WELL-BEING AND ADVANCE DIRECTIVES AMONG PROLONGED MECHANICAL VENTILATION PATIENTS AT HOME VERSUS HOSPITAL
Bibliographic record
Abstract
Abstract Despite increasing numbers of older patients requiring Prolonged Mechanical Ventilation (PMV), little is known concerning their mood, well-being, distressing symptoms and attitudes towards ventilation. Furthermore differences may exist according to place of care- whether Home Hospital or Hospital Long Term Care (HLTC). These issues were addressed using the revised Edmonton Symptom Assessment System (r-ESAS)(10 items, max severity score=100), and Short Geriatric Depression Scale, in a study of the majority of PMV patients (n=120/123) aged ≥18 (range 18-96 years) all Clalit Health Service insurees, in Jerusalem. Communicative patients were interviewed (40/46 at home, 22/74 in HLTC, average age 54 vs.73 years, p<0.01). The following symptoms (dichotomized to “not-a-problem”/“problematic”) were frequently reported as “not-a-problem” among patients (Home,HLTC): tiredness (59%,58%), poor appetite (95%,90%), pain (69%,84%), drowsiness (77%,90%), nausea (85%,84%), and shortness of breath (82%,90%). General well-being (categorized to good/mild/moderate/severe impairment) was reported more frequently as good or mildly impaired at Home vs. HLTC (54% vs.26%), as was lower frequency of depression (34.4% vs. 44.4%, p=0.049). The total r-ESAS score was similar irrespective of setting: Home-24.9/100 (inter quartile range {IQR} 13.5-32.5) vs. HLTC-23.7/100 (IQR 17.5-32),p=0.74. The majority (119/120) of patients were without advanced directives prior to initiation of PMV. When asked if they had to choose again, 82% and 91% of communicative patients at home vs. HLTC would opt again for ventilation, as would 75% of caregivers of uncommunicative patients. Our findings emphasize the resilience and low levels of distressing symptoms among PMV patients, and may contribute to the decision-making process concerning advanced directives.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".