Responding to SUPPORT: an academic medical center examines its end-of-life care practices. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

The purpose of this exploratory study was to examine the end-of-life (EOL) care rendered to patients and families within a large midwestern academic medical center during a recent one-year period. An investigator-developed audit tool was used to review the final hospitalization records of 100 patients. Data were collected regarding demographic variables, final hospitalization, medical diagnoses and histories, and documented end-of-life care. Major findings included a majority of deaths occurring within medical services on critical care units, a frequent short length of stay, a majority of Do Not Resuscitate or Withdrawal of Support orders being written 1-3 days prior to death, an unstable health status prior to admission, and presence of at least one significant chronic illness in the past medical history. Findings are being used to address EOL care related issues within the institution.

Effectiveness of education-screening on cholesterol levels of students.

Increases of cholesterol levels from the age of 16 years have been demonstrated in community-based studies. Cholesterol education to students aged 15-17 years in 5 high schools was presented prior to cholesterol screening with the Reflotron. First screening took place in March 1987. An identical program was repeated 11 months later, again followed by screening in March 1988. Of the 5 schools, 2 were assigned to involve teachers. There was a significant cholesterol reduction in these 2 schools, i.e., -17 and -19 mg/dl (p less than 0.05). The effectiveness of the physicians' education and the compliance of the students with the teachers' recommendations certainly must have been enhanced by a different family environment with a higher socioeconomic stratum prevailing in these 2 high schools. However, these factors did not influence the baseline in all 5 schools. In the 3 remaining schools no increases in cholesterol levels expected for this age were observed.