scholarly journals Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Pia von Blanckenburg ◽  
Nico Leppin ◽  
Katharina Nagelschmidt ◽  
Carola Seifart ◽  
Winfried Rief
Keyword(s):  
End Of Life ◽  
Primary Outcome ◽  
Death And Dying ◽  
Control Group ◽  
Psychological Interventions ◽  
Death Attitudes ◽  
Life And Death ◽  
Very High ◽  
Death Acceptance

<b><i>Introduction:</i></b> Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated. <b><i>Objective:</i></b> To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages. <b><i>Methods:</i></b> 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up. <b><i>Results:</i></b> IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (<i>F</i>[5.61, 307] = 4.83, <i>p</i> &#x3c; 0.001, η<i>p</i><sup>2</sup> = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high. <b><i>Conclusions:</i></b> Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.

scholarly journals Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones

Thorax ◽  
2019 ◽  
Vol 74 (4) ◽  
pp. 328-336 ◽  
Author(s):  
Carmen H M Houben ◽  
Martijn A Spruit ◽  
Hans Luyten ◽  
Herman-Jan Pennings ◽  
Vivian E M van den Boogaart ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Intervention Group ◽  
Control Group ◽  
Life Care ◽  
Quality Of Death ◽  
Advance Care

RationaleAdvance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).ObjectivesTo assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up.MethodsA multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying.Results165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p<0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p>0.05). The quality of death and dying was comparable between both groups (p=0.17).ConclusionOne nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

scholarly journals A Comparison of Effectiveness of Compassion-Focused Therapy (CFT) and Mindfulness-Based Stress Reduction (MBSR) on Psychological Flexibility of HIV Patients in Imam Khomeini Hospital

2021 ◽  
Author(s):  
Manzar Amirkhani ◽  
Shohreh Ghorbanshiroudi ◽  
Mohammadreza Zarbakhsh Bahri ◽  
Seyed Ahmad Seyed Alinaghei
Keyword(s):  
Stress Reduction ◽  
Psychological Flexibility ◽  
Analysis Of Covariance ◽  
Psychological State ◽  
Control Group ◽  
Psychological Interventions ◽  
Hiv Patients ◽  
Compassion Focused Therapy ◽  
Mindfulness Based Stress Reduction

Background: HIV patients are exposed to many psychological problems, including psychological inflexibility. It seems that psychological interventions can be effective to improve the psychological state of these patients. Therefore, in this study, we aimed to compare the effectiveness of interventions with 2 methods of Compassion-Focused Therapy (CFT) and Mindfulness-Based Stress Reduction (MBSR) program on psychological flexibility of HIV patients in Imam Khomeini Hospital. Methods: The present study was a descriptive-analytical study that was performed as an intervention in the period from May to January in 2020 on 54 HIV patients referred to Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital Complex. The samples of the study mode were selected by available sampling and randomly divided in 3 groups of 18 people based on CFT, MBSR session and the control group. Each treatment was presented to 2 experimental groups for 10 sessions per week and the control group was placed on a waiting lists. Patients' psychological flexibility was assessed by the Acceptance and Action Questionnaire- II "AAQ-II" in 3 stages: pre-test, post-test and follow-up. SPSS 23 software and analysis of covariance, bonferoni test and one-way analysis of variance were used to analyze the data. Results: The results showed that CFT and MBSR were effective on increasing psychological flexibility of HIV patients (p < 0.01). Comparison of the effectiveness of the 2 therapies showed that CFT caused a further increase on increasing psychological flexibility (p < 0.01). Changes in follow-up 3 months after treatment also remained stable (p < 0.01). Conclusion: Findings of the study show that the use of therapies in this study can be effective in planning psychological interventions to promote and improve mental health in HIV patients.

Effect of ICT-Based Self-Management System DialBeticsLite on Treating Abdominal Obesity: Randomized Controlled Trial. (Preprint)

2021 ◽  
Author(s):  
Masahiro Kondo ◽  
Teru Okitsu ◽  
Kayo Waki ◽  
Toshimasa Yamauchi ◽  
Masaomi Nangaku ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Intervention Group ◽  
Metabolic Parameters ◽  
Control Group ◽  
Physical Parameters ◽  
Lifestyle Behavior ◽  
Randomized Controlled

BACKGROUND Mobile health interventions, a more cost-effective approach compared to traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. It is useful to know the efficacy of mobile apps in treating abdominal obesity, as it is a known risk factor for metabolic disorders and type 2 diabetes. OBJECTIVE This study aimed to determine whether a mobile self-management app (DialBeticsLite) could be used by patients with abdominal obesity to achieve a reduction in visceral fat area (VFA) and other physical parameters. METHODS This study was an open-label, 2-arm parallel-design randomized controlled trial. We recruited 122 people in September 2017, and randomly assigned them into either the intervention group or the control group. All participants attended an educational group session, which delivered information regarding diet and exercise. Additionally, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior, and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters, from baseline to the 3-month follow-up. Welch t test was conducted to analyze the effects of DialBeticsLite on both the primary outcome and the secondary outcomes. RESULTS Out of the 122 participants recruited, 75 participants were analyzed due to 47 participants being excluded: 37 due to ineligibility and 10 due to withdrawal of consent. The mean age was 49.3 (standard deviation: SD 6.1) in the intervention group (n=41) and 48.5 (SD 5.3) in the control group (n=34), and all participants were male, though unintentionally. Baseline characteristics did not differ significantly between the intervention and control group, except for VFA. The averaged change of VFA was -23.5cm2 (SD 20.6) in the intervention group and +1.9cm2 (SD 16.2) in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI and waist circumference. These findings did not change after adjusting for VFA at baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day, and between the change in VFA and calorie intake per day within the intervention group. CONCLUSIONS Our findings indicate that although unsuccessful in improving metabolic parameters, a mobile health intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior, can be highly effective in inducing visceral fat loss and weight loss among adults with abdominal obesity. CLINICALTRIAL Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042045 Retrospectively Registered; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000046495&type=summary&llanguag=J

P–328 Dienogest significantly decreases the size of the cyst and alters Anti-Müllerian Hormone concentration in patients with endometrioma

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Karataş ◽  
B E Temiz ◽  
S Mumusoglu ◽  
H Yarali ◽  
G Bozdag
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Drop ◽  
Mean Size ◽  
The Mean ◽  
Respective Figure

Abstract Study question Does utilization of dienogest make any impact on the size of cyst and Anti-Müllerian Hormone (AMH) concentration in patients with endometrioma throughout 12-months? Summary answer Although dienogest makes a gradual reduction in the size of endometrioma cyst throughout 12-months, a significant drop in AMH serum concentration was also noticed. What is known already According to recent studies, pre-operative serum AMH levels might be illusively increased with parallel to the size of endometrioma which will be a misleading factor while deciding to operate the patient via cystectomy. Although dienogest is one of the medical options that might be commenced in patients with endometrioma cyst, there is limited data about its effect on the size of the endometrioma and hence serum AMH concentration throughout 12 months of follow up. Study design, size, duration The current observational cohort study was conducted among patients with endometrioma those treated with dienogest from January 2017 to January 2020. The primary outcome was alteration in diameter of endometrioma cyst at 6th and 12th months of treatment. Secondary outcome was alteration in serum AMH concentration in the same period. Of 104 patients treated with dienogest, 44 patients were excluded due to being treated with any type of surgical intervention during follow up period. Participants/materials, setting, methods A total of 60 patients were recruited for the final analysis. Of them, primary symptom was dysmenorrhea, chronic pelvic pain and menstrual irregularity in 16 (26.7%), 25 (41.7%) and 8 (13.3%) patients, respectively. Eighteen patients (30%) were asymptomatic. As 21 patients had bi-lateral endometrioma, size of the leading cyst was considered to be analyzed for the primary outcome measure. Paired-t test was used for comparison of numerical values and p ≤ 0.05 was taken as statistical significance. Main results and the role of chance The mean age was 31.5±8.0 years. In the time point when dienogest was started, the mean size of the endometrioma was 46.3±17.4 mm. The mean serum AMH concentration was 3.6±2.4 ng/ml. After 6 months of treatment, the mean size of the endometrioma decreased to 38.6±14.0 mm which corresponds to a mean difference of 7.8 mm (95% CI: 3.0 to 12.6; p: 0.003). The respective figure for AMH was 3.3±2.7 ng/ml which corresponds to a mean difference of 0.3 ng/ml (95% CI: –0.2 to 0.8; p: 0.23) at 6 months. After 12 months of treatment, the mean size of the endometrioma was 37.5±15.7 mm which corresponds to a mean difference of 8.9 mm (95% CI: 2.9 to 14.9; p: 0.005) at the end of 12 months. The respective figure for AMH was 2.7±1.9 ng/ml which corresponds to a mean difference of 0.9 ng/ml (95% CI: 0.1 to 1.7; p: 0.045) at the end of 12 months. The mean diameter of endometrioma and AMH concentration did not differ throughout the time period between 6th and 12th months of the treatment. Limitations, reasons for caution Although herein we present the largest data that depicts the alteration of endometrioma cyst and AMH concentration with the application of dienogest, the lack of control group is a limitation that avoids to perform any comparison. Wider implications of the findings: A shrinkage after commencement of treatment suggest that dienogest might present improvement in patients with endometrioma with respect to radiological findings, but further studies are required whether a decline in AMH concentration after 12 months refers to a genuine decrease in ovarian reserve or resolution of misleading high pre-treatment levels. Trial registration number not available

scholarly journals P092: Combatting sedentary lifestyles; can exercise prescriptions in the emergency department lead to a behavioural change in patients?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S89-S89
Author(s):  
D. Lewis ◽  
K. Leech-Porter ◽  
F. Milne ◽  
J. Fraser ◽  
S. Hull ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Exercise Prescription ◽  
Behavioural Change ◽  
Significant Proportion ◽  
Intervention Group ◽  
Routine Care ◽  
Control Group ◽  
Post Hoc

Introduction: Patients with chronic diseases are known to benefit from exercise. Such patients often visit the emergency department (ED). There are few studies examining prescribing exercise in the ED. We wished to study if exercise prescription in the ED is feasible and effective. Methods: In this pilot prospective block randomized trial, patients in the control group received routine care, whereas the intervention group received a combined written and verbal prescription for moderate exercise (150 minutes/week). Both groups were followed up by phone at 2 months. The primary outcome was achieving 150 min of exercise per week. Secondary outcomes included change in exercise, and differences in reported median weekly exercise. Comparisons were made by Mann-Whitney and Fishers tests (GraphPad). Results: Follow-up was completed for 22 patients (11 Control; 11 Intervention). Baseline reported median (with IQR) weekly exercise was similar between groups; Control 0(0-0)min; Intervention 0(0-45)min. There was no difference between groups for the primary outcome of 150 min/week at 2 months (Control 3/11; Intervention 4/11, RR 1.33 (95%CI 0.38-4.6;p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (Control 75(10-225)min; Intervention 120(52.5-150)min;NS). 3 control patients actually received exercise prescription as part of routine care. A post-hoc comparison of patients receiving intervention vs. no intervention, revealed an increase in patients meeting the primary target of 150min/week (No intervention 0/8; Intervention 7/14, RR 2.0 (95%CI 1.2-3.4);p=0.023). Conclusion: Recruitment was feasible, however our study was underpowered to quantify an estimated effect size. As a significant proportion of the control group received the intervention (as part of standard care), any potential measurable effect was diluted. The improvement seen in patients receiving intervention and the increase in reported exercise in both groups (possible Hawthorne effect) suggests that exercise prescription for ED patients may be beneficial.

Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey

2020 ◽  
pp. 003022282096123
Author(s):  
Deniz Sanli ◽  
Fatma Iltus
Keyword(s):  
Nursing Students ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Death And Dying ◽  
Life Care ◽  
Death Attitudes ◽  
Positive Attitudes ◽  
Dying Patients ◽  
And Behaviors

Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.

Effect of Senior Dance (DanSE) on Fall Risk Factors in Older Adults: A Randomized Controlled Trial

2020 ◽  
Vol 100 (4) ◽  
pp. 600-608 ◽  
Author(s):  
Marcia R Franco ◽  
Catherine Sherrington ◽  
Anne Tiedemann ◽  
Leani S Pereira ◽  
Monica R Perracini ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Control Group ◽  
Eyes Closed ◽  
Sit To Stand ◽  
Single Leg Stance ◽  
Community Dwelling Older People

Abstract Background Older people’s participation in structured exercise programs to improve balance and mobility is low. Senior Dance is an alternative option, as it may provide a safe and fun way of targeting balance. Objective The aim was to investigate the effect of Senior Dance on balance, mobility, and cognitive function compared with a control intervention. Design The study was a randomized controlled trial. Setting/Patients Eighty-two community-dwelling older people aged 60 years or over and cognitively intact were recruited in Brazil. Intervention Participants were randomly allocated to 2 groups: Dance plus education (intervention group) and education alone (control group). The Senior Dance program consisted of 12 weeks of twice-weekly group-based dance classes. Participants in both groups attended a single 1-hour educational session on prevention of falls. Measurements The primary outcome was single-leg stance with eyes closed. Secondary outcomes were timed sit-to-stand test, standing balance test, timed 4-m walk, and cognitive function tests, for example, Trail Making Test and Montreal Cognitive Assessment. Results Of the 82 participants randomized, 71 (87%) completed the 12-week follow-up. Single-leg stance with eyes closed (primary outcome) improved in the Senior Dance group (mean difference [MD] = 2.3 seconds, 95% confidence interval [CI] = 1.1 to 3.6) compared with the control group at follow-up. Senior Dance group performed better in the standing balance tests (MD = 3.7 seconds, 95% CI = 0.6 to 6.8) and were faster in the sit-to-stand test (MD = − 3.1 seconds, 95% CI = −4.8 to −1.4) and 4-m walk test (MD = −0.6 seconds, 95% CI = −1.0 to −0.1). There were no significant between-group differences for cognitive function tests. Limitations Participants and therapists were not blinded. Conclusion Senior Dance was effective in improving balance and mobility but not cognitive function in community-dwelling older people.

scholarly journals The effect of Hydroxychloroquine use due to rheumatic disease on the risk of Covid-19 infection and its course

2021 ◽  
Author(s):  
Tanzer Korkmaz ◽  
Aslı Şener ◽  
Vedat Gerdan ◽  
İlker Kızıloglu
Keyword(s):  
Rheumatic Disease ◽  
Incidence Rate ◽  
Chronic Diseases ◽  
Patient Group ◽  
Primary Outcome ◽  
Local Area ◽  
Control Group ◽  
Efficiency And Reliability ◽  
Pcr Test

Introduction COVID-19 virus continues to spread and die worldwide. Some studies examining hydroxychloroquine as a prophylactic agent reported that its efficiency and reliability have not been proven so that it must not be used for prophylaxis other than clinical researches. However we think that the results of this study we conducted in a local area will contribute to the literature data. Methods The study was designed as adult patients who were in follow-up taking HC due to their chronic diseases were included. 384 patients who were taking hydroxychloroquine regularly and 299 patients who were not taking hydroxychloroquine were included. The primary outcome of this study is to detect a positive PCR result in patients who received a PCR test and to determine the incidence rate and its course of the disease among those who were taking HC and those who were not taking hydroxychloroquine. Results The majority of the patients (median age: 51.8- range 17-89) were women and housewives. In the patient group using hydroxychloroquine, 22 patients were tested for PCR and only 2 positive patients were found. Covid-19 was detected in 24 (8.02%) of 65 (21.73%) patients who underwent PCR test at Control group (n = 299). PCR positivity was statistically lower in the HK group (n = 2, 0.52%, n = 24, 8.02%, respectively, p = 0.0001). Conclusions Our study supported the fact that there is a lower PCR positivity and symptoms are milder among patients who are using HC regularly, as compared to those who are not using hydroxychloroquine.

scholarly journals DNR order in SARS-CoV-2 patients: preliminary guidelines validation and quality of palliative care in a single Swiss COVID-19 Center.

2021 ◽  
Author(s):  
Giorgia Lo Presti ◽  
Maira Biggiogero ◽  
Andrea Glotta ◽  
Carola Biondi ◽  
Zsofia Horvath ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Control Group ◽  
Do Not Resuscitate ◽  
Medical Sciences ◽  
Borg Scale ◽  
Early Access ◽  
Post Traumatic

Background: The worldwide pandemic situation forced many hospitals to improve COVID-19 management. In this scenario, the Swiss Academy of Medical Sciences (SAMW/ASSM) organized guidelines based on expert opinion to identify Do-Not-Resuscitate (DNR) patients, which often need palliative care (PC) due to a large symptoms burden. In our specialized COVID-19 Center, we investigated characteristics and mortality of DNR patients according to SAMW/ASSM guidelines, comparing to non-DNR patients. Methods: Pilot retrospective validation study, evaluating consecutive COVID-19 patients admitted to Internal Medicine Department. A sub-analysis of the deceased patients care was performed, using both Richmond Agitation-Sedation Scale-Palliative care (RASS-PAL) for sedation and agitation (+4/-5) and modified Borg Scale for dyspnea (1-10). Primary outcome was a 30-days survival of DNR patients comparing to non-DNR patients. Secondary outcomes reported quality of PC, especially on dyspnea and restlessness. Results: From March 16 to April 1 2020, 213 consecutive patients were triaged; of 40 DNR patients 25 (64%) were males with a mean age of 79.9 years. At 30-days follow-up, 9 (22.5%) of DNR patients died; 4 patients (2.2%) died in the control group. The higher mortality rate in DNR group was further confirmed by Log-Rank Mantel-Cox (23.104, p < 0.0001). PC was applied using oxygen (100%), opioids (100%) and sedatives (89%); the mean RASS-PAL improved from 2.2 to -1.8 (p < 0.0001) and Borg scale improved from 5.7 to 4.7 (p = 0.581). Conclusion: The SAMW/ASSM guidelines identified patients at higher risk of short-term death. In the end-of-life management, an early access to PC becomes crucial, both improving patients' end-of-life treatment and reducing psychological families' post-traumatic disorders.

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