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The effect of prophylactic digitalization on the development of left ventricular hypertrophy was studied in adult rats. Digitoxin, 0.1 mg/100 g body wt or solvent was given daily for 1 wk prior to either aortic constriction or sham operation and was continued until the animals were killed, either 1 or 4 wk after surgery. A hemodynamic study was done in those animals killed 1 wk after surgery; hearts of all animals were examined for evidence of myocardial hypertrophy. Constriction of the ascending aorta had no significant effect on cardiac output but did reduce peak flow velocity and flow acceleration. An increase in left ventricular mass, RNA, and hydroxyproline was found in the animals with aortic constriction. Digitoxin treatment did not alter peak flow velocity or flow acceleration, but did significantly increase isovolumic (dP/dt)P-1. Digitoxin had no effect on body weight, heart weight, RNA, or hydroxyproline in either the sham-operated animals or in the animals with aortic constriction. Therefore, despite plasma digitoxin levels sufficient to affect myocardial contractility, left ventricular hypertrophy still developed after aortic constriction.

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Results. Survey response rate was 31% (MD/DO 31%, RN 60%, APP 9%). Experiences in providing palliative care was variable. Routine symptom management was reported by 89%, while goals of care conversations (55%) and emotional support to other clinicians were less routine (53%). The majority of respondents (95%) believed palliative care was an important part of their patients' care; 79% felt they could personally provide this care; and 84% felt they could ask for PCC. The most commonly perceived barriers to PCC were patient/family reluctance or uncertainty, disagreement within or between teams, and inadequate comfort level. Active stage IV malignancy, patient/family support, or request and decision to forgo life-sustaining treatment were the most commonly reported PCC triggers. Conclusion. While a majority of ICU clinicians report PCC is important, experiences, attitudes, and barriers in providing such care vary widely. Implications for Research, Policy, and Practice. This survey involving key stakeholders identified barriers to target for interventions, including development of a PCC trigger tool, tailored to needs of ICUs in this health system.