Chest
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To determine the influence of mini-BAL culture results on subsequent changes in antibiotic therapy and patient outcomes. ⋯ These data suggest that antibiotic selection prior to obtaining the results of lower airway cultures is an important determinant of outcome for patients with suspected VAP. A delay in initiating adequate antibiotic therapy was associated with a greater mortality. Therefore, the initial selection of antibiotics for the empiric treatment of VAP should be broad enough to cover all likely pathogens, including antibiotic-resistant bacteria. This appears to be especially important in patients having received prior antibiotics.
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Comparative Study
Comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding drug therapy for acute myocardial infarction.
This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners. ⋯ For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.
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Vocal cord dysfunction (VCD) has been reported in adolescents only rarely. Two patients are described whose initial diagnosis was exercise-induced bronchospasm (EIB). ⋯ Patients were treated with speech therapy and have remained free of symptoms. VCD should be considered in adolescents who are unresponsive to treatment for EIB.
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Meta Analysis
Quality of life in patients with lung cancer: a review of literature from 1970 to 1995.
A review of the literature was carried out covering the last 25 years (1970 to 1995) by searching through the MEDLINE and manually. The review consists of two companion parts. The first includes studies of quality of life in lung cancer patients in general, while the second part is restricted to defined samples of small and non-small cell lung cancer patients. ⋯ It is argued that palliation of symptoms, psychosocial interventions, and understanding patients' feelings and concerns all contribute to improving quality of life in lung cancer patients. It is concluded that the future challenge in treatment of lung cancer lies not only in improving the survival, but mainly the patients' quality of life regardless of cell type. Clinical trial and epidemiologic population-based outcome studies are recommended to provide this and to allow a better understanding of the contribution of the socioeconomic characteristics of the patients to their pretreatment and posttreatment quality of life.