JAMA : the journal of the American Medical Association
-
Individuals susceptible to high-altitude pulmonary edema (HAPE) are characterized by exaggerated pulmonary hypertension and arterial hypoxemia at high altitude, but the underlying mechanism is incompletely understood. Anecdotal evidence suggests that shunting across a patent foramen ovale (PFO) may exacerbate hypoxemia in HAPE. ⋯ Patent foramen ovale was roughly 4 times more frequent in HAPE-susceptible mountaineers than in participants resistant to this condition. At high altitude, HAPE-susceptible participants with a large PFO had more severe hypoxemia. We speculate that at high altitude, a large PFO may contribute to exaggerated arterial hypoxemia and facilitate HAPE.
-
Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years.
Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported. ⋯ In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts.
-
Case Reports
End-of-life care for homeless patients: "she says she is there to help me in any situation".
Homelessness annually affects an estimated 2.3 million to 3.5 million individuals living in the United States. Homeless people face difficulties in meeting their basic needs. Many have substance abuse problems and mental illness, lack social support, and have no medical insurance. ⋯ Clinicians should have frequent, well-documented conversations with these patients about end-of-life wishes. Homeless people can rarely use hospice services because they lack the financial resources for inpatient hospice and have neither the home nor the social support required for home hospice. Developing inpatient palliative care services at hospitals that serve many homeless people could improve the end-of-life care homeless people receive.