Background:Many patients show deterioration in functioning and increased care needs in the last year of life. End-of-life care needs and health care utilization might differ between groups of acutely hospitalized older patients.Aim:To investigate differences in geriatric conditions, advance care planning, and health care utilization in patients with cancer, organ failure, or frailty, who died within 1 year after acute hospitalization.Design:Prospective cohort study conducted between 2002 and 2008, with 1-year follow-up.Setting:University teaching hospital in the Netherlands.Participants:Aged ⩾65 years, acutely hospitalized for ⩾48 h, and died within 1 year after hospitalization. At admission, all patients received a systematic comprehensive geriatric assessment. Hospital records were searched for advance care planning information and health care utilization. Differences between patient groups were calculated.Results:In total, 306 patients died within 1 year after acute admission (35%) and were included; 151 with cancer, 98 with end-stage organ failure, and 57 frail older persons. At hospital admission, 72% of the frail group had delirium and/or severe pre-existing cognitive impairment. The frail and organ failure group had many pre-existing disabilities. Three months post-discharge, 75% of the frail and organ failure group had died, 45% of these patients had an advance care plan in their hospital records.Conclusion:Patients with frailty and organ failure had highest rates of geriatric conditions at hospital admission and often had missing information on advance care planning in the hospital records. There is a need to better identify end-of-life needs for these groups.
Despite its widespread occurrence, the topic of failure is barely addressed in entrepreneurship education. Consequently, students are given an incomplete and unrealistic picture of the complexity of being entrepreneurs. This study explores the pedagogical potential of introducing vicarious learning about failure in educational programs rather than focusing solely on starting, growing and success. Taking a qualitative approach, this study examined students’ reflective reports written after an interview with an entrepreneur on their experience of failure. Using concepts emerging from these reports and theoretical constructs, it was established whether and how students drew lessons and reflections from the failure stories. The findings show that interviewing and reflecting about the experiences of entrepreneurs allow for vicarious learning from failure, yet without students having to experience it themselves. The lessons learned and the reflections feed each other in a continuous loop. Students recognized that entrepreneurship involves trial and error instead of one straight road. Important lessons include the importance of adaptable behavior, access to key resources, insights in business development and the benefits of networking. Hence, this article contributes to the pedagogy of entrepreneurial education and provides initial suggestions for educators to introduce vicarious learning about failure as a topic in their programs.--Malgré sa fréquence élevée, le sujet de l’échec est à peine abordé dans l’enseignement de l’entrepreneuriat. En conséquence, il est communiqué aux étudiants une image incomplète et irréaliste de la complexité d’être un entrepreneur. Cette étude explore le potentiel pédagogique de l’apprentissage par procuration sur l’échec dans les programmes éducatifs, plutôt qu’une focalisation seulement sur le démarrage, la croissance et la réussite. En adoptant une approche qualitative, l’étude a examiné les rapports de réflexions rédigés par les étudiants à la suite d’un entretien avec un entrepreneur, centré sur son expérience de l’échec. À l’aide de concepts émergeant de ces rapports et de constructions théoriques, la manière dont les étudiants tiraient des leçons et des réflexions des récits d’échec – si tel était le cas - a été établie. Les résultats montrent que les entretiens et la réflexion sur l’expérience des entrepreneurs permettent un apprentissage par procuration concernant l’échec, sans pour autant que les étudiants aient eux-mêmes à vivre un échec. Les leçons apprises et les réflexions se nourrissent mutuellement dans une boucle continue. Les étudiants ont reconnu que l’entrepreneuriat a pour implication des épreuves et des erreurs, plutôt qu’une ligne toute droite. Parmi les leçons apprises majeures, citons l’importance des comportements adaptatifs, l’accès aux ressources-clés, les connaissances en matière de développement commercial et les avantages du travail en réseau. Ainsi, cet article contribue à la pédagogie de l’éducation sur l’entrepreneuriat et fait des suggestions pour les enseignants afin qu’ils introduisent l’apprentissage par procuration sur l’échec en tant que sujet à aborder dans leurs programmes.
Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2–5) chest radiographs and a median of one (1–2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2–21) days after arrival in the ICU and 18 (9–22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.
