Process and summative evaluation demonstrated a willingness of staff to learn a new procedure, particularly when they had identified the need for change. In addition, infants were not subjected to multiple, ineffective blood draws.