ObjectivesThere is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.MethodsThis was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.ResultsThe composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.ConclusionThe scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.Practice implicationsStandardized discussion of code status and training in communication of end-of-life care merit further research.

Benzoyl peroxide is macrolide antibiotic used commonly for the treatment of acne either alone or in combination. But it suffers from side effects like skin redness, irritation, itching, and edema. Niosomes, a nonionic surfactant vesicular formulation, have been explored extensively for topical application to enhance skin penetration as well as to improve skin retention of drugs. In the present study, Benzoyl peroxide was entrapped into niosomes by thin film hydration technique, and various process parameters were optimized by partial factorial design. The optimized niosomal formulation was incorporated into HPMC K15 gel and extensively characterized for percentage drug entrapment (PDE) and in vitro release performance. The stability of above formulation was studied at different temperatures. The present study demonstrated prolongation of drug release, increased drug retention into skin, and improved permeation across the skin after encapsulation of benzoyl peroxide into niosomal topical gel.

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