RESUMEN
Colorado's manslaughter law classifies assisted suicide as a felony. Because terminal patients are close to life's end, death while being treated is inevitable, therefore, there was concern among physicians that the fear of prosecution continued to prevent adequate pain relief for terminal patients. A group of physicians and concerned citizens set out to amend Colorado Revised Statutes to reassure doctors and others prescribing or administering palliative care for terminal patients that they would not be indicted under the law prohibiting assisted suicide. The 2006 Assembly passed the amendment (quoted in the text) with virtually no opposition in either house and it was signed into law by the governor, effective July 6, 2006. Note that in addition to allowing appropriate pain management, it specifically emphasizes that it does not permit assisted suicide.
Asunto(s)
Crimen/legislación & jurisprudencia , Responsabilidad Legal , Cuidados Paliativos/legislación & jurisprudencia , Colorado , Humanos , Suicidio Asistido/legislación & jurisprudencia , Decisiones de la Corte Suprema , Cuidado Terminal/legislación & jurisprudenciaRESUMEN
OBJECTIVES: To evaluate pain management satisfaction in elderly postoperative patients; to define pain management strategies documented in the medical record (MR) that predict patient satisfaction. DESIGN: Prospective cohort. SETTING: Eight urban hospitals. PARTICIPANTS: Three hundred twenty-two postsurgical patients aged 65 and older. MEASUREMENTS: Patients were surveyed regarding satisfaction with pain management in the first 24 hours postsurgery and the survey results summarized in a score. Pain management variables (patient education, pharmacological and nonpharmacological interventions, demographic variables, and surgery and anesthesia information) were abstracted from their MR. The correlation between the satisfaction score and MR variables was assessed using linear regression. RESULTS: Sixty-two percent of patients experienced severe postoperative pain, yet 87% reported being satisfied with the treatment. The mean satisfaction score+/-standard deviation was 59.3+/-10.8 (range 10.6-84.3; potential range 0-100, higher score=higher satisfaction). MR variables explained 14% of the satisfaction score variation. The worst pain intensity in the first 24 hours postsurgery as documented in the MR was the most powerful predictor of satisfaction. Other predictors associated with satisfaction were younger age, male sex, preoperative education, surgery type (laparotomy/thoracotomy patients were more satisfied than orthopedic patients), shorter recovery room stay, analgesic given through oral route, and morphine (compared with other opioids). CONCLUSION: Pain in elderly surgical patients remains undermanaged. Simple strategies such as emphasizing preoperative education may have a large effect in pain management. This study developed a validated patient satisfaction score and a MR instrument to assist in monitoring pain management quality.
Asunto(s)
Documentación , Adhesión a Directriz , Registros Médicos , Dolor Postoperatorio/terapia , Satisfacción del Paciente , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Electivos/efectos adversos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medicare , Dimensión del Dolor , Dolor Postoperatorio/etiología , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , PsicometríaRESUMEN
BACKGROUND: Current US and European guidelines recommend that ejection fraction (EF) be measured at least once in patients with congestive heart failure (CHF). However, it is not known how age and sex influence adherence to this recommendation. METHODS: We reviewed a national sample of Medicare patients discharged with a principal diagnosis of heart failure and sought to determine the frequency of measurement of EF and the frequency of preserved systolic function (EF > 40%) by age and sex. RESULTS: A total of 2,239 patients were included in this study. EF was known or measured in 59.2% of all admissions. EF was measured less often in women and with increasing age, but using logistic regression only increasing age (P <.0001) and not sex (P =.247) was associated with a lower frequency of EF measurement. Women were more likely than men to have preserved systolic function in all age groups older than age 65 (P <.001), but the frequency of preserved systolic function increased with age in both men and women. CONCLUSIONS: In Medicare patients discharged with a principal diagnosis of heart failure, only 59% have a measurement of EF. Women have EF measured less often than men; this is solely a function of the older age of women. Preserved systolic function increases in both men and women with CHF with increasing age, but women are far more likely than men to have preserved systolic function at all ages.