The Mount Sinai journal of medicine, New York
-
Geographically based inpatient geriatric units are an increasingly common organizational approach throughout the world for the care of the hospitalized frail elderly with complex, multidisciplinary acute care needs. The unit provides comprehensive and efficient quality care to these patients by bringing together, in a geographically based unit, specialists from a multiplicity of disciplines to provide needed services in a coordinated manner. ⋯ The education of medical students, medical housestaff, and geriatrics fellows is a critical function of the unit. The unit also serves as a site for research in improving the care of the hospitalized frail elderly.
-
Since The Mount Sinai Hospital in New York City began delivering care in the mid 1800s, the medical services and, shortly thereafter, the nursing service have consistently given priority to improving patient care. Through the decades of the late 19th and 20th centuries, the Department of Nursing has remained current with the evolving concept of quality improvement. A historical overview of key elements in the evolution of quality improvement in nursing is presented.
-
Atrial fibrillation (AF) is a risk factor for ischemic stroke. In randomized trials, AF raised the risk of stroke nearly sixfold, cumulating in a 35% risk over a lifetime. Anticoagulation with warfarin reduces the danger of ischemic stroke, but carries hemorrhagic risks, making this agent unsuitable for treating many patients. ⋯ Secondary analysis of patients given placebo identified predictors of thromboembolism, including a history of hypertension, congestive heart failure, and prior stroke or transient ischemic attack, and echocardiographic findings of left ventricular dysfunction or left atrial enlargement. The absence of these risk factors selects a fairly large subgroup of AF patients at comparatively low risk of stroke, for whom the danger and inconvenience of chronic anticoagulation may not be warranted. It is becoming clear that specific clinical and echocardiographic features allow individualized antithrombotic approaches within the broad category of patients with AF, to enhance therapeutic benefit while minimizing hemorrhagic risk.
-
Clinical Trial
Phase II trial of etoposide, carboplatin, and ifosfamide as salvage therapy in advanced ovarian carcinoma.
A phase II study combining etoposide with carboplatin and ifosfamide as salvage therapy in advanced ovarian cancer was undertaken. Objective responses were achieved in 37.5% of 16 evaluable patients with a mean progression-free interval of 8.6 months. Stable disease was present in 25% of patients; in 37.5% of patients the disease progressed on salvage. ⋯ No life-threatening, nonhematologic toxicities were seen. One death occurred secondary to nadir sepsis. The combination of etoposide, carboplatin, and ifosfamide is an active salvage regimen in patients with advanced ovarian carcinoma; however, severe myelotoxicities and inability to produce long-term responses underscore the need for continued trials to find a more durable salvage regimen.