If you’re lucky enough to be able to choose your hospital and have time to research your choices, you’d naturally take mortality rate into account. There’s a problem with that, and one change in how mortality rates are calculated could help solve it.
I think the authors may have missed a larger point. The variation in DNR patients may track facilities who serve more acutely ill populations. Without a more sophisticated look at the populations served, acuity of patients presenting for care, and level of patients kept versus being transferred out due to acute illness – incorporating DNR orders in the score weighting may not make them more accurate.
The interesting point for further research is whether or not DNR orders are a useful indicator or perhaps substitute measure for the other complex variables I noted above. Not having access to the study, I can’t tell whether the authors considered the point.
In every single country on the planet, women live longer than men. In response to this unpleasant fact, men are fond of replying, “That’s because we have to put up with women.” Humorous though it may be, that’s not the actual reason women live longer than men. In fact, it wasn’t until the beginning of the 20th Century that the “mortality gap” between men and women became so striking.
To investigate the underlying reason for the gender gap in life expectancy, a team of researchers examined mortality data for people born between 1800 and 1935 in 13 developed countries. Using this data, they were able to determine changes in the male-female mortality ratio, as well as determine when and why women began to outlive men.
The over 40 sample is great because it eliminates the two biggest gender specific dangers – childbirth and war. I would really like to see a study comparing the life spans of childless women, compared to those with children. One advantage of pregnancy prior to age 30 is a reduced risk of breast cancer. But pregnancy increases risk for osteoporosis associated complications.
Most patients receiving end-of-life care want to avoid aggressive attempts to prolong their life, but medical culture and practices often contradict these wishes. Part of the problem is due to confusion surrounding do-not-resuscitate orders. Here’s what patients really need to know about the “no code.”
First-responders would likely ignore any DNR-themed jewelry, markings, or tattoos, and only a specific form from the health sector specifically targeted at first-responders would stop them from providing standard care. Are first responders going to rifle through your pockets looking for such a form while they’re trying to save your life? Probably and hopefully not. The hospital setting, however, is where living wills, DNR-orders, powers-of-attorney, next-of-kin, etc. can be more readily honoured and better detailed. You could probably check the policies in your own jurisdiction for clarification.